Isaiah J. Poole is the executive editor of TomPaine.com.
This week the public is getting two sharply divergent views of the future of health care, one that would take the status quo and make it worse for millions of Americans, and one that would get us closer to sensible, universal health care.
Fortunately, the former vision, outlined in President Bush’s fiscal 2008 budget proposal, is not going to get a serious hearing, especially from the Democrats who now control Congress. The plans Bush sent to Capitol Hill would actually increase the number of people in America without health care coverage and would force millions of others who do have health insurance to pay more.
Contrast that with a plan unveiled by Democratic presidential candidate John Edwards . He describes his plan as one of “shared responsibility.” While that has the odor of a conservative catchphrase, what he is really talking about is a partnership of government, the private sector and individuals to provide health care that is universal and efficient. It does not go as far as many progressives would like, but it is a good starting point for giving what our broken health care system needs: an overhaul, not just a series of patches.
The patches favored by President Bush would give health care tax credits that help only the comfortable, but erode employer health plans; cut Medicare expenditures by forcing middle-class retirees to pay higher premiums; cut state Medicaid payments for coverage of poor people in need of health care, and undermine the goal of covering all children by cutting the State Children’s Health Insurance Program.
No serious health experts—and few American families—believe that a tax credit will help Americans get good health care coverage. Under a health care tax credit system, private insurance companies would still simply refuse to sell health insurance at an affordable price to those who really need it. Poor people cannot afford coverage—and, since the tax credits are not refundable, the poor will not be eligible. Middle-class families whose breadwinner is suddenly unemployed will likely have some family member with pre-existing conditions, which insurance companies use to deny coverage. Meanwhile, wealthy people, who are already good at sheltering their money from taxes, will buy whatever plan they were going to buy anyway and pocket the tax credit.
President Bush claims that too many of us have “gold-plated” health care plans. He’s mostly talking about union members who have managed to negotiate good benefits. And taxing these people on those benefits will do nothing to encourage “excessive use of health care”—because most Americans want to see doctors only for prevention and when they are really sick.
Under Bush’s proposed budget, states would get less money to cover children of families living at twice the poverty level or more. Medicaid would see a $7 billion cut, mostly through lower payments to states for administrative costs. These cuts will hurt the millions of Americans who rely on Medicaid for their health and is reflective of a larger trend in the Bush budget—while the rich get tax cuts, the poor get hit with cutbacks in vital services.
Bush’s proposal would force middle-class retirees to pay higher Medicare premiums. At the same time, health care providers like hospitals and nursing homes would see their payments reduced. The president would freeze their Medicare payments and reduce the inflation allowance. This could result in a reduction in health care quality. At the same time, Bush would protect more costly payments to private managed care plans, which are seen as a step towards privatizing the program.
Finally, at a time when states like New York, California, Pennsylvania and Illinois are trying to extend insurance coverage to more children of working families, the Bush administration is moving in the opposite direction, putting hundreds of thousands of children at risk of losing their health coverage at a time when there are still 9 million uninsured children in the nation. While the president's budget proposal finds $295 billion to fund the Iraq War, it includes less than half the funding needed to keep current children enrolled in the State Children's Health Insurance Program—and has no funding to support state efforts to cover more children.
The Edwards plan stands in sharp contrast to what the administration is proposing. It would require businesses and other employers to either cover their employees or help finance their health insurance. There would be new tax credits offered in conjunction with that mandate, plus an expansion of the Medicaid and SCHIP programs. It would also reform insurance laws and take steps that would squeeze unnecessary costs out of the health care system. Once all of the elements of the plan are in place, everyone would be required to have some form of health insurance.
What Edwards proposes borrows heavily from one being put forward by Jacob Hacker, author of The Great Risk Shift and a political science professor at Yale University. Hacker, who is working with the Campaign for America’s Future on its health care initiative, says the plan has merit:
It includes two key building blocks for affordable universal coverage: a requirement that employers either cover their workers or make a reasonable contribution to the cost of coverage, and the creation of a new, publicly overseen insurance pool through which workers without secure workplace coverage can have a choice of guaranteed public or private insurance, including an insurance plan modeled after the popular Medicare program.
Hacker adds that Edwards' proposal could be less complex and even more effective:
I would prefer, for instance, a single national insurance pool for those without workplace coverage, and I believe the public Medicare-style option should be allowed to offer the broader benefits necessary to attract younger workers and compete on a level playing field with private insurance plans.
If this were done, as Edwards himself has said, the system may evolve over time toward a Medicare-like approach—the only approach that has been proven to control costs over time without shifting more costs and risks onto patients.
That being said, though, is that we have one presidential candidate who has jumped out early with a comprehensive health care plan worth discussing—far more than what can be said for what has come out of the White House, which deserves noting more than derisive dismissal. Now is a good time for other candidates and progressive leaders who have better ideas to come forward, and let’s have the urgent push for a new health care system that we desperately need now.