Ill Communication by Jonathan Cohn

[Guest guest]

http://www.tnr.com/doc.mhtml?i=express & s=sotu012803#ill

 

The New Republic

 

Ill Communication by Jonathan Cohn

 

 

ill Communication

Health care wasn't topic A or even topic B in Tuesday's State of the Union

address. Those distinctions went to Iraq and the economy, and appropriately so.

Still, given the extent to which the administration has been talking about

access to health care in the last few weeks--and the extent to which Americans

are clearly worried it--it's a bit surprising the president didn't have more to

say on the subject. Yes, Bush touted his plan for reinventing Medicare. But he

gave precious few specifics. He said even less about helping the non-elderly get

health insurance. He acknowledged that " for many people, medical care costs too

much--and many have no coverage at all. " But he didn't even make a cursory

reference to his two favorite remedies: giving refundable tax credits for health

insurance and creating purchasing pools to help small businesses buy insurance

for their employees.

 

In fairness to Bush, some of those details will come soon. Today the president

travels to Grand Rapids, Michigan, to talk about Medicare. Conversations about

what to do about the uninsured will follow after that, if only because

Democratic presidential candidates will be making it a major issue in the 2004

campaign. So by giving health care just a few short paragraphs, maybe Bush

wasn't slighting it. Maybe he was just saving it for another occasion, when the

specter of an even weightier issue--war with Iraq--doesn't loom so large. Hey,

fair enough.

 

Unfortunately, what Bush did say about health care wasn't exactly encouraging.

America is going through a period very similar to the early 1990s: The entire

health insurance system is breaking down and the country needs to make a choice

about how to reinvent it. Liberals and conservatives have very different ideas

about how to make that decision, and it's a debate worth having. But rather than

articulate his conservative position and defend it, Bush did what he always

does: cloak it in liberal language to make it sound more palatable.

 

Consider this key passage in his speech: " We must work toward a system in which

all Americans have a good insurance policy; choose their own doctors, and

seniors and low-income Americans receive the help they need. Instead of

bureaucrats, and trial lawyers, and HMOs, we must put doctors, and nurses, and

patients back in charge of American medicine. " Listening to this description,

you might think the heart of his health care agenda was to move Americans out of

managed care plans that restrict access to doctors and treatments. But Bush's

Medicare plan would do precisely the opposite. In order to get a prescription

drug benefit, seniors would have to leave traditional Medicare--an

old-fashioned, fee-for-service plan that allows seniors to see almost any doctor

they want--and enroll in private, managed care networks. No HMO, no drug

coverage.

 

Now, this is hardly an indefensible position. On the contrary, principled

conservatives--and even some thoughtful liberals--believe that the only way to

make Medicare financially viable over the long run is to stop giving senior

citizens such lavish health care. If seniors expect prescription drug coverage,

the argument goes, then they'll have to live with less generous insurance

overall--i.e., HMOs that offer fewer options for care. But you heard no such

explanations from Bush on Tuesday night. He made no call for shared sacrifice,

no statement about the coupling of rights with responsibility. Instead, he made

it sound like seniors could have it all.

 

The other curious, and disturbing, passage on health care was this one,

following the line about rising costs and the plight of people without

insurance: " These problems will not be solved with a nationalized health care

system that dictates coverage and rations care. " It's curious because no elected

official not named Ted Kennedy is seriously proposing national health insurance

right now. And it's disturbing because not even Kennedy himself proposes to

" nationalize " health care--at least not the way it's done in, say, Great

Britain, with government employing doctors and hospitals directly. (The most

far-reaching, single-payer health care proposals in America all leave physicians

and hospitals as part of the private sector.) So during the time Bush could have

spent giving people some idea of how he intends to solve the problems of rising

costs and the uninsured, Bush instead chose to bash an alternative solution--one

that nobody is actually proposing.

 

Of course, the true irony is that the health care system we have today--the one

Bush likes so much--rations care all the time. It rations care by allowing HMOs

to limit physician and treatment choices. And it rations care by denying basic,

sometimes life-saving treatments to the 42 million Americans who have no

insurance at all. Again, principled conservatives will acknowledge the existence

of such rationing. It's necessary, they say, in order to control costs and keep

people from gaming the system. But on Tuesday, Bush eschewed such candor.

 

Can Bush get away with this? He certainly has in the past. Just look at his tax

cut package, sold to the American public as broad-based tax relief even though

it showered the vast majority of its benefits on the wealthy. Or look at his

continued insistence upon fiscal discipline even as he's squandered Clinton-era

surpluses and run up huge deficits. Then again, the anxiety about health care in

America is real--and growing. Seniors follow what happens with Medicare very

closely. People with private insurance know first-hand how care gets rationed

under the current status quo, as do those without insurance at all. They'll see

Bush's plans for what they are, no matter how he describes them. And unless he

comes up with some new ideas soon, it's a good bet they won't be happy.

 

 

 

 

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