Is it better to have the government pay doctors directly, or does it make more sense to let Medicare consumers make choices? Republicans created a plan called Medicare Advantage, which allows Medicare recipients to choose, if they so decide, to participate in PPOs or HMOs, like most the rest of us do.

Some consumers will find this option attractive because their Medicare plan will then offer more services than traditional plans, as well as lower out-of-pocket payments. In addition, studies have shown private organizations deliver more money to health consumers than the government does -- so it appears Medicare Advantage could us more bang per buck.

Needless to say, some Democrats are angry about the existence of this program and want it killed. Here's Clare McCaskill, in The Daily Dunkin Democrat. She's clearly worried about the growth of this program, and uses words which evoke worry and link it to the free market with phrases like "people are worried" and imagery about "bad behavior by companies".

McCaskill said "with enrollment in Medicare Advantage plans increasing rapidly, she's concerned that aggressive marketing will continue or get worse if action is not taken." "Congress last week attempted to pass legislation that would have helped prevent predatory sales tactics for Medicare Advantage plans," according to McCaskill.

So what is this legislation which attempted to "protect" us from "predatory sales tactics"? (You know: marketing -- the same "evil" system we use to learn about choices for our cars, homes, food, and vacations?) Via the AP (bold mine):

This year majority Democrats homed in on cutting the Medicare Advantage program, which is an ideological issue for both parties. The Bush administration and Republicans like Medicare Advantage because it lets the elderly and disabled choose to get their health benefits through private insurers rather than through traditional Medicare. Democrats argued that government payments to the insurers are too generous.

The White House warned that President Bush would be urged to veto a bill that contained cuts to Medicare Advantage. "The bill would fundamentally change the private fee-for-service program and consequently reduce access, benefits and choices for many of the approximately 2.25 million beneficiaries" in such plans, the White House said in a statement.

In other words, Democrats are trying to nuke the Medicare Advantage program (which seems to be popular with consumers!) by making it economically infeasible. Nice tactic, huh? (I guess Democrats don't really care if Medicare recipients have a "choice".) So we hear Democrats telling us that Republicans are trying to shut down Medicare, deny payments to doctors, etc., rather than admitting the whole story.

What do the Republicans say in response?

Republican leader Mitch McConnell of Kentucky shot back that Democrats were acting irresponsibly by not granting his request for a 30-day extension of current physician payment rates in order to give the two sides time to work out a compromise... The doctors' cut will take place "because of this recalcitrant view, this excessively partisan approach that refuses to accept any input from this side of the aisle," McConnell said.

Sen. Arlen Specter, a moderate Republican from Pennsylvania, said he objected to the take-it-or-leave-it approach of the Democrats and gave assurances that Congress would take steps in early July to eliminate the doctor cuts and take care of hospitals and providers.

Sen. Jim DeMint, a conservative Republican from South Carolina, said he backed alternative legislation to protect physician fees but couldn't support what he said was "a deliberate attempt to move Americans away from private insurers and into socialized medicine."

So that's the play: Democrats want to destroy an attempt to move Medicare into a more market-based program, and have linked that tactic with continued physician payments. They have refused all offers by Republicans to continue the payments while the bill is being debated -- leaving Republicans no choice but to oppose a bill containing both moves, or agree to the destruction of the Medicare Advantage program.

Now it's up to the American people, and especially those involved in (and dependent upon) government healthcare dollars. Will they take a few minutes out and learn both sides of the story? Or will they simply be a reflexive tool of Democrats and barrage principled Republicans with angry letters to get them to go along with Democrats tactics? Will they act only in their own personal short term interest? Or are they willing to consider taking a longer view of what might provide the most good to the most people?

In the end, is it better to give people choices?

Or is it better, as the Democrats' moves imply, to remove options and revoke Medicare consumer choice?