Trembling Reformers

HEALTH-CARE reform wasn't going to stay buried as a national issue, even after the pummeling Bill Clinton took on the subject during his first two years in office. But it's ironic, to say the least, that the issue is now being revived by Republicans who recognize, correctly, that the health-care delivery system has to be retooled if their goal of a balanced federal budget by 2002 is to be even approached.

In this context, health-care reform is inseparable from Medicare reform. Spending on that enormous program, which last year covered 36 million older Americans at a cost of $160 billion, is growing by about 10 percent a year, according to Congressional Budget Office estimates.

The main GOP reform idea, at this juncture, is to move a significant portion of Medicare recipients into so-called managed-care programs over the next few years -- a concept that figured in the Clinton reform plans, too, though the president's proposals would have merged Medicare changes into a broader systemwide overhaul. Managed care has certain proven budget savings, but its drawback, from the elderly's perspective, is diminished freedom of choice with regard to physicians and treatments.

The Republicans' efforts to push Medicare into the deficit-reduction arena is likely, in fact, to run into a buzz saw of opposition -- both from lobbyists representing older citizens and from Democrats who want to get in a few blows of their own after taking so many on the chin in '93.

The political fisticuffs should be restrained on all sides, however, by the realization that the increasingly expensive entitlements serving senior Americans have to be part of the push toward fiscal responsibility. Tightening and trimming -- lower payment rates for doctors and hospitals and some move toward having better-off recipients pay more of their own way -- ought to be considered.

Similar tightening may also have to be applied at some point to that other untouchable -- Social Security. Both the Social Security and Medicare trust funds have unsure futures.

A few brave souls in Congress, like Sen. Alan Simpson (R) of Wyoming, have served notice that they're ready to take on these programs and the muscular lobbies -- such as the American Association of Retired Persons -- that guard them. If fiscal responsibility at the federal level is to have any real meaning in the years ahead, their ranks will have to grow.