Bush Merely Shrugs as Democrats Raise Health Care Issue

Posted January 23, 2004 at 5:43pm

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. [IMGCAP(1)]

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. [IMGCAP(2)]

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.