High-Wire President

President Bush's surprise Thanksgiving trip to Baghdad perfectly captured his style of leadership. This president takes big risks and shows fierce resolve in the face of criticism.

That was the case with Iraq, even though most of the world opposed the U.S. invasion. That was the case with Bush's tax cuts, a risky economic policy for which there was no great public pressure. And that is the case now with revamping Medicare, another bold policy about which the public is skeptical—and the risks for Bush, particularly among his base supporters, are great.

To judge what's at stake politically on the Medicare issue, look at the last presidential election. Among voters under age 65, the 2000 contest was a dead heat: 48 percent for Bush, 48 percent for Vice President Gore. Seniors gave Gore his popular-vote edge over Bush: Voters age 65 and older voted 50 percent for Gore and 47 percent for Bush.

With the Depression generation diminishing in numbers, seniors—once a solidly Democratic bloc—have now become swing voters. Bush's campaign promise in 2000 was aimed squarely at them. "Prescription drugs must become an integral part of Medicare once and for all," Bush said in a campaign debate.

Republicans have delivered. Rep. Bill Thomas, R-Calif., chairman of the House Ways and Means Committee, challenged Democrats during last month's floor debate. "Medicare isn't a Democrat program," he said. "You don't own it." Now, the GOP can claim authorship of the first major new federal entitlement program since 1965: prescription drug coverage.

Democrats claim it's a phony reform, aimed at undermining Medicare. "We estimate that about one-quarter of all senior citizens will be worse off virtually the day this bill passes," said Senate Minority Leader Tom Daschle, D-S.D. And Sen. John Kerry, D-Mass., warned, "The impact on seniors will be that they cannot choose their own doctors. They're going to pay more money if they stay on Medicare, or they'll be pushed into HMOs."

Like most Democrats, Kerry is counting on a senior backlash against the GOP. "I believe what's going to happen is, you're going to find seniors as angry with this as they were with catastrophic health insurance when we passed it in the 1980s and then had to take it back," he said in Iowa.

Remember the pictures of angry seniors attacking the car carrying Dan Rostenkowski, then the powerful chairman of Ways and Means? That's a vivid memory for members of Congress. Republicans were determined not to make the same mistakes this time.

So they made participation in the new prescription drug program voluntary. "This bill gives seniors choice of coverage," declared Sen. Orrin Hatch, R-Utah. "It's all about choice." Catastrophic insurance forced retirees to give up coverage they already had from their former employers and go into a less comprehensive government plan. The new Medicare bill subsidizes employers to keep retiree plans as an alternative to government insurance.

Still, voters are suspicious about what's in this bill. In a National Annenberg Election Survey taken just before Congress voted last month, 40 percent of respondents said Congress should pass the Medicare reform bill, and 42 percent said it should not. Seniors opposed passage, 49 percent to 33 percent.

The public is skeptical about revamping Medicare, just as it was skeptical about tax cuts and war in Iraq. "If this was such a terrific bill," presidential candidate Howard Dean recently asked, "why do you suppose the president put the enactment date in 2006?" To avert any political backlash in 2004, that's why.

Republicans contend that the real parallel is not to the catastrophic health insurance catastrophe of 1989, but to President Clinton's welfare reform triumph of 1995. Clinton stole an issue from the other party and made it his own. Back then, liberals protested what their own president was doing. "Today will go down in history as the day the Senate turns its back on needy children and poor mothers struggling to make ends meet," Sen. Edward Kennedy, D-Mass., warned in 1995.

Now conservatives are protesting what their own president is doing. "The bill would add a universal drug entitlement to a largely unreformed Medicare program," said Rep. Mike Pence, R-Ind., adding that it "warns for a fiscal disaster." Robert Moffit of the Heritage Foundation complained, "Deficits are exploding. Republicans are supposed to be the party of fiscal responsibility!"

By supporting a costly new entitlement program, Bush risks alienating his base. Last month, The Wall Street Journal ran an editorial warning Republicans, "Entitlements Are Forever." That's not quite true. Clinton was the first president to end an entitlement program (welfare). George W. Bush will be the first Republican president to create one (prescription drugs).

Liberal protests against welfare reform were shut down when Clinton got re-elected in 1996. Republican leaders expect to be able to make the same argument to conservatives after next year's election: "It worked. Shut up."

Bush's high-wire leadership style explains the public's response to his presidency. Because he is willing to take big risks, he alienates women, who tend to be more risk-averse than men. But his resolve in the face of opposition earns him high marks for leadership. Two-thirds of Americans describe Bush as a "strong leader." That has always been his most admired quality. And the public's impression that he is a strong leader has never wavered.