First reform Medicare

The heated debate over health-care reform is inducing hard feelings across the political spectrum. That much was clear at an occasionally rowdy forum conducted by 1st District Rep. Henry Brown Thursday night in North Charleston.

Yet the intense debate is also moving many Americans to take a hard look at the bottom-line realities of our entire medical system. Look hard enough, and it's clear that the segment of U.S. health care in the most urgent need of reform is Medicare.

President Barack Obama and his congressional allies argue that while Medicare reform must come eventually, a sweeping transformation of the non-Medicare portion of American health care should come first. They also offer assurances that their reform package won't impose any negative consequences on Medicare recipients.

The public, including many people at Thursday night's forum, rightly finds those contentions highly questionable.

But there's no question that in recent years Medicare trustees have had to repeatedly move up their projections of fiscal collapse. They reported in May that the system's hospital fund will be "exhausted" by 2017 -- two years sooner than the official estimate issued a year earlier. They also warned that "substantial changes" would be required "even in the short-range alone."

Translation of "substantial changes": Premium hikes.

Though the president is correct in pointing out that health-care costs are a major factor in the federal deficit, poll trends show that he can't seem to sell his dubious pitch that his brand of reform will reduce those costs. And now the White House, responding to the public demand, apparently is backing off its demand for a "public option."

Regardless of how the president frames his non-Medicare "reform" package, however, the demographic trend of a steadily growing portion of our population aging into Medicare eligibility persists. The financial squeeze on that system will only tighten without fundamental changes.

As former Federal Reserve Chairman Alan Greenspan recently told ABC News: "There is no question that the core of the problem on the long-term deficit is Medicare specifically, and health care more generally, in the sense that it affects revenues."

Like Social Security, Medicare faces a relentless decline in the ratio of those paying into it and those taking money out of it. And President Obama has fairly criticized his Oval Office predecessor for adding a costly prescription-drug program to Medicare's costs.

So why add another huge health-care entitlement before fixing the one we already have -- the one that's accelerating toward a date with fiscal oblivion?

The overdue task of reforming American health care to make it solvent and sustainable should start with Medicare.