Bush's 2007 budget proposal predictably follows his approach to policy solutions: take a bad situation and make it worse. Let's face it- we have a president addicted to failure. What's interesting is to look behind what appears to most of us to be unabashed failure and see that George W. Bush may indeed be achieving precisely the success he may have intended. Bush's signature domestic policy issue for this year is health care. His failure to find a workable solution for the average American and the uninsured is far from a failure for his administration.
Polls indicate that Americans feel their number one domestic problem is access to decent, affordable health care. Currently there are 46 million Americans lacking health care coverage. Five million more Americans have joined the ranks of the uninsured under Bush's watch.
In 2003, Bush and the Republicans pushed through a pharmaceutical industry's dream: a prescription drug benefit bill that mandates the privatization of Medicare for seniors wishing to receive the drug benefit. This privatization scheme, known as the Medicare Part D Prescription Drug program, took a relatively efficient public health program and made it more costly and infinitely more confusing. This bill went into effect January 1 of this year and so far 24 states are stepping in to pay for prescription drugs of seniors, disabled, and mentally ill Americans whose pharmacists have not been able to navigate this grossly ineffective new system. The Washington Post reported this month on some of the nation's 2 million mentally ill patients who depend upon their medications to keep them from danger and out of the hospital. It reports that since New Year's Day, people have fallen through the cracks, lost coverage for crucial meds or discovered that they are left without any insurance.
On Capitol Hill Wednesday, Health and Human Services Secretary Mike Leavitt was questioned by Democrats and some Republicans about the mess created by this newly implemented drug benefit. Leavitt responded that he was "Proud of Part D. We are 38 days into the biggest change in Medicare history."
As much as this may seem a failure to seniors and mentally ill people currently unable to attain their medications, it clearly seems to the Bush administration a feather in their hat. Where is the success? Well, certainly they have succeeded in further endearing themselves to the pharmaceutical companies and private insurance industry as their profits continue to soar. This is a goal not antithetical to keeping the pro-business Republican Party in power.
The failure continues with Bush's latest privatization scheme. His new budget proposal, released earlier this week, ensures that the cost of health care coverage will continue to skyrocket. In it, Bush urges great expansion of his Health Savings Accounts program, initially introduced as part of the 2003 Medicare reform bill. These are tax free savings accounts for out of pocket medical expenses as part of high deductible health insurance plans. How they function, however, is as tax shelters for the wealthy. They were created under the guise of giving consumers more control over their money and health care. The argument is that if consumers pay out of pocket costs for a high deductible health plan, they won't go to the emergency room for a stuffy nose as often as if they were more removed from the costs- as they are, for example, under an employer-based health plan. Consequently, so the argument goes, health care costs would decrease over time.
Instead, this expansion of Health Savings Accounts will do the opposite for at least four reasons:
First, the proposal is to increase from $2,000 to $10,500 the amount that a couple or family can put away tax free to spend on high deductible insurance plans. Only the wealthy can afford to do this. Further, these tax benefits increase as tax brackets increase;
Second, high deductible plans simply discourage average and low-income people from getting the care they need, consequently escalating costs as health problems compound;
Third, the vast majority of our nation's health costs come from chronic illness and end-of-life care; high deductible health plans are for the more healthy;
Finally, as the wealthy and healthy choose the tax sheltering HSAs, the remaining risk pool becomes sicker and premiums for traditional plans skyrocket out of reach. As January's issue of the well-respected magazine, The Economist, puts it, "The Bush agenda may speed the reform of American health care, but only by hastening the day the current system falls apart."
Here again, HHS Secretary Leavitt defended these accounts: "HSAs will make cost-conscious consumers which will lessen the cost of health for all." Not only does he ignore the problems HSAs present, but nowhere in the administration's marketing of this new tax shelter will you see the cost of implementing this plan according to government studies: $40 billion over 10 years. Forty billion dollars is roughly the cost of the recent cuts made to Medicaid, child care, child support enforcement, foster care, student loans and other crucial domestic social services.
One may reasonably conclude that Health Savings Accounts fail as a solution to curbing health costs and insuring the uninsured. However, we may again miss the point. George Bush certainly will have succeeded in his goal of extending even more tax cuts to the already well off. It certainly is difficult to see how much else could have been the goal.
For George W. Bush, nothing succeeds like failure.
Karen Dolan is a Fellow at the Institute for Policy Studies in Washington D.C., She also directs the Cities for Progress project there. Email to: firstname.lastname@example.org