We have George W. Bush to thank for this, too: The country has experienced a sudden epiphany in the winter of 2007 and realized that universal health insurance is a virtual necessity for its salvation, but it can do little about it because all political will has been sapped in the final miserable lap of his reign.
In the space of 10 days, we had these spectacles: The people who ran the famous “Harry and Louise” commercials that in 1994 torpedoed the Clinton universal health-insurance bill, jeeringly nicknamed “Hillarycare” after its chief author, joined 16 medical, business and insurance groups in saying that the country had to adopt universal coverage soon, starting with children. In Washington, the Business Roundtable joined AARP and the progressive poor people’s union that was spawned by Acorn in calling for immediate steps to begin to provide medical coverage to everyone. They said the nation’s competitiveness was at stake.
What they tend to describe and what some dozen governors, Republican and Democrat, promote in their own states are eerie versions of the Hillary plan, although everyone avoids the comparison. Like the Clinton plan, they employ government mandates for coverage but achieve it through the private health insurance industry. That is far and away the most expensive route, but the only one available to a state, which cannot imitate Medicare or embroider on Medicaid beyond what Congress authorizes.
So Tuesday night, hearing the clarion call perhaps but mainly to change the subject from Iraq, President Bush joined the campaign for health-care reform. But true to form the problems that Bush identified and solved bore no resemblance to the problems that beset the 46 million people in working families who have no health insurance.
Bush lives on a planet where everybody is well off and can buy everything their heart desires. They just need to have their income taxes raised or cut to force them to do the right thing. He wants to cut income taxes by up to $15,000 for families who will buy private insurance policies but raise taxes on workers who pay for really good plans so that they will buy only minimum coverage for their families. Good health plans in his words are “gold-plated.” When one family pays too much for their insurance, he imagines, it somehow must raise the insurance premiums for others.
He has never understood that for people who do not earn enough to pay much income tax a hefty tax break is no incentive to do anything. What good is a $15,000 tax deduction to a family that owes no income tax?
Bush’s foolish tax incentives will go nowhere in the new Congress but that is not the problem. A half-dozen or so health plans have been filed by individual members of Congress, including the surest and most economical way, to expand access to Medicare to people under 65. But Democrats have no will to do anything bold in spite of the rallying of groups all across the spectrum and polls that consistently show overwhelming favor for the government doing something bold. They don’t want to be called socialists or radicals, even by a man hardly anyone in America any longer believes. They await the 2008 election, when the presidential and congressional elections may produce a clear mandate for national insurance — or not.
Meantime, it is up to the states. Part of the national impetus this year comes from bold proposals by two Republican governors, Mitt Romney in Massachusetts and Arnold Schwarzenegger in California, to cover everyone under systems roughly patterned after Hillarycare. Massachusetts adopted the plan.
Maine, Hawaii and Vermont have already done it, phasing nearly universal coverage in over several years. Last week, the Democratic governor of Pennsylvania proposed a state-subsidized private-insurance plan to cover most of the 767,000 people who uninsured by taxing tobacco and businesses that do not cover their employees.
Eleven other state legislatures, including neighboring Louisiana and Missouri, are considering proposals to sharply increase coverage. But not Arkansas.
Mike Beebe, who sponsored and passed the ArKids First children’s health program in 1997 and who evinces a concern for the plight of poor working families, ought to be a good prospect for leadership in this area. Maybe he will show it in time.
You will recall that Mike Huckabee became a convert in 2000, boldly announcing that he intended to guarantee medical coverage for everyone in Arkansas before he left office. Six and a half years later he departed without trying. Oh, he did put in place last year a plan to let businesses buy into Medicaid to cover their low-wage workers in exchange for their arranging private insurance for higher-salaried employees, but even that anemic plan will provide poor results unless Beebe and the legislature can supply carrots and sticks to make it work.
Huckabee actually left Beebe one of the best men in the business, health director Joe Thompson, who came up with the Medicaid buy-in program. The governor should tell Thompson to supply him a plan to cover nearly everyone in six months or he’s gone.