Thomas Daschle: “I couldn't agree more. In fact, what troubles me is there are those who would turn Medicare into a great big HMO. I…”

“I couldn't agree more. In fact, what troubles me is there are those who would turn Medicare into a great big HMO. I don't know many people who are enthusiastic about the kind of care they get from their HMO. There are some good ones, I certainly would not deny that. But I must say, HMOs are not the panacea. There is not a one-size-fits-all HMO, health maintenance organization, or PPO, for that matter, preferred provider system, that would work in rural areas. We know. We have seen from our own experience. They have tried it. They have attempted to create managed care systems in rural areas. The demographics don't work. Our health care delivery system in rural areas does not allow for a managed care system that works. Perhaps it does in Washington DC, or Los Angeles or New York. So we cannot have a one-size-fits-all system. That is the beauty of the Medicare system. The Medicare system has adapted over the years, organizationally and administratively, to fit Alaska and South Dakota and Nevada in a way that has worked far beyond the expectations, I am sure, of many who created the system in the 1960s. Let us not throw out a system that has worked well. Let's improve it. Let's build on it. Let's provide better benefits through it. But to privatize Medicare--to eliminate it and replace it with a new HMO in the name of Medicare--is a mistake that we will fight to the last day.”