Polls show most Americans don't want to tinker with Social Security. Many Republicans, facing re-election, don't want to touch it. Why still flog it?

Because Social Security is a place holder. As long as it remains on the domestic agenda, it blocks consideration of the real domestic crisis President Bush doesn't want to touch: the health care system.

Consider the symptoms. Medicare, the government's health care program for the elderly, is heading toward bankruptcy faster than Social Security. Its future unfunded liabilities are seven times larger. Social Security is projected to be in financial trouble in four decades; Medicare, within 10 years.

Medicaid, the government's health care program for the poor, is also in trouble. Its costs are rising so fast the White House and congressional Republicans want to whack it by $10 billion over the next five years. But governors don't want Medicaid cut. States pick up half its cost. If the feds bow out, states will have to make up the difference.

Symptom No. 3 is the increasing number of Americans without health insurance. Ten years ago, when President Clinton's proposal for universal health care tanked, 38 million lacked health insurance. Now, 44 million are without it at some point during the year.

Meanwhile, Americans who get health insurance through their employer are suffering sticker shock. That's because companies are rapidly shifting the escalating costs onto their employees. They're doing it through higher co-payments and larger deductibles and premiums.

The last symptom is the huge financial burden on companies that can't shift rising health care costs onto employees because of union contracts. For example, every car General Motors produces costs thousands of extra dollars because of GM's health care tab. Health care is the single most contentious labor-management issue today.

But it's possible to control health costs and at the same time give Americans far more health security.

One step is to use the government's bargaining clout to cut the prices medical providers and suppliers charge. Through Medicare and Medicaid, the U.S. government is the biggest health purchaser in the world. It has the heft to get pharmaceutical companies to agree to far lower drug prices. The same bargaining power could be used to bring down prices of other health care supplies and services.

Another step is to offer every American the chance to buy basic health insurance for the family at say, a few hundred dollars a year. The low cost would be possible because so many Americans would be in the same plan, generating vast economies of scale. In such a uniform system, transacting with a doctor or hospital of your choice would be as easy as using an ATM.

As a result, far more Americans would get regular checkups, and health problems could be prevented. Chronic illnesses such as heart disease could be identified before they got out of control. And catastrophic illnesses such as cancer could be treated early. We'd end up with lower costs and better care.

It's the perfect time to respond to America's health care crisis. With the middle class squeezed by soaring costs, big companies reeling and governors screaming, the political momentum is there.

But the Bush administration doesn't want to tackle it. Doing so would require an active role for government, and they're ideologically opposed. They know the nation can pay attention to only one big domestic crisis at a time. So they're using the fake crisis of Social Security as a diversion.

That's a shame. The real crisis of health care demands the nation's real attention.

Robert B. Reich, former U.S. secretary of Labor, is professor of social and economic policy at Brandeis.

© 2005 USA Today

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