President Bush has opened a second front in the war on terrorism. He wants to revamp bloated and broken programs long in need of revitalization. He's doing it in the context of the war so that any criticism might be seen as hurting the war effort by undermining our economic health and national resolve.
Politically, this is a good strategy. It's also good policy. Health care, especially, has long needed reform. Democrats and Republicans have said so, but the politics of it never seemed right. The president thinks the climate is right now.
In a speech Feb. 11 at the Medical College of Wisconsin, Bush linked reform of the health care system to a future filled with "amazing (scientific) discovery." Message: The cure for cancer and other diseases will come more quickly if we change the way we currently deliver health care.
The indictment of the health care system is familiar to most people and the president summarized it in his speech: "Too many patients feel trapped by the system, with decisions about their health dictated by HMOs or government bureaucracies. Too many doctors feel buried in paperwork. I've heard it said that some doctors feel they don't practice medicine, they practice insurance."
That's true of my doctor, who says his days are increasingly consumed with paperwork instead of patients. He argues with government bureaucrats or insurance companies over whether an office visit by a patient should cost $20 or $10.
Health costs are up and service is down. What to do?
The president said in his speech that while "government has got to take an active role in reform," its function "is not to centralize; nor is government's role to control the delivery of medicine."
Bush proposes reform that would allow all Americans to choose a health care plan that meets their needs at affordable prices. Currently, too many plans take a one-size-fits-all approach. Bush wants to give workers more choice by reforming medical savings accounts. An MSA allows pre-tax contributions to an interest-bearing account. When minor medical and prescription needs arise, the account holder writes a check.
"Instead of paying a large (health insurance) premium every month for services you may not use, I believe we ought to have an account that allows a person to pay a much smaller premium for major medical coverage, and then put the savings into a health account, tax free," Bush said Monday. Unlike existing MSAs, any money left at the end of each year would not be forfeited.
"The money is your money...not the government's money," Bush said. "If you don't use it, it's yours to keep. And for the more affordable premium, you also get catastrophic care, protection in case of serious illness."
Bush also wants to help those who cannot afford health insurance (estimated at
close to 40 million). "...(W)e ought to allow employers to pool together -- through an industry association or perhaps the Chamber of Commerce -- so that they can get the best deal for their workers, just as large corporations are allowed to do," he said Monday. For the poor, the president proposes "new credits (so they can) afford health coverage -- up to $1,000 for an individual, or $3,000 for a family."
This is a far cry from the previous administration, which tried to nationalize health care under government control.
Centralized health planning - whether by government or an HMO - fails because it is not responsive enough to the needs of patients. When third parties control the money, they get to make decisions based more on cost than quality of care. When people control their own dollars, whether through an MSA or tax credit, they can purchase the health care that best suits their needs.
Competition helps improve health care quality while controlling costs. Putting more control in the hands of individuals has the added benefit of reducing bureaucratic hassles, which discourage many people from signing up for government programs in the first place.
Bush's proposal would also solve the problem inherent in the proposed "patients' bill of rights." If a health plan refused to pay for a treatment or exam, an individual could pay for it out of his or her medical savings account.
The first President Bush did not try to link success on the battlefield with success at home. He won abroad and lost domestically. It is said the son has learned an important lesson. Apparently he has. The battle over domestic issues has begun.