Dean Struggles With a Stance Over Medicare

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Dean Struggles With a Stance Over Medicare

By Robin Toner, The New York Times
October 1, 2003

Back in 1995, when a new Republican-controlled Congress was in a pitched ideological battle with the Democrats over the budget, Howard Dean was an iconoclastic, budget-balancing governor of Vermont and chairman of the National Governors Association, willing — even eager — to challenge party orthodoxy on spending.

Dr. Dean said, according to news reports at the time, that he "fully subscribed" to the idea of substantially reducing the growth rate in Medicare spending and he praised that element of a Senate Republican budget plan that was vehemently opposed by Democrats on Capitol Hill.

He argued that "we ought to put Social Security back on the table " in an effort to balance the federal budget, and he suggested that Congress consider raising the retirement age.

He also sharply criticized the speaker of the House at the time, Newt Gingrich, on a variety of other issues like welfare and Medicaid.

But today, it is his stands on Medicare that have resurfaced as a difficulty. Dr. Dean, after all, is a candidate running as the champion of the "Democratic wing of the Democratic Party," who has faulted many of his rivals for not holding the line against President Bush and Congressional Republicans.

Dr. Dean's opponents, who have researched his past, assert that the record shows Dr. Dean did not stand with his party when it counted on an issue of critical importance to older voters, who loom large in early primary and caucus states like Iowa .

Dr. Dean has scrambled to explain. In last Thursday's debate, when Representative Richard A. Gephardt and Senator John Kerry accused him of siding with Mr. Gingrich on Medicare, Dr. Dean flashed with anger and declared, "That is flat-out false."

On Sunday's "Face the Nation," Dr. Dean said: "The person I supported was Bill Clinton. Bill Clinton signed a bill which was very much like what I was proposing."

On Monday's "Talk of the Nation" on National Public Radio, he said, "I was the first person to pick on Newt Gingrich when all the other Democrats in Washington were paralyzed."

Dr. Dean's allies argue that his views were common among Democratic deficit hawks in the mid-1990's, and among Democrats who worried about the long-term solvency of Medicare and Social Security. As one aide put it, Dr. Dean "was in the mainstream of the moderate wing of the Democratic Party." Moreover, Dr. Dean maintains that his views on reining in Medicare spending were eventually embraced by Mr. Clinton and codified in the 1997 Balanced Budget Act.

"I believe I'm a far-sighted person," Dr. Dean said in Iowa on Sunday. "I believe Medicare had to be saved and I supported the plan that Bill Clinton eventually signed."

The debate has become a war of old news clippings, many of them collected and circulated by the Gephardt campaign, which first raised the issue in in Iowa . That is widely considered a crucial state for Mr. Gephardt, now in a fierce fight there with Dr. Dean. The Dean campaign is now circulating news accounts of its own, which highlight Dr. Dean staunchly criticizing Mr. Gingrich and his "Contract With America."

The Dean campaign also released endorsements from fellow governors and a former longtime liberal member of the Senate, Howard Metzenbaum of Ohio . "Eight years ago, when Howard Dean saw Medicare spinning out of control and facing bankruptcy, he joined with the Clinton Administration and key members of Congress in calling for cost controls," Mr. Metzenbaum said. He added that the efforts resulted in the 1997 budget act, "that balanced the budget, saved Medicare and laid the foundation for a strong economy."

But several veterans of the budget wars of the mid-1990's noted that there were major differences between the Republican plans for Medicare in 1995 and the one that ultimately passed with bipartisan support two years later. For one thing, the spending reductions in Medicare. were smaller. (An estimated $260 billion over seven years in the Senate plan in 1995, compared with an estimated $200 billion a few years later.)

Chris Jennings, Mr. Clinton's health care adviser, said: "Dean is right that the Clinton Administration desired to constrain growth in the Medicare program and strengthen the trust fund. But we did not embrace the magnitude of cuts advocated by the Republican leadership."

Robert Reischauer, who headed the Congressional Budget Office in the early 1990's and now is president of the Urban Institute, said: "There was a pretty broad consensus that Medicare spending would have to be slowed down. The program was careening toward insolvency, and there were many proposals to reduce the rate of growth of Medicare."

But when Democrats were confronted by the Republican proposals in 1995, "there was a feeling that it was too much and that it came in the wrong form," Mr. Reischauer said.

Other Democrats on Capitol Hill, who were reluctant to speak publicly about a candidate at the top of the polls in Iowa , argued that 1995 was a searing time for their party, when it had just lost control of Congress and when signature Democratic programs like Medicare seemed on the brink of wholesale restructuring.

At stake was not just a reduction in spending in Medicare, but whether it should continue in its traditional form as a social insurance program, those Democrats said.

In that context, one veteran Democratic staffer said, anyone breaking ranks and saying positive things about the Republicans' spending goals was "extremely unhelpful."

In his comments in May 1995, Dr. Dean praised the budget plan advanced by Senator Pete V. Domenici, Republican of New Mexico, which called for reducing the rate of growth in Medicare spending by about $260 billion over seven years. A spokesman for Dr. Dean noted that the candidate supported Mr. Domenici's general goal on Medicare spending.

Like so much other legislation that year, the plan passed the Senate later that month on a largely party line vote, with the support of three Democrats — Senators Charles S. Robb of Virginia, Sam Nunn of Georgia and Bob Kerrey of Nebraska, all known for their fiscal conservatism.

Mr. Kerrey, now president of the New School University in New York , said in an interview that "the essence of what Domenici was saying was right," that spending on Medicare had to be reined in, and that broader changes in Medicare and Social Security were essential to preserving them over the long term.

Mr. Kerrey, who has not endorsed a candidate in the Democratic race, added that such a position was "a difficult thing in a Democratic primary to defend," recalling the difficulties that the late Paul Tsongas faced in the 1992 race for the Democratic nomination, when he advanced similar positions. But Mr. Kerrey added of Dr. Dean, "If he gets through the Democratic primary he'll be much stronger against President Bush."

Dr. Dean has said that he no longer supports raising the Social Security retirement age. "I want to leave the retirement age exactly where it is," he said on CBS on Sunday. "That was a time where the budgetary situation was a disaster in this country. Bill Clinton has shown that when the economy gets better and people start paying payroll taxes, Social Security becomes solvent."

Nor is Dr. Dean now calling for any spending reductions in Medicare. Like the rest of his party, he supports adding a prescription drug benefit.

Dr. Dean has also been haunted by comments he made about Medicare in 1993, when, according to an account by The Associated Press, he described it as "one of the worst things that ever happened" and a "bureaucratic disaster."

His allies say he was simply describing the management of the program from a doctor's point of view. Bruce Vladeck, who was running Medicare and Medicaid at the time, said he remembers Dr. Dean "saying something gratuitous" about Medicare.

"It sounded to me like the complaints of a general practitioner, who really didn't know what he was talking about," said Dr. Vladeck, now a professor of geriatrics and health policy at Mount Sinai Medical Center in Manhattan . "But he did run a really good Medicaid program."