The healthcare plans offered by Sens. Hillary Rodham Clinton and Barack Obama would speed the bankruptcy of Medicare, President Bush’s most senior health official charged Tuesday.

The administration attack on the two Democratic presidential hopefuls came on the day Republican presidential candidate Sen. John McCain (Ariz.) offered details on his own healthcare reform platform.
Health and Human Services Secretary Mike Leavitt gave an address in Washington warning that “Medicare is drifting toward disaster.”

Before the speech, Leavitt told reporters that promises made by Clinton (N.Y.) and Obama (Ill.) would do nothing to reform the program but would push it closer to the fiscal cliff.

“I don’t see anyone [in the Democratic primary] talking about the bigger problem. I see people talking about how can we make it worse, but I don’t see anybody talking about how we could make it better,” Leavitt said.

The Democratic candidates’ platforms “would steepen the descent and hasten the day of insolvency,” Leavitt said.

Obama’s campaign website claims “he will reduce waste in the Medicare system, including eliminating subsidies to the private insurance Medicare Advantage program, and tackle fundamental healthcare reform to improve the quality and efficiency of our healthcare system.” Clinton makes a similar case for her proposals.

McCain’s rhetoric is similar, but his methods are not. “Government programs such as Medicare and Medicaid should lead the way in healthcare reforms that improve quality and lower costs,” he said in Tampa, Fla., on Tuesday. He also launched a TV ad in Iowa to tout his plan.

McCain, who claims the mantle of a fiscal hawk, routinely rails about the underlying fiscal vulnerabilities of Medicare and Social Security. This month he reiterated his support for charging higher premiums for the Medicare Part D prescription drug benefits to wealthier beneficiaries. President Bush has proposed the same thing.

McCain’s argument against the Democratic proposals sounded like Leavitt’s. He said they said would “replace the inefficiency, irrationality and uncontrolled costs of the current system with the inefficiency, irrationality and uncontrolled costs of a government monopoly.”

Neither Clinton’s nor Obama’s platform calls for everyone to enroll in a single, nationalized healthcare program. Both candidates would largely seek to preserve and strengthen a private health insurance market while subjecting it to more federal oversight and offering premium subsidies to some lower-income people.

The Democrats’ plans would, however, allow people to opt for subsidized coverage through a public plan that would compete with private insurance. In addition, Clinton would permit people to purchase coverage from the system that administers health benefits for federal employees and Obama would create an analogous system to administer private insurance options.

Although Clinton and Obama are not campaigning for a nationalized health insurance program, many Democratic lawmakers support enrolling all U.S. residents in Medicare, or at least permitting some or all people to buy into the program, a proposal Leavitt said would crush Medicare.

“One of the plans is to give everybody access to the federal plan. What is it they like about that? Is it the subsidized portion or the price-fixing portion?” Leavitt remarked. “Medicare covers a relatively small percentage of the total population, but you add everybody else to that and it just accelerates the nature of the [fiscal] problem.”

Though the emphasis of McCain’s healthcare platform, unveiled at the University of South Florida, is on market-based ways to reduce costs, the presumptive GOP nominee also proposed providing federal money for state-based, nonprofit “high-risk pools” to cover people who cannot buy private insurance, such as those with pre-existing conditions.

For the rest of the population, McCain wants to replace the income tax exemption for health insurance premiums with a tax credit that can be used to purchase insurance not connected to employment, and by deregulating the insurance market. McCain believes this would help more people to get covered but does not claim it would lead to universal coverage.

In a statement, Clinton blasted McCain for looking to sever coverage from employment. “The McCain plan eliminates the policies that hold the employer-based health insurance system together, so while people might have a ‘choice’ of getting such coverage, employers would have no incentive to provide it,” she said.

Despite sharp exchanges between Clinton and Obama about their health plans and between both Democrats and McCain, the looming insolvencies of Medicare and Social Security have not risen to the top of the campaign agenda.

“It troubles me that this matter has not been receiving more attention in the presidential candidate discussions,” Leavitt said. “The next president, whoever it will be, will have to deal in significant part with this program.”

Leavitt said any healthcare reform effort that does not explicitly include substantive changes to Medicare would be incomplete. “Successfully changing Medicare will change healthcare. Now, that’d be better news if changing Medicare was not politically or bureaucratically complicated,” he said.

The early months of the next presidency could offer a chance to begin a serious debate on Medicare, Leavitt said, if the next president and the two parties can seize it. “There will be times and opportunities in the future, maybe very soon, when political power will be uncertain, and that will be a time for great statesmanship,” Leavitt said.

In order to achieve this goal, he emphasized, Congress would have to forgo its regular procedures, offering the military base closures process as a model for reforming Medicare. Senate Budget Committee Chairman Kent Conrad (D-N.D.) and ranking member Judd Gregg (R-N.H.) have offered legislation to establish such a process, Leavitt noted.