Bush Health "Reform:" Lipstick on a Pig

Losing an election certainly concentrates a politician’s attention.

President Bush, backpedaling on a number of issues, now seems ready to address health care reform, which helped elect Bill Clinton in 1992 but also helped establish a 12-year Republican congressional ascendancy hostile to more universal health care.

In his Saturday morning radio talk, a preview of his State of the Union address remarks on health care, Bush listed his reform proposals.

The sham is apparent from his opening assertion that American has the best health care system in the world. If he believes that, no proposal by this administration has any hope of solving what most of the people think is the most pressing domestic issue.

The United States still ranks miserably low among industrialized countries in the overall quality of health care despite spending more than double the amount of its GDP than the average of all peer nations. It is a complicated set of formulas by The Commonwealth Fund, but the scorecard rating performance on 37 different measures yields a U.S. rating of 66 on a scale of 100. In deaths due to preventable causes, America is 15th out of 19 countries, with France numéro un.

Administration health policy has been assumed by many to be a creature of the insurance and pharmaceutical companies. The new Bush approach, however, seems to be a creature of the cosmetics industry, as in putting lipstick on a pig.

The key element is “tax reform,” under which individuals can take a deduction for buying health insurance at market prices. Just as with the administration’s Health Savings Accounts and Bush’s proposal to let small businesses (but not Medicare recipients) get the same discounts big businesses get, the new plan rewards the “haves.” The “have-nots” are taken care of to some extent by Medicaid and Medicare. So that leaves the “have-not-so-muches” in the working class to bear most of the burdens and get the least benefit of "reform."

Republican governors in Massachusetts and California have proposed making health insurance as mandatory as car insurance, and Bush compares the proposed health care deduction to the existing deduction for homeownership. But these analogies are not quite valid because health is a commodity like no other. If you don’t have car insurance, you are usually not allowed to drive, and if you default on your mortgage payments, you not only lose the deduction, they take your house away.

No matter how much opponents of single-payer health insurance dress up tax reform as a method of health care reform, a large number of Americans are still going to have the potential of better health taken away from them.