Bush’s “Health Care Reform” 2: Selling the Scam

In the previous post, I said Bush’s pro-corporate proposal to address the health care problem through tax policy was liable to turn out to be the only initiative in the SOTU that he actually cared about and might try to implement. So far, I seem to be batting a thousand. He hasn’t mentioned the ethanol/alternative fuels thing, and even in the White House nobody knows what “Civilian Reserve Corps” means, let alone how it would be set up, who would be in it, or what it would do. But less than 48 hours after the speech ended, he was already out on the hustings hustling his health care “reform” package.

Speaking at a roundtable before an audience made up largely of journalists, Bush promoted his plan to offer new tax incentives for people to get modestly priced health insurance through their employers or on their own.


“The best way to do that is through private health insurance,” Bush said. “Therein lies part of the debate we have in Washington. We believe the private sector is the best delivery of health care. We know there’s a role for the federal government, but it’s not to dictate, it’s not to be the decision-maker.”

“The Decider” has been replaced as of Wednesday by “The Decision-Maker” in the limited Bush vocabulary. That’s Cheney & Co screwing around with the PR. “The Decider” had become a joke but they had no intention of giving up using language that makes it clear that Bush/Cheney is The Boss and the rest of us – including the Congress – better just shut up and follow The Leader, so they’re trying this. Since in this context “a role for the federal government” translates as “a role for Congress”, his use of the phrase is a not-so-subtle warning that he, as Emperor, has made the decision that private is better than public because he says so, and that’s that.

Although he does, for once, offer several putative “explanations” for why his “idea” is better than everybody else’s.

  • His “proposal would help some of the 47 million uninsured buy coverage”.
  • It would give “everyone a financial incentive to seek reasonably priced health plans”.
  • It “would slow spiraling health costs in the long run”.
  • “He also promised to redirect some federal health money to state efforts to help low-income people and those whose chronic health conditions make it hard to get health insurance.”

Nice thought but following precedent, he’ll never do it. It’s just another empty Bush promise, one of so many we’ve simply all lost track of them.

(Paranthetically, I was going through the old Trenches posts that I imported from Blogger, categorizing them so they’d be easier to find, and one of the things I noticed as I was re-reading them was how many of them contained promises by Bush to do this or that or the other that never saw the light of day after the first 3 seconds they were out of his mouth. One of these days I’m going to put a list together and post them all. They cover everything from federal money for health care to federal money for NYC after 9/11 to federal money to support the ethanol industry to federal money for schools – well, you get the idea.)

In any case, once again nothing he said is true.

President Bush likes to say that his health-care proposal would “level the playing field” between people who get health coverage through their job and those who buy it on their own.

But experts said yesterday that it would tilt that field toward a kind of health insurance that Bush has long favored — a high-deductible plan paired with a special tax-exempt health savings account, or HSA.


Len Burman, director of the nonpartisan Tax Policy Center, said that, in leveling the field, the White House should also seek to scrap the HSA tax break, whose purpose is to counter the tax code’s current bias toward comprehensive and expensive employer-provided coverage. Under Bush’s plan, it would be the only extra tax break for health insurance — one that would most benefit wealthy people, who can best afford the financial risk of a high-deductible plan and to sock away a lot of money in an HSA.

“It’s a really generous tax break,” said Burman, whose center is a joint project of the Urban Institute and the Brookings Institution. “If the goal is to try to get people to spend less on health care, why subsidize high-deductible health plans over aggressively managed care? People who believe that the market is the solution ought not to be prescribing one particular approach. Just create the right incentives for people to economize . . . and let them pick the option that works best.”

When Bush was Governor of Texas, he once said to a visitor (Sojourner‘s Jim Wallis) that he doesn’t “get” poor people.

The first time I met him, he actually said this very candid thing: “I don’t understand poor people, I’ve never been around poor people. I’m a white Republican guy who doesn’t get it. I’d like to. How do I get it?”

Wallis calls it “candid”, I call it clueless. He obviously hasn’t changed much, except that now he doesn’t even bother to keep up a pretense of caring (that visit was in the old “compassionate conservative” days, before he was elected and became The Decider The Decision-Maker and didn’t have to care any more).

Meanwhile, the less-greedy portion of the corporatocracy, the portion that has some slim, tentative idea that a healthy workforce is better than a sick one, is coming up with ideas of its own – and they don’t include Bush’s.

Start with the children and work up from there. For corporate America and Washington policy experts, that seems to be the emerging consensus about how to begin tackling the problem of the 47 million people in this country without health insurance: Start with the more than 8 million uninsured children.

Then maybe add four million college students who do not have insurance but might not cost all that much to cover because they tend to be young and healthy.

Next might come the 1.4 million or so uninsured people in households with total income at least $75,000, who are perhaps in a position to purchase insurance — if insurance became mandatory and if a market for affordable personal policies was created.

Those are among the ideas arising from corporate America as change in the nation’s health insurance system seems increasingly to become a political imperative.

Employers, much of the glue holding the nation’s piecemeal health care system together for half a century, have been reluctant to agree to a larger government role in medical coverage. But straining under runaway costs for providing health insurance — partly because of the costs imposed on the medical system by people with no insurance at all — many executives and their representatives see the time as ripe for starting to overhaul the system.

“There is more frustration and less acceptance of the current system among employers than we have ever seen in my 30 years in this field,” said Helen Darling, president of the National Business Group on Health, an organization made up of large companies.

On the plus side, incremental movement could bust up the political logjam and lead to an eventual acceptance by Corporate America that universal health care really is the only smart way to go – that is clearly the direction these suggestions point in.

On the minus side, building a jigsaw-puzzle jumble of health care initiatives piecemeal may make the creation of public health insurance easier to swallow politically but it usually leads to confusion if not chaos, and reams of the rules and regulations conservatives demand because they’re so sure we’re going to rip them off. They destroyed LBJ’s Great Society programs precisely that way – by larding them with so many eligibility requirements and means tests and cut-offs that they created a class of poor people who couldn’t live without welfare and another class of poor people who weren’t allowed any help at all.

This tactic successfully pitted one group against the other and the anismosity that grew between them allowed the Republicans to attack the whole idea of “welfare” backed by a lot of people in the second group who were bitter about being left to die a slow death while others got at least a survivable pittance.

There’s also the little problem of quitting: once you’ve picked up the fruit laying around on the ground, why climb the tree if you’ve got enough in your basket for a pie and a batch of applesauce? Don’t be misled by the tone of desperation that’s driving this section of the corporatocracy: if they get enough relief for their bottom lines from a few painless adjustments like the ones they’ve come up with, there’s a good chance they’ll lose their present jones for a solution and abandon the effort long before we get to anyplace that might even marginally deserve the title “universal”. They could even use whatever progress had been made up to then as an excuse: “We don’t need universal health care. Our employees are fine.” They are not, as any one of them will tell you, a philanthropic organization.

Still, it’s a beginning, and wisely handled (which includes dumping the Bush “reform” overboard like the explosive debris it is) it could lead to something important – if not universal care, at least a dressing for a badly-wounded system.

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