Five years into his administration President Bush has proposed a
health-care plan which, like his tax cuts and proposed Social
Security overhaul, is good news for the healthy and wealthy. But is
it wise?
Its centerpiece is the expansion of tax-exempt medical savings
accounts, enacted in 2003 with the trouble-plagued Medicare drug
plan. The more money you make and save, and the longer you save it,
the greater the value of the tax shelter. It’s a self-restricting
benefit.
Five years into his administration President Bush has proposed a health-care plan which, like his tax cuts and proposed Social Security overhaul, is good news for the healthy and wealthy. But is it wise?
Its centerpiece is the expansion of tax-exempt medical savings accounts, enacted in 2003 with the trouble-plagued Medicare drug plan. The more money you make and save, and the longer you save it, the greater the value of the tax shelter. It’s a self-restricting benefit.
The accounts will do nothing for the basic insurance needs of the nation’s 46 million uninsured, often hardworking people whose employers don’t offer health insurance and who don’t earn enough to save for their own. Unemployed? Tough.
Health care becomes affordable to the greatest number of people by broadening the client pool, not narrowing it. That’s how insurance works, and that’s the basic argument behind single-payer health care.
The same argument supports public education. A system dependent on private schools provides no guarantee of universal basic education. Just as that guarantee doesn’t include a college education, single-payer health systems typically promise only an agreed upon level of basic care. That sounds like rationing, and it is, but like education it is based on need, not by ability to pay. And the better off can still supplement their care with private insurance.
Opposition to single-payer is based on the philosophy that individual choice is the best way to provide quality health care. But the choice provided in Bush’s plan will actually make a bad situation worse.
As the young and/or wealthy opt for health savings accounts, group plans will increasingly depend on a contracting financial base dominated by the poor and sick. Per capita costs will go up, further encouraging those who can afford to leave to do so.
Overcrowded emergency rooms signal a resulting two-tiered health system in which local government is footing the bill for a growing class of medically indigent.
As for quality, if basic yardsticks like infant mortality and life expectancy are the measure, we have one of the worst health-care systems in the industrialized world, compared to countries with single-payer systems.
A single-payer system would also save us billions of dollars each year.
We spend about twice as much per person on health care in this country as in Western Europe, and about 75 percent more than Canada. Government allocations are about the same. The difference – in higher drug costs and the 20 percent overhead charged by insurance companies – comes straight out of your pocket.
Simply including everyone in the Medicare, where overhead is only 3 percent, could save us $150 billion a year in paperwork alone. Taxes are cheaper than premiums, and even greater savings could be realized if the insurer, your government, were allowed to enforce price discipline on the pharmaceutical industry the same way it does doctor’s fees.
And there’s the rub. Those two lobbies, along with the insurance industry, constitute a powerful trifecta of opposition to a system favored by 72 percent of Americans, according to a 2003 Pew poll.
Lately consumers have gained a new ally. It’s no longer just the poor and uninsured who are clamoring for change. Medical expenses are bankrupting businesses and individuals alike. With $1,500 per employee in health benefits included in the cost of every car, even General Motors, which lost $8 billion dollars last year, is begging for government intervention.
The fact is our current employer-based system began to collapse years ago. According to a study by the Kaiser Family Foundation, some five million jobs have lost insurance coverage since 2001.
The Bush administration has long been aware of the problem. A 2002 study by the National Academy of Sciences, commissioned by then-director of Health and Human Services Tommy Thompson, concluded that “The American health care system is confronting a crisis” and was “incapable of meeting the present, let alone the future, needs of the American public.” Interestingly, it recommended using the states as incubators to try both medical savings accounts and single-payer plans.
Many of the arguments for and against single-payer health care are familiar, and the ideological basis of the president’s plan is unquestioned. But the true bottom line for many Americans is this: Why should the average citizen’s health care plan provide anything less than the coverage we already provide children, seniors and veterans – or for that matter the generous health care subsidies members of Congress and the president have given themselves?
