Medicare and Leftovers

Congress did the right thing last week by overriding a presidential veto of some modest Medicare reforms. But as welcome as it was, the quick and decisive response highlights a long-standing inequity in federal spending.

The measure will prevent a 10 percent cut in fees for doctors who treat elderly and disabled Medicare patients. It also slightly reduces overpayments averaging 13 percent to private insurance companies that sell what are called Medicare Advantage plans.

Both Republicans and Democrats wanted to avoid the fee cuts for doctors, but President George W. Bush balked at cutting insurance overpayments. He vetoed the bill on July 16. Within hours, Congress overrode his rejection. Thus, the political popularity of Medicare, a program that mainly benefits older Americans, was reaffirmed.

That's a very different outcome from last summer, when Bush twice vetoed popular bipartisan bills that would have extended and expanded an important children's health insurance program. Even though the children's health insurance bills had attracted overwhelming support, Congress could not reverse the president's vetoes because some conservatives who originally supported the bills switched their votes.

But this year's vote concerned older Americans, and they have far more political clout than kids. This year's bill actually received more votes after the president's veto than it got originally. Among those to change their votes was Rep. Kenny Hulshof, R-Mo., who's in a primary fight to represent his party in the November election for governor.

Those changed votes might reflect the dwindling power of a lame-duck chief executive or politicians' sensitivity to the upcoming congressional elections.

It also could be a response to Bush's cratering popularity.

But in recent years, the percentage of federal spending devoted to the elderly has grown far faster than the amount spent on children.

A recently released report from the Urban Institute found that federal spending on programs for children increased by 0.7 percent between 2006 and 2007, while spending on programs for the elderly grew by 5.3 percent. That's more than double the rate at which the nation's economy grew overall.

Another report from a bipartisan children's advocacy group called First Focus concluded that federal spending on programs for children has grown only one-tenth as fast as the rest of the budget.

The political popularity of Social Security and Medicare often is ascribed to the voting habits of older Americans: They show up on Election Day. Children can't, and their parents often don't.

But there's another factor that too often is overlooked: Medicare and Social Security are open to everyone, rich or poor. Since the 1980s, programs that benefit children have increasingly become needs-based — available only to the poor, America's least-influential political constituency.

So it's no surprise that, adjusted for inflation, the percentage of domestic spending devoted to children went from 20 percent of the federal budget in 1960 to 16 percent in 2007. It's no surprise, but it is a shame.

It's a mark of our compassion and decency that we care for the elderly, whether they are rich or poor. It's a mark of our foolishness that too often we fail to invest in children. Whatever their backgrounds, those kids' futures are our own.

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