First, a look at the president’s past performance.
Four years ago, Bush chided the Clinton‐Gore administration for squandering eight years without reforming Medicare. He proposed spending $158 billion over 10 years to reform the health‐care program for the elderly and to provide prescription drug coverage to some seniors and said that where Vice President Al Gore “trusts the government, I trust the people.” Bush’s spokesman warned, “Debt will remain a problem unless and until a leader reforms our entitlements.”
But Bush’s trust in government grew in office. Last year, he persuaded Congress to approve a law that created a prescription drug benefit within Medicare.
Among the president’s tools of persuasion was a willingness to hide the law’s true cost. While Congress understood the law to cost $400 billion over 10 years, the Bush administration possessed information that the law would cost up to $200 billion more. Yet the White House did not trust the people with this information, and senior officials withheld it from Congress until after Bush signed the bill into law. The White House now acknowledges the law will cost at least $553 billion over 10 years.
Regarding debt, the law increased the present value of Medicare’s future deficits by one‐third, to a total of $62 trillion. That’s six times the total unfunded obligations of Social Security.
What scant reforms the law contained will not take effect until 2010, or nine years after Bush took office.
The law’s only “trust the people” provision is health savings accounts, which give patients far more control over their medical care and will rein in health care costs. Yet here too Bush deserves no credit. During the Medicare debate, health savings accounts were a side issue for him and only included at the insistence of House Ways and Means Chairman Bill Thomas (R‐Calif.) and House conservatives. Were Bush serious about health savings accounts, he would have included them in either of his tax cut bills.
So much for a reformer with results.
While less ambitious, Bush’s current health‐care agenda still places more trust in government than in the people.
Admirably, Bush would preserve and strengthen health savings accounts by allowing individuals to deduct the cost of their insurance premiums from their taxable income. But he also supports unconstitutional federal limits on medical liability awards; health care subsidies that would create new welfare payments and impede tax reform by further complicating the tax code; expanding federal regulation of health insurance; and having government manage the health care sector’s use of information technology, rather than getting the government out of the way and letting markets do their work.
Given a choice between these proposals and a status quo where health savings accounts are alive and growing, America might be better off doing nothing and letting health savings accounts reform America’s health care sector from within.
Bush’s dishonorable handling of Medicare will cause advocates to question whether they can trust him with vital reforms. The Bush administration withheld information in the past. Would it do so in the future?
Though Bush’s health care agenda deserves criticism, Kerry’s deserves far more. Kerry would increase taxes by $1 trillion over 10 years to have Washington take over much of what’s left of the private health care sector. While in the Senate, Kerry repeatedly voted against health savings accounts. On the campaign trail, he likens them to the tax relief he seeks to eliminate. And certainly there are those who question Kerry’s credibility.
It comes down to this: Is a mostly unhelpful health care agenda, advanced by a candidate who has deceived you in the past, preferable to a much worse health care agenda from a candidate who ranks it among his priorities?
In terms of health care, a second Bush term may be preferable to a first Kerry term if only because Kerry would destroy health savings accounts while Bush would preserve them.
But the difference between Kerry and Bush is hardly night and day. It’s more like night and fog.
One longs for a more appealing alternative.