The Medical Freedom Channel

In the midst of his prattlings about the war, the environment and other matters, President George W. Bush used a portion of this year’s State of the Union speech to address the healthcare fiasco. Almost as soon as he had finished speaking, the pundits started alternately praising and condemning his words on the topic. The response ranged all over the political map, from conservatives to progressives to libertarians of all stripes. The verdict from nearly all regions was pretty much the same: For once, the “stopped clock” was telling the correct time, at least somewhat.

Of course, there were a number of things he got wrong, and some of those don’t even seem to be showing up among the flood of commentaries, both positive and critical. In particular, we would note the omission of discussion of how to break the “insurance fetish” out of the equation, and shift the focus to how we can become healthier individuals, with less reliance on end-of-life aftercare and maintenance of physical husks, and more on wellness and prevention in the here and now. However, before we delve into this publication’s perspective, a roundup of just some of the postings analyzing the Bush Health Plan:

From the conservative side, Linda Chavez may have made the best case, in her “How to Cure the Health Insurance Crisis” piece at Town Hall. As she notes, “The health insurance problem is two-fold: Too many Americans, some 47 million, lack basic health insurance; and the rising cost of health care makes even those with insurance at risk of being unable to afford good care.” But as she also correctly states, a large part of the problem is that most healthcare insurance, involving about 175 million Americans, is delivered through employee benefit programs offered by their employers, with tax benefits accruing to both ends of the deal, since the costs are untaxable.

Since there is no similar provision for those who are providing for their own healthcare, the Bush plan addresses this, in two ways: (a) removing the exemption for tax-free healthcare for all of us, and (b) creating a new standard deduction for healthcare costs, $7,500 per individual ($15,000 for families). As Chavez notes, the average employee policy cost now runs about $11,500 per family (or $4,500 per individual), which would thus provide ample benefits for those now enjoying tax-free healthcare coverage. Only those with excessively low-deductible, unlimited-service (and thus very high-premium) insurance would feel any real negative effects from such a move.

But the real advantage of the Bush concept, as she points out, is its incentive for the currently uninsured (though employable and working) folks, who might avail themselves of low-premium, high-deductible coverage, using money that would have gone to federal taxes to pay for their healthcare premiums. Chavez notes that “for someone in the 30 percent tax bracket, that would be $4,500 they could use to pay for health premiums.” While acknowledging that the program would be insufficient to help every working person, since the working poor “pay little or no income tax” as it is, she affirms the value for the beleaguered middle class worker, as well as the incentive to take personal responsibility for wellness. (As has been affirmed here many times, the solution to the healthcare mess lies in isolating the issues: promoting wellness for the able-bodied and employed, and separating this from the properly charitable concerns about those who cannot manage their own lives.)

Chavez also predicts that alternatives to the present system are far more likely to be explored and discovered, once the new demand for low-premium, flexible coverage programs kicks in. She compares this to the much wider variety of auto insurance options now available, including low-premium, high-deductible coverage, limited liability, optional collision and other aspects now available. She also notes how analogues to “safe driver” programs might be adopted, rewarding healthful behavior, much as life insurance coverage now does: “A slim non-smoker who doesn’t engage in risky hobbies would pay lower life insurance premiums than a chubby, pack-a-day amateur skydiver would. Maybe if more Americans had to pay their health insurance premiums directly, they’d be more likely to follow their doctors’ advice to lose weight, quit smoking and engage in moderate exercise, because their premiums would go down accordingly.”

So Linda Chavez gets a piece of the puzzle right: the Bush plan WOULD make things a little easier for the middle class, and provide an incentive for at these those folks to take charge of their wellness, reaping tax benefits as never before in the process.

A similar analysis comes from the relatively objective Christian Science Monitor’s editorial board, which calls the Bush plan a “starting block.” It extols the virtues of the proposed tax-deduction, while condemning opposition to the idea, noting that “the Democrats’ rejection of his plan to fix the tax code to favor the uninsured could mean the majority party in Congress simply wants healthcare to be campaign fodder for the 2008 election.” It also affirms the free-market aspects of the issue, by asserting that, “Individuals must retain the freedom to choose their type of healthcare, and that requires a market-based approach in which patients and their healthcare providers have maximum say.”

