Health insurance is the issue
Trailing Democrats by more than 20 points on the issue, Republicans ought to think boldly about health care and recommend truly universal insurance coverage — by making it mandatory and paying for it by capping tax deductibility of insurance premiums. For that matter, it’s an idea Democrats could also support. After the two parties fight about details during the election year, they actually could pass it into law some year soon. The insurance crisis demands it.
Mandatory health insurance — making it like auto insurance in every state — would cover all of America’s 43 million uninsured, lower costs for employers (who aren’t hiring new employees in the U.S. partly because of rising rates) and improve health quality.
Right now, the idea is being promoted by one of the most imaginative think tanks in Washington, the New America Foundation, a veritable font of proposals to reshape politics and the economy for the Information Age and the baby boom retirement era. The foundation’s president, Ted Halstead, estimates it would cost the government $80 billion a year to assure all Americans have health insurance — $10 billion less than Sen. John Kerry, D-Mass., is proposing to cover only 27 million of the nation’s 43 million uninsured.
But Thomas Scully, President Bush’s former Medicare chief, says the cost could be substantially paid for by limiting the tax deductibility of insurance premiums and ending current subsidies to hospitals to treat the uninsured. There wouldn’t be any uninsured.
For Bush and Republicans, the short-term political benefits of the idea are blazingly obvious — it would give them an answer to the Kerry proposal that they don’t now have.
Bush’s current ideas — a tax credit for low-income workers and association health plans for small employers — would cover at most 8 million at a cost of $79 billion over 10 years.
Besides countering Democrats, a universal, mandatory proposal would have an added benefit for the GOP — Republicans could say, as Democrats already do, that lowering health insurance burdens on employers will help create jobs in America.
As The Washington Post reported last Saturday, U.S. automakers pay about $1,300 in employee health costs for each mid-size car they build in America — but practically nothing when they build it in Canada.
The Post’s Kirstin Downey quoted Ford vice chairman Allan Gilmour as saying that high health costs have “created a competitive gap that’s driving investment decisions away from the United States. If we can’t get our arms around this issue as a nation, our manufacturing base and many of our businesses are in danger.”
Under present circumstances, most workers have no choice of health plans and have to accept what their employers give them. Under a NAF proposal, they’d have wide choice and could take their policies with them if they switched jobs.
Average premium costs also would go down because everyone would be in the nation’s insurance pool — including millions of healthy young people who pass up coverage because they don’t think they need it.
Health quality would improve because insurance companies would have an incentive to provide preventative services to keep their patients out of hospitals.
Bottom line: There’s a big, great idea out there that could solve a major national problem. It’s just waiting for a political taker.
Morton Kondracke is executive editor of Roll Call, the newspaper of Capitol Hill.