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Bush's flawed health care plan

There are times when the president of all the people sounds more like the mouthpiece of the few. George Bush's unveiling of his health care "reform" plan was such an occasion. He clearly thinks it is more important to spare pain to the private medical-insurance complex than to remedy the glaring inequities of the American health-care system. This isn't conservatism. It is individualism run wild.

All three major features of the president's plan strike glancing blows, at best, at real problems. The working poor, who generally pay no taxes, would be eligible for health-insurance vouchers, worth up to $3,750 per family, exchangeable for private coverage. But in many urban areas the cost of health insurance is much higher. Who covers the gap? The government? The insurance companies, that is, other policyholders?

At higher income levels, up to $80,000 a year in family pay, buyers of insurance would enjoy deductions on a sliding scale. But the cash value of these deductions ranges from modest to slight.

Under the president's plan, small businesses which now cannot buy health insurance for employees would be encouraged to pool their needs with other small companies in "health insurance networks." But even for very large firms, depending on their location and the ages of their work force, the cost of health insurance coverage has been rising unmanageably. So what is the advantage of these networks? The idea smacks of PR.

Finally, the Bush program promises gestures of cost containment. In fact, the virtually uncontrolled inflation of health care costs inAmerica ($665-billion in 1990, or more than 12 percent of GNP) typically runs 6 to 8 percentage points a year above the basic rise in the cost of living. At that pace the total price tag is doubling about every decade. This inordinate rise of costs is clearly tied in with the patchwork private insurance system, with its large administrative overhead.

American health care is indeed excellent in some ways, especially for those who find cost no object. U.S. medical scientists and researchers consistently outrun others at winning Nobel