However, in both cases, these prescriptions miss a much larger concern, and interestingly enough it is the left-progressive sector that identifies this problem correctly. Typical of these analyses are Ezra Klein’s “Healthy bottom lines” in The American Prospect, John Nichols’ “The President’s healthcare deform plan” in The Nation, Sharon Smith’s CounterPunch analysis, “Healthcare reform for the insurance industry” and and Marilyn Clement, writing at Tom Paine on “Bush’s healthcare conspiracy.”

Smith in particular identifies the basic failing, not only of Bush’s plan but of several others:

At first glance, Bush’s punitive proposal seems to bear little in common with the “Healthy Americans Act” introduced by Oregon’s Democratic Senator Ron Wyden or the “bold plans” of Republican governors Mitt Romney and Arnold Schwarzenegger … to mandate universal coverage in Massachusetts and California. But don’t be fooled. These bipartisan plans aim to provide a cash cow for the insurance industry, while demanding nothing in return: no curtailing of the obscene profits of healthcare conglomerates and no caps on skyrocketing insurance premiums or deductibles that sharply increase out-of-pocket costs. Instead, these plans will be financed by further bleeding workers. (Rather than quoting extensively from the rest, we direct your attention to the articles themselves.)

Athough Smith’s agenda and proposed solution involve some variation on the “national healthcare” model (which, as the Monitor editorial correctly notes, would be “a nationalized (and thus rationed) healthcare system like those in Canada, Europe, and Japan”) – she also has her finger on the bigger problem: the Bush plan has no provision for reforming the Big Insurance game that has managed (whether by “create, promote or allow”) things to become so ridiculous. In fact in each of the Bush proposals, as in all existing plans, the focus is on how “insurance premiums” are being handled, with little apparent thought toward reducing the numbers involved there. (One might note that none of these writers, anywhere on the political spectrum, seems to consider the impending Cover TN program in Tennessee, which attempts to push low-cost and partially state-subsidized plans, affordable by pretty much anyone. Perhaps this too will change, as that program unrolls officially this spring.)

Among the columnists cited here, only Chavez raises the idea of how a wider variety of options might ensue – although even then she does so only by comparing healthcare premiums to other types of “insurance”: auto and life, both of which have their own abuses within the fine print. (In the former case, we mainly insure our vehicles against harm to others, and only after-the-fact for “collision” on the vehicle itself; in the latter, we take out life insurance primarily for the good of beneficiaries, as a means for providing collateral on other purchases, or to cover the costs of our own funerals. Neither is undertaken mostly for our own direct well-being, and both are protections against calamity, not for the maintenance of our own bodies, as is healthcare coverage.)

Meanwhile, as for the push for “universal healthcare” – on account of the usual “poor folks” who can’t benefit from tax-policy benefits, since “they don’t pay taxes” – as usual it’s misguided. Making all of us conform to a program that rations services (because it would have to), simply because some of us do need extra assistance, is not only unjust but counter-productive. It makes the same mistake the “fair tax” people do in trying to force state income taxes where there are none. Instead of focusing on fixing that low-income issue specifically (by repealing the food tax, period!), those crusaders seek to penalize everyone in the process.

Similarly, instead of aiming their efforts at providing a “safety net” (by charitable or other organization) for those unable to fend for themselves, those folks seek only to lump the issues together, allowing no quarter without their “universal” solution. (Once again, it’s perhaps significant that the pundits have avoided mentioning Tennessee, which is attempting to create three very distinct pathways: Cover TN, for the working folks; Access TN, for the disabled and needy; and Cover Kids, for children without other means of getting medical care. Splitting the fight into its component battles has a far better chance of succeeding, due to the focused targeting of funds and energy.)

And so in the final analysis, the Bush plan – in spite of seeming to address one aspect of the question, by seeking to delegitimize the “employee benefits” model – fails to offer a truly comprehensive blueprint for a solution to the healthcare mess. It obviously remains for his critics to show how this idea, in conjunction with other theories, might actually lead to some real reform in this arena. We’ve attempted to do that over these many months, and will continue to do so. For the moment, all we can do is urge the Democrats not to reject the Bush proposal completely, but seek to reshape it to apply to a broader audience, while continuing to offer ways out of the mire.