The Bush campaign hasn’t done much in telling voters what the president would do with another term — just vote for him, they’ll tell us why afterwards — but his platform is not without ideas. Of course, whether those ideas are any good is another matter.
Almost four year ago, at the second presidential debate, moderator Jim Lehrer asked Bush what he’d do about the 40 million Americans who don’t have health insurance. Bush gave his standard smirk and said, “Well, I’ve got a plan to do something about that.”
Four years later, the ranks of the uninsured have swelled to almost 44 million. The good news Bush really does have a health care plan. The bad news is no one seriously believes it’s going to help most American families.
Projections by the Congressional Budget Office, the Treasury Department, academics and the campaign’s Web site suggest that under the best circumstances, Bush’s plans for health care would extend coverage to no more than 6 million people over the next decade and possibly as few as 2 million.
“There’s little reason to expect that there would be any reduction in the overall numbers of Americans without health insurance,” Brookings Institution health policy expert Henry J. Aaron said. “We’re swimming against a rather swift current in our efforts to reduce the number of uninsured, and the power of President Bush’s proposals to move against that current is, it seems to me, very, very limited.”
Paul Krugman recently took a closer look at the backbone of Bush’s plan — health savings accounts. Take a guess who benefits from the policy.
[H]ealth savings accounts don’t seem to have much to do with the needs of the families likely to find themselves without health insurance. For one thing, such families need more protection than a plan with a $2,000 deductible provides. Furthermore, the tax advantages of health savings accounts would be small for those families most at risk of losing health insurance, who are overwhelmingly in low tax brackets.
But for people whose income puts them in high tax brackets, these accounts are a very good deal; making the premiums deductible turns them into a great deal. In other words, health savings accounts will offer the already affluent, who don’t have problems getting health insurance, yet another tax shelter. Meanwhile, health savings accounts, in the view of many experts, will actually increase the number of uninsured.
This perverse effect shouldn’t be too surprising: unless they are carefully designed, medical policies often have side consequences that worsen the problems they supposedly address. For example, the Congressional Budget Office estimates that one-third of the retirees who now have drug coverage through their former employers will lose that coverage as a result of the Bush prescription drug bill and will be forced to accept inferior coverage from Medicare.
In the case of health savings accounts, the key side consequence is a reduced incentive for companies to insure their workers. When companies provide group health insurance, healthier employees implicitly subsidize their sicker colleagues. They’re willing to do this largely because the employer’s contributions to health insurance are a tax-free form of compensation, but only if the same plan is offered to all employees.
Tax-free health savings accounts and premiums would provide healthier and wealthier employees an incentive to opt out, accepting higher paychecks instead, and would lead to higher insurance premiums for those who remain in traditional plans. This would cause some companies to stop providing health insurance, or raise employee contributions to a level some workers can’t afford.
The difference couldn’t be starker. Mr. Kerry offers a health care plan that would extend coverage to most of those now uninsured, paid for by rolling back tax cuts for those with incomes over $200,000. President Bush offers a tax credit that would extend coverage to fewer than 5 percent of the uninsured, plus a new tax break for the affluent that would actually increase the number of uninsured…. I don’t see how Mr. Bush can win this debate.
The only way Bush wins this debate is if it doesn’t occur.