Perhaps no other health issue is as important to so many Americans now and in the future as Medicare. In this ongoing series, “Covering Medicare,” we will follow the reportage and offer Medicare beat memos from time to time.
A few weeks ago, Amy Goldstein of The Washington Post gave her readers a short Medicare history lesson. She harkened back to another bipartisan commission set up in the late 1990s that was similar to the Simpson-Bowles deficit commission appointed by the president last year. Like the newer version, its task was to recommend changes for Medicare. After a year and a half of debate on a voucher plan similar to the one proposed by Wisconsin Rep. Paul Ryan, the Commission failed by one vote to recommend the change to Congress.
Goldstein served up some other historical tidbits supporting her theme that the voucher idea really had bipartisan roots. In the 1980s, she reported, Reagan budget director David Stockman and Rep. Richard Gephardt, a Missouri Democrat, proposed vouchers. The term “premium support,” which carries less stigma, came from not from conservative pols but from health policy experts Robert Reischauer, president of the Urban Institute, and Henry Aaron of the Brookings Institution, who told the Post “the idea of vouchers was abroad in the land. We thought there was sort of a free-market-will-cure-all mentality.” Aaron has since had second thoughts. Goldstein pointed out that Medicare’s prescription drug benefit is based on a voucher-like model.
However, she omitted an important part of the story—the way Republicans and conservative think tanks used the media to advance the agenda of privatizing Medicare, which was the end game of a voucher arrangement. Beginning in early 1995, the Heritage Foundation launched a concerted effort to influence the media. In my book Slanting the Story—The Forces That Shape the News, I reported that the Heritage Foundation issued a six-page special report to the House Ways and Means Committee which framed the discourse for that year and beyond. Heritage made a case for raising Part B premiums that pay for physician services and hospital outpatient care, offered some options, and emphasized that changes “should be taken in tandem with steps toward structural reform of the entire Medicare program.” The brief noted the aim of such changes:
“should be a Medicare system in which retirees receive a contribution toward the cost of coverage (perhaps inversely related to income) which they may use to enroll in a plan of their choice.”
The voucher movement began to build with a lot of help from Heritage, and news outlets reported favorably on vouchers for Medicare. Throughout the year Heritage bombarded members of Congress and journalists with press releases, memoranda, “Dear Journalist” letters, backgrounders, guides, quotes from Heritage analysts, and op-eds that had been placed in other publications by politicos and others friendly to Heritage’s position. Between August and November 1995, I documented no fewer than twelve such communications pieces from Heritage. Conservative media outfits attacked journos who failed to report the “correct” messages.
MediaNomics, a publication of the Media Research Center, criticized Linda Douglas, then of CBS, for reporting that the senior citizens lobby had warned that the Republican budget will gut Medicare. A sister publication called Media Watch chastised USA Today for saying that Senator Pete Domenici’s budget would “make huge cuts in Medicare and Medicaid.”
Republican pollster Frank Luntz swung into action advising that the right terminology was necessary to build popular support. He suggested that the phrase “saving, preserving, and strengthening Medicare” must be repeated. Voucher plan proponents use the same words today. On Fox News Sunday, Senate Minority Leader Mitch McConnell said that a Medicare voucher plan is a “very sensible way to go to try to save Medicare.” Ah, the long legs of Frank Luntz!