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Look to Medicare's future

Congress leaves town for its summer break without having started a serious debate on fixing Medicare. President Clinton needs to move the process along by plugging the holes in his own Medicare plan and by preparing the American people for the hard choices ahead for keeping the program afloat.

The president has put too much emphasis on rallying Democrats around his proposal to cover prescription drugs, an initiative popular with seniors and baby boomers and pivotal for strengthening Medicare over the long term. The issue is not whether, but how, to provide a reasonable drug subsidy. He needs to shift the debate before drug manufacturers pick apart the details of his plan with a misleading, though effective, advertising campaign.

Drugmakers already are sprinkling the debate with the same divisive themes that helped to undercut public support for the earlier Clinton health-care plan. In new television ads, the industry's fictional pitchwoman, Flo, laments: "I don't want big government in my medicine cabinet."

The Clinton administration is vulnerable to such attack because it has focused on adding coverage for drugs _ which adds, not reduces, costs to Medicare _ to the exclusion of other reforms necessary for improving Medicare's financial footing.

The outlines of a bipartisan plan are clear: more competition, expanded use of managed care, broader choice of medical plans, added inducements for supplemental coverage, clearer rules for providers on reimbursement, tougher policing of Medicare fraud and a long-term supplement of federal funds. But the real debate breaks out over the details, as leaders of both parties jockey for leverage in the 2000 elections.

The president has more room to maneuver than he may think. Thursday's mini-mutiny by moderate House Republicans, who joined Democrats to support a comprehensive bill to regulate health maintenance organizations, shows that bipartisan support exists for improving access to medical care. Americans don't want their health turned into a partisan issue, but any further delay in shoring up Medicare will threaten support for change by giving Congress time to fritter away a future surplus that may or may not exist.

The congressional recess comes at a good time. Lawmakers should spend the break meeting with constituents to discuss a simple question neither they nor their president has had the courage to ask: What are Americans willing to sacrifice to protect Medicare?

Drug coverage, competition, supplemental premiums and the like will go only so far to care for a growing population whose retirement years will be the longest and most expensive in history. Even a cursory look at the billions Americans are socking away into retirement accounts shows that boomers in the workforce understand the wisdom of investing more now for a stable future.