Having established his credibility by improving Medicare and strengthening Social Security, George W. Bush is moving on to address America’s health-insurance crisis. Still guided by the deep social and economic insights that brought us those earlier triumphs, he is promoting the same panacea he applies to almost every domestic problem: tax cuts favoring the wealthy.
Although he once flattered himself as “the reformer with results,” Mr. Bush seems unfazed by the dismal results he has achieved to date. Last year at this time, he announced that privatizing Social Security— or establishing “personal accounts,” the pollster-approved phrase he prefers—would become the highest domestic priority of his second term. And he looked forward to the bright dawn of his Medicare prescription-drug plan, a central legislative priority of his first term.
Today we know how those two bold initiatives have worked out. Americans rejected his Social Security privatization scheme by an overwhelming margin, and they are refusing to participate in his impossibly complicated, ridiculously overpriced and patently useless prescription-drug plan.
Mission accomplished, eh? No wonder the President believes he is ready to tackle even bigger problems.
The American health-care system certainly requires reform, with its unsustainable costs and unsatisfactory performance. Indeed, the awful defects of that system harm not only the uninsured and underserved, but even threaten the national economy, driving major corporations and millions of individual families toward bankruptcy.
Unfortunately the President’s “medical savings accounts,” like his Social Security and Medicare schemes, are more likely to aggravate than to resolve those problems. By attracting younger and healthier insurance clients away from the “risk pools” of employer plans, the accounts will undermine the solvency of traditional insurance. The chief beneficiaries will be those who can take advantage of yet another tax shelter.
Most Americans will get nothing, and many could lose their insurance if these tax breaks encourage employers to cut off insurance benefits. The President’s plan risks precisely such perverse incentives by luring away the healthiest workers and forcing employer plans to pay higher premiums to serve older and sicker workers.
Proponents of medical-savings accounts promise that they will provide “choice” to medical “consumers,” as if buying health care were as simple and straightforward as purchasing groceries. People will make the best choices for themselves and budget their health purchases prudently. That will supposedly create competition, reduce spending and eventually lower costs.
Similar assumptions lay behind the Social Security privatization and Medicare prescription-drug programs—but as it turns out, the world doesn’t work as simply as the President and his ideological advisors would have us believe.
The elderly (and their adult children) struggling to make sense of the Bush drug plan have learned that there can be such a thing as too much choice. They have no idea which plan will provide needed medications while saving money. They have no capacity to negotiate with drug companies to lower prices. They have no time for all of this nonsense.
The Presidential fumbling over health care is opening up the most important opportunity for true reform since the debacle of the Clinton initiative. What Democrats should explain this time is that we can achieve quality universal coverage, cut the economic costs of the present system and reduce the burden on industry with a single-payer plan.
Instead of cutting the Medicaid benefits provided to poor children, as the Republicans propose to do in the current federal budget, we could ensure that no American child will ever be deprived of care again. Instead of wasting $700 billion a year on extraneous expenses, we could capture those dollars to provide insurance to every family and individual. Instead of encouraging the most unhealthy behavior by consumers and the most inefficient behavior by providers, we could promote preventive care and best practices.
The best way to drive down costs is not to impose greater costs on workers and families whose real wages have been falling for years. And forcing people to forgo clinic appointments to save money, as the medical-accounts model will do, will only discourage prevention and lead to more disease, more suffering and more waste. Bigger savings can be found in the bloated administrative budgets of private insurance companies and health-maintenance organizations, and in the extortionate prices charged by pharmaceutical companies. Skeptics should ponder the following statistic: Private health insurers spend as much as 30 percent of their budgets on administration, compared with the 2 percent spent by Medicare.
Conventional wisdom dictates that universal single-payer health care is politically impossible. The special interests that profit exorbitantly from the current system are just too powerful. That perception is accurate, of course, but only if nobody has the courage and wit to mobilize the anger of dissatisfied voters.
Those voters are waiting to hear a brave Democrat—perhaps a potential candidate for President—utter three words that remain taboo in conservative Washington.
Medicare for all.
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