Bush Should Try To Trump Kerry On Health Care

Posted July 21, 2004 at 4:51pm

President Bush has a chance to trump Democrat John Kerry on the health care issue — if he’s bold enough to offer insurance coverage to every American.

Kerry’s plan, which is far ahead of anything Bush is currently proposing, would cover 27 million of the nearly 44 million uninsured. Bush would cover only about 10 million.

[IMGCAP(1)] White House officials say Bush will unveil a new health care plan for the fall campaign, but its contents are a deep secret. There is no indication that he plans to back universal coverage. But it would be a coup if he did.

It could be done one of two ways: either by following Kerry in trying to plug the big holes left between current private and public coverage, or by proposing a single, comprehensive plan for everyone. The latter could be done by proposing an insurance mandate on employers or individuals, by offering tax incentives for them to buy insurance or by expanding government insurance programs.

On Tuesday, the National Coalition on Health Care — a consortium of 100 businesses, unions, churches, health groups and pension funds — called for mandatory coverage of all Americans. Instead of recommending a formula, the coalition issued “specifications” for addressing the “three huge and interlocking problems” that bedevil the current health system: rapidly escalating costs, the burgeoning ranks of the uninsured and “an epidemic of sub-standard care.”

The coalition’s report projected that average annual premium costs for employer-sponsored family coverage would rise from $9,000 in 2003 to $14,500 by 2006, and that the number of uninsured Americans would grow from the current 44 million to between 51 million and 54 million.

In addition, it cited a major new RAND study of thousands of patients in 12 metropolitan areas. The study showed that these patients received recommended treatment for their conditions only 54.9 percent of the time.

Dr. Henry Simmons, the coalition’s president, said the aim was “to make health care reform the transcendent issue in the coming election campaign and in the next Congress.”

Indications are that it will be a major issue, though less prominent than Iraq, terrorism, the economy and “character” issues such as trustworthiness and consistency of leadership.

So far, Kerry is well ahead of Bush on health issues, with a plan — estimated to cost $656 billion over 10 years — that would provide tax credits for small businesses and individuals to buy private insurance or to buy into the federal government’s employee health plan, and to enroll all children under 300 percent of poverty and parents under 200 percent in Medicaid.

Kerry also proposes that the federal government would pay 75 percent of the cost when an employee faces catastrophic medical costs exceeding $50,000 a year.

As generous as this is — Republicans estimate it would actually cost $1 trillion over 10 years — Simmons noted in an interview that Kerry’s plan still fails to cover all Americans and lacks an effective system to control costs.

Kerry speaks vaguely about “discouraging” unwarranted medical malpractice suits to hold down costs. His major mechanisms are government “negotiation” of prescription drug prices and enhanced computerization of medical records to bring down administrative costs.

Bush’s plan, by comparison, is much more modest, costing $117 billion over 10 years. Its biggest item, costing $89 billion, is a refundable tax credit that would enable 4.2 million lower-income persons to buy insurance.

Bush also calls for expanding tax-exempt health savings accounts, encouraging small businesses to form insurance-purchasing pools and increasing the number of children covered by Medicaid. All told, these measures would cover about 6 million uninsured Americans.

Bush’s main cost-containment proposal is a cap on noneconomic (or “pain and suffering”) damages in medical malpractice cases. He, too, favors upgrades in computerization to reduce medical errors and to increase efficiency.

The National Coalition on Health Care called for Congress to establish a basic coverage plan for all Americans, though it left open the question of whether health care should be expanded through an employer mandate, through enlargement of existing government programs, or the establishment of a “universal publicly financed program.”

Coalition officials said that they were not recommending a Canadian-style government-run insurance plan but rather an opportunity for the uninsured to participate in the Federal Employee Health Benefit Plan.

The coalition offered no estimate of what it would cost to cover the uninsured because of its inability to predict what coverage plan would be involved.

Other experts have calculated that providing a basic Blue Cross plan for all the uninsured would cost about $10 billion a year. But coalition officials said “vast sums” could be saved over time through computerization of all medical records, disease management and prevention and quality control — all after a big investment in technology.

The coalition suggested, controversially, that during the phase-in of such cost-saving mechanisms, Congress should empower an independent board to set rates at which health care premiums and provider costs rise in line with the growth of annual GDP. Currently, health costs are rising at double to triple that rate.

In 2000, Bush matched Democrats on education. Can he do the same with health care this year? So far, he’s not even trying.