Commentary

Four Cheers for Bill Bradley

By Greg Scandlen
October 5, 1999
Presidential candidate Bill Bradley deserves four cheers and a slap on the back for his recent health care reform proposal. Two of these cheers would be of the “hip, hip, hooray” variety, but the other two would be of the kind most often associated with New York’s Bronx.

Bradley’s proposal would require all children to be covered at the moment of birth. He would allow parents to enroll their kids in their own health plan but would have federal back up for the rest. He would also allow adults to enroll in the Federal Employees Health Benefits Program (FEHBP) and provide a mix of tax credits and deductions to help families afford the coverage.

Bradley deserves one robust cheer for separating health insurance from employment. We will never have a market-driven health care system as long as employers make health care decisions for their employees. Workers must be able to choose their own health plans and keep them even when changing jobs. Bradley sensibly proposes that workers be allowed to purchase their own health insurance, independent of their employers, under a system of tax credits and deductions to help them afford it.

Bradley gets another hearty cheer for proposing to abolish Medicaid and allow Medicaid recipients to join the mainstream of society by participating in the private health insurance market, just like everybody else. Medicaid is a failure by any measure that counts. Eliminating the program will be one of the best things we could do for the poor.

The less flattering cheers are reserved for two other concepts Bradley offers.

The first is because Bradley wishes to make the raising of children a federal responsibility. He says, “Because our children are our national future, their health care must be a federal responsibility.” That is a startlingly arrogant notion that could be easily expanded to include housing, diet, clothing, exercise and every other aspect of child rearing. America’s parents don’t need Washington to tell them how to raise their kids.

Enacting a federal mandate requiring parents to cover their kids is an affront to America’s families. Parents don’t purposefully withhold insurance coverage from their children. Those without coverage simply can’t afford the expense. Making coverage more affordable for these families should be enough, without resorting to the federal policing powers Bradley would use.

The second Bronx cheer is for the notion of putting everybody into FEHBP. Although purchasing insurance independent of the employer is a good idea, FEHBP is a poor vehicle to use to accomplish that. FEHBP offers a variety of enrollment options, but they all have to meet the same federal standards, which include ever-richer benefits and ever-higher costs. Many people would prefer to have a lower-cost plan and fund their additional health care needs with either a medical savings account or other noninsurance methods. But the federal employee unions won’t allow this kind of flexibility and experimentation.

Another problem with the FEHBP is that it requires fee-for-service plans to charge the same premium regardless of location. This means that federal workers in a low-cost area like Omaha, Nebraska, subsidize the health care of workers in Washington, D.C., even though health care costs half as much and federal wages are lower in Omaha. Even the Medicare program recognizes the importance of geographic differences in health care costs. The Medicare Part A payment rates for private health plans in a single state (New York) varies from a high of $458 per month in Richmond County to $218 per month in Broome County.

FEHBP also requires traditional insurance companies (non-HMOs) to be available in all 50 states if the companies want to be part of the program. This makes it impossible for smaller, regional companies to participate, even if they provide better services for less cost. It is a giveaway to a handful of giant national insurance companies. Curiously, the same requirement does not apply to the HMOs that participate in FEHBP.

There are many other ways for working people to come together to purchase coverage outside of the employment system. Labor unions, credit unions, banks, social clubs, churches and housing developments all make for perfectly good pooling mechanisms that can respond to the needs of the membership without cramming everybody into a gigantic federal program.

Finally, the slap on the back is for raising the issue of fundamental health care reform at a time when Republicans and Democrats are all running for cover on the issue. Bradley’s proposal is important and should re-energize the health care debate across the country. He has shown courage and originality in his ideas, and these are qualities that are too rare in politics.

Greg Scandlen is a fellow in health policy at the Cato Institute.