Bush's Health Plan and the Virtue of Modesty

A health-care program is suddenly to elected officials what cameras are to cell phones: once optional equipment, but now mandatory.

Ever since President Clinton’s attempt to remake the industry blew up in his face, most politicians have avoided it like the Ebola virus. Last week, though, President Bush unveiled a major health care initiative, and Barack Obama called for universal health care. Also in the works is a plan from Hillary Clinton — author of the 1994 debacle.

If Hillary Clinton is willing to brave the dangers of going back into the lion’s den, it’s because there are even greater political dangers in staying out. An October poll by the Kaiser Family Foundation showed that 46 percent of Americans are "very worried" about paying for health care. Among the issues deemed most important, health care came in second only to the war in Iraq.

Of course Americans were concerned about the issue in 1994 as well, only to conclude that some cures are worse than the disease. Since then, though, the number of people without medical coverage has risen from 39 million to 47 million, and health care spending has grown from 13.7 percent of gross domestic product to 16 percent.

But if the problem has gotten worse, the solutions have not gotten any simpler. Today, as in 1994, the options are basically three: leave things as they are, look for ways to expand coverage while preserving a system based largely on private insurance, or move toward universal coverage administered by Washington.

President Bush, like other politicians, has decided that the status quo is no longer acceptable. His plan, which would change the tax treatment of health insurance to encourage more people to buy it, may be faulted for being too modest. But governments more often err by overreaching than underreaching, particularly when it comes to promising things that everyone wants but no one wants to pay for.

The administration proposal has two conspicuous virtues. One is that it would increase the number of Americans with health insurance. The other is that it would build on the existing system rather than abandon it for one dominated by the federal government.

His blueprint offers a good start, but it would need to go further to make real progress. The administration estimates that if we give families without employer coverage a $15,000 tax deduction to buy their own, between 3 million and 5 million people would move into the ranks of the insured. But those most in need of help wouldn’t get it.

A tax deduction is fine for those in higher brackets, but it’s less useful to people who pay little or nothing in federal income taxes. What they need is a refundable tax credit, allowing them to get cash from Washington to pay for health insurance.

Would that cost money? Of course. But it would pay for itself, in part, by reducing what governments spend on medical treatment for people who lack coverage. Bush also proposes to give states more leeway to use federal funds to cover the uninsured, which would also offset some of the expense, while further reducing the number of uninsured.

Democrats were quick to attack the president for not trying to cover more of this group. But most congressional critics, while favoring universal coverage, have yet to spell out their own ideas for reaching that ambitious goal. One idea that has fans on the left is championed by Sen. Edward Kennedy, D-Mass. — expanding the federal Medicare program, which now covers the elderly, to include everyone.

This idea brings to mind the saying that for every complex problem there is a solution that is clear, simple and wrong. One gaping flaw is that it would be expensive, and we are having trouble paying for Medicare in its current form.

Another is that it threatens to bring on the sort of rationing that has occurred in Canada, where patients typically wait weeks or months to see specialists or undergo surgery — and where, according to the Supreme Court of Canada, some people with health insurance nonetheless die waiting for treatment.

The United States has exceptionally good health care, the problem being that not everyone has full access to it. The president has remembered something crucial: In fixing what’s wrong with our system, we need to make sure we also preserve what’s right.