January
27, 2004
Bush Merely Shrugs As Democrats Raise Health Care Issue
By Mort
Kondracke
Distinctly stingy in the "compassionate conservative"
department - especially in regard to 43 million Americans who
lack health insurance - President Bush's State of the Union message
last week suggested that he thinks he's got re-election locked.
Bush and his advisers evidently think they've done all the reaching
out to moderate and swing voters that they need to do by passing
a Medicare prescription drug bill for seniors and proposing a
work permit plan for immigrants, mainly Latinos.
Most notably, Bush's speech to Congress contained absolutely
nothing to counter the main item on each of his Democratic rivals'
agenda - plans to guarantee insurance coverage to the uninsured.
That suggests supreme - I hope unwarranted - self-confidence.
Usually the only time Republicans ever pay attention to the social
needs of ordinary Americans is when Democrats force them to do
so. That means Democrats have to be strong enough to put a scare
into the GOP.
Instead of reaching out, Bush's speech to Congress last week
was rich with items designed to keep his conservative base well
tended, including a possible constitutional amendment to ban gay
marriage, expansion of teen abstinence programs and the biggest
single proposal on his agenda: making his tax cuts permanent.
That will cost $1.8 trillion over 10 years.
The speech also contained an aggressive defense of his foreign
policy, offering a foretaste of confrontations to come with Democrats
- including all of the leading presidential candidates - who opposed
his $87 billion proposal to give U.S. troops "the resources
you need to fight and win the war on terror."
Bush also stuck it to Democrats who demand that he "internationalize"
the Iraq conflict by blasting the idea of requiring a "permission
slip" from foreigners before protecting U.S. national security.
And he set a trap for Democrats who fell into it by cheering
the possible lapsing of the USA Patriot Act. A Gallup poll last
year showed that only 30 percent of Americans think the act goes
too far in limiting liberty in the name of preventing a terrorist
attack.
But Bush's speech contained precious little to attract moderate
swing voters. He immediately went out on the road to tout a "Jobs
for the 21st Century" program to match community colleges
with employers in high-demand sectors.
However, all of Bush's education proposals cost just $470 million
and we won't know until his budget comes out whether this is new
or re-programmed money.
Given his promise to hold domestic spending down to 4 percent
growth - another conservative base-tender - it's likely paid for
with cuts in other education programs.
Bush's election-year agenda contains enough items that he could
claim a "health initiative," but his proposals would
offer health insurance to only 10 million of the 43.3 million
people who lack coverage.
Conservatives argue that many of the uninsured forgo coverage
by choice, but the fact is that only 7 percent of the 43 million
have incomes of more than $55,000 for a family of four. The rest
don't have insurance because they can't afford it.
Two-thirds have incomes under $29,000 a year, according to the
Kaiser Family Foundation. Nine million are children. And 81 percent
are in families in which someone is employed. This is overwhelmingly
a problem of the working poor.
It's a national scandal and it kills people.The National Academy
of Science's Institute of Medicine estimated that 18,000 people
a year die because they didn't get the tests or treatment they
might have if they were insured.
According to Princeton University health expert Uwe Reinhard,
it would cost $100 billion a year - or roughly $1.3 trillion over
the next 10 years, counting inflation - to give all the uninsured
the same level of coverage as the two-thirds of Americans who
have insurance, usually through employers.
The major Democratic candidates are offering plans ranging in
cost from $500 billion to $900 billion over 10 years, covering
half to two-thirds of the uninsured. Most plans guarantee, as
a start, that all children will be covered.
In response to the Democrats' challenge on the health front,
Bush merely resurrected his 2002 and 2003 proposals to offer a
refundable tax credit, costing just $89 billion over 10 years,
to cover the poorest 4 million uninsured.
Bush's plan is even stingier than one offered by his father
in 1992, a refundable tax credit designed to cover 24 million
people and estimated then to cost $35 billion a year.
To be fair, Bush is also proposing to allow small businesses
to form association health plans, covering an estimated 2 million
workers, and the Medicare bill opened the way for employers and
workers to open tax-deductible health savings accounts.
Bush's 2004 agenda would allow account holders to deduct the
cost of catastrophic health insurance policies. HSAs would benefit
an estimated 4 million people, but would be of little help to
the working poor, who have difficulty saving and pay too little
in taxes to benefit from deductions.
For the poor, Bush is proposing to expand community health centers
and his agenda contains items like medical malpractice reform
to lower the cost of health care and computerization of medical
records to improve quality.
But the plight of the uninsured deserves to be a major issue
in the 2004 campaign. If it were the only issue, Bush would lose.
Too bad it isn't. The prospect of losing would make him act.
Mort Kondracke is the Executive
Editor of Roll Call.
