August 03, 2003
It’s a Dems’ Game, but Bush has to Play It.
Nothing foments conservative blood quite like the concept of universal health care. According to the left this is because of the cold reptilian nature of their vital fluids, the same reason they oppose all the left’s programs of “social-consciousness.” Yet, the real motive is that conservatives and libertarians alone understand the ineptitude of government paternalism, and to have it threaten an industry as important as medicine scares the bejeezus out of them. And they know the stakes are high, while it’s easy to offer the people government services, it’s virtually impossible to take them away. Thus, there is no second chance on health care reform.
The 2004 democratic primaries are starting to impress upon the public consciousness and the one thing that is certain about the coming race is that Health Care is on the agenda in a big way. In 2000 we were subjected to empty and ignorant promises about prescription drug benefits (remember Gore, his mother and his dog). Neither candidate discussed WHY drugs cost so much, i.e. the draconian requirements of the FDA, but merely pledged to pay for them in one way or another. Quite predictably that ‘throw money at it’ approach looks to dominate again in 2004.
So prerequisite is a health program to the democratic presidential nomination that most all the candidates have already announced their plans and we’re still five months away from the first votes. Gephardt had his plan out several months ago in fact, making him the early bird that probably won’t catch the worm. Why? His program is the most expensive and the most ambitious of the viable candidates. (I say viable candidates because there is always the stargazing Kucinich, who stands no chance at mainstream support for his government-run single payer plan that would be financed by a 7% tax on employers.) The Gephardt fiasco would cost around $212 billion dollars and require employers to provide health-care to all employees, with up to 60% of the cost subsidized via tax credits. Gephardt, along with Dean, would reverse ALL of Bush’s tax cuts in order to afford his program. It doesn’t seem to be of much concern that a shrinking economy would only create a downward spiral of government spending on health care. Rising unemployment under the Gephardt dream would simultaneously create increasing claims for Medicare benefits (which Gephardt would provide) and decreasing tax revenue to pay for those benefits. But this spiral is nothing new I suppose.
Next among the big-spenders is the precipitous Howard Dean. Dean’s plan is likely to get respect because Dean is a doctor, but policy wise it doesn’t seem to part much from Gephardt’s spend-spend approach. Dean would allow all Americans to buy in to the same coverage federal employees receive and expand Medicaid and/or CHIP to insure everyone under the age of 25 with an income of less than three times the poverty level. This move no doubt panders at least a little to the 18-25 year old voting bloc, notably the weakest in the electorate, but probably the most susceptible to the Dean’s seduction. Dean’s plan would cost about $88 billion.
Edwards, just recently announced his plan and it is the cheapest and most conservative of the bunch, placing the burden of mandatory insurance for children on the parents but providing tax credits to help pay for it. He would also, like Dean, allow lower income families to buy in to state health insurance. His plan would cost a measly $53 Billion, but would probably still require tax hikes.
The most rational plan (rational for a Democrat anyway) is probably John Kerry’s. Kerry wouldn’t repeal all of Bush’s tax breaks, he would, of course repeal those cuts that benefit the wealthy. He would also close unspecified corporate loopholes. We shouldn’t hold this against him, he is a democrat after all … and a rich one at that. Kerry’s $72 million program would reimburse employer cost up to 50%, as well as pick the tab on state’s expanding Medicaid to cover 20 million uninsured children. Remarkably though, Kerry at least addresses the issues of cost reductions. He would create a catastrophe fund, similar to terrorist insurance, that would help pay for insurance claims exceeding $50,000 (only about 0.4% of all claims). Kerry also recognizes the inefficiency of the medical bureaucracy pointing out that “While banks have cut their costs to less than a penny per transaction using computers and technology, a single transaction in health care can cost as much as twelve to twenty-five dollars.” Yet, mere recognition of this problem does little to solve it and so far recognition is all Kerry seems to have.
Given the electorate’s interest in the issue (polls usually show health care as the number one domestic issue after the economy), Bush cannot appear to champion the status quo. He will have to come up with some viable alternative to these warm, fuzzy, “compassionate” financial disasters. One way to do this is to become visibly passionate by the exponentially rising costs of health care and to develop a multi-pronged attack on the crisis from a cost-reduction angle. A catchy name like “Health of the Nation” or “A Nation of Choice” would allow him to maximize his still strong rapport with the American people, while promoting a plan that, above all, must have substance. Bush might also want to co-opt the Catastrophe fund idea and provide a few more restrictions on its use. This would surely anger some conservatives, but the mainstream would love it. A catastrophe fund would certainly be an added government service but it would be easier to repeal once the “Health Care Crisis” abates, thus making it a fairly safe compromise (unlike Bush’s behemoth prescription drug benefit). Bush has to be aggressive and creative on the health care issue. Anything less will risk the health and the freedom of future generations.
Extremely well written article and informative. Thanks.
It was inescapeable however, that your argument is critical of any plan for national health insurance that would cost money. Are you hinting at free health care for all? Or, a Republican plan that hides the costs where the average lower and middle class worker won’t see it?
The only reason our nation should be discussing national health care options is because we are the wealthiest nation in the world. If other, less wealthy, nations have demonstrated that they can provide national health insurance, why shouldn’t America’s health system reflect the same compassion for its own people. As opposed to our current lack of compassion of leaving 40 plus million Americans without coverage, which far too often means, without health care at all.
That kind of suffering is beyond the pale in the wealthiest nation on earth. Anything less than universal health care access by all Americans is unacceptable. Funding for it should come from where it is most available and where the collection of the funding will do the least harm to the least number of Americans and to our economy. The more plans that are put out there on the table, the more ‘Choice’ American voters will have. And we know how Republicans love choice, right?
Very good article. I tip my hat, Mike.
Posted by: DRRemer at August 3, 2003 11:02 PMSo draconian policies at the FDA are the problem in drug prices? I have also heard that patents and profiteering are the problem.
Care to elaborate? The FDA has a very somber job — a certain degree of difficulty in the drug approval process is required. What things go overboard?
Posted by: cram at August 4, 2003 12:35 AMFDA are requirements are a serious factor, not the only one.
I would agree that excessive patents are also a problem…but I am afraid they might be a necessary evil given that it takes a company sometimes 10 years to push a drug through the FDA.
So the solution is two fold…we have to make it easier for drugs to get to the market, but also make it easier for generics to compete.
Posted by: Mike Van Winkle at August 4, 2003 08:19 AMMike, I really like this line in your article: “This would surely anger some conservatives, but the mainstream would love it. A catastrophe fund would certainly be an added government service but it would be easier to repeal once the “Health Care Crisis” abates, thus making it a fairly safe compromise.” So basically lets make false promises to win the election, and then once were in office, take them back. Sounds like a plan that should fit right in with the Bush administration’s SOP. I can’t believe there are so many ignorant people out there that actually buy-in to this stuff. Bush smiles, says some nice guy comment that really doesn’t mean anything, and they think he is one of them, that he really cares about the average American. Truth is he never actually reveals a real plan to do anything. I doubt he is smart enough to really come up with anything on his own, but this is the kind of trickery and deceit that fits right in to his well-crafted agenda. Mike you should become one of his advisors. Problem with that is, he won’t be around after 2004. But if you want to watch him strut around in his flight jacket and tell his make-believe stories around the campfire, you’ll have to join him in Crawford Texas!
Posted by: keep up the spin at September 3, 2003 01:17 AM