President Bush is said to be looking for something “big” to propose in his next State of the Union message, possibly another manned trip to the moon. He may even do it this week. I have a better idea: a moonshot for a healthy America. [IMGCAP(1)]

Elements of the initiative could include proposals to deal with the country’s health insurance crisis and the crushing costs that caring for aged baby boomers will impose on the economy; medical liability reform plus improvements in health quality management, and a renewed medical research push to conquer costly chronic diseases.

Bush may think that passage of a Medicare prescription drug bill has solved his political “health problem” — the tendency of voters to trust Democrats more on health issues than Republicans. Not so.

Democrats are bent on spending the next year attacking his plan as stingy and dangerous to seniors’ beloved Medicare program. Polls show that seniors and people on the verge of retirement are deeply skeptical about his plan, which cannot erase doubts until it takes effect in 2006.

Bush also needs more than the prescription drug plan to revive his image as a “compassionate conservative,” badly tarnished since his tax cuts primarily benefit the wealthy and his budget cuts primarily impact programs to help the poor.

Bush does not have to spend the kind of money that Democratic presidential candidates are proposing to help the nation’s 42 million uninsured get health insurance.

Those proposals range in cost from Rep. Richard Gephardt’s (Mo.) $2 trillion over 10 years to cover 40 million people, to between $500 million and $700 million proposed by other candidates to cover 30 million, principally children or “working poor families.”

Bush will have to do better than the $79 billion plan he has proposed, covering only 4 million lowest-income uninsured. But his target should be the 15 million workers and their families whose employers — mainly small businesses — provide no health insurance.

Democrats tend to favor expansion of existing low-income programs — Medicaid and the SCHIP program for children — as their means of providing insurance. Bush could rely more on conservative free-market solutions such as medical savings accounts, tax credits and “association health plans.”

MSAs are tax-exempt accounts, akin to IRAs and state college savings plans, that can be tapped for medical costs or kept as savings. Businesses or individuals would get tax credits for insurance purchases. Trade associations representing small businesses should be allowed to form insurance pools to cover their workers.

The health insurance crisis is not limited to lack of coverage. Health costs are rising at a double-digit rate and so are health insurance costs for employers large and small — a key Bush constituency.

Covering the uninsured — thereby enabling them to get medical attention before illnesses become acute and expensive — will help contain health costs.

Bush also should be proposing measures to hold down the costs of prescription drugs — not by imposing price controls or importing price controls from Canada, as Democrats propose — but by negotiating with other countries to drop their controls and creating fair world prices for drugs.

Another savings plan, proposed by former Speaker Newt Gingrich (R-Ga.), would require drug companies to disclose the true cost of their products and for public or private entities to publish comparisons of similarly effective drugs, enabling consumers to shop for the cheapest alternative.

Gingrich also proposes a national effort to standardize and computerize health records to reduce paperwork costs and medical errors, which cost up to 90,000 lives per year and billions of dollars in added medical expenses.

Yet another cost-saver would be a cap on medical liability claims, which drive up malpractice insurance costs for doctors and hospitals and health costs in general.

Republicans want to make a new push to pass liability reform, but it shouldn’t happen without a combined effort to reduce medical errors that kill and maim people and generate lawsuits.

Bush’s initiative also should address the looming retirement costs of baby boomers — particularly for long-term care.

According to statistics assembled by the National Governors Association, the average person retiring nowadays has saved only $30,000, but the average annual cost of nursing home care is $57,000.

That means that when the proportion of the American population over 65 rises from its current 12 percent to 20 percent by 2030, state and federal Medicaid costs will explode to pay for the care of impoverished baby boomers.

The NGA, under its current chairman, Idaho Gov. Dirk Kempthorne (R), is determined to get every governor in the country thinking about how to cope with the costs.

(Disclosure: I moderated a PBS television show launching the NGA effort, for which I will receive an honorarium.)

States can encourage steps to “seniorize” housing to enable people to remain in their homes as long as possible, promote in-home health care to avoid institutionalization, and urge fitness and healthy lifestyles to avoid chronic illness.

But Bush should join the effort by offering tax incentives for pre-retirees to buy long-term care insurance. That could be an interim step toward his goal of creating private savings accounts as part of Social Security. Democrats will fight that with all their power.

Finally, Bush should reverse his apparent decision to cut funding for medical research. Research is the key to wiping out such costly chronic maladies as cancer, diabetes, heart disease and Alzheimer’s disease.

After doubling the budget of the National Institutes of Health over the past five years from $15 billion a year to $30 billion, Congress is about to approve an increase of only 3 percent for fiscal 2004, and Bush proposes increases of only 2 percent in future years.

That includes vital increases in funding for bioterrorism research, meaning that research to find cures for other diseases will be cut. Labs will close and scientists will be forced out of basic research.

The difference between a 2 percent increase for NIH and an 8 percent increase, which scientists say is a minimum figure, is only $2.5 billion — far less than Congress is spending on pork projects and hundreds of billions less than a new moon visit would cost.

A moonshot is a “been-there, done-that” project, not much of a legacy at all. A healthy America — that’s something that President Bush could call his own, and steal a march from Democrats at the same time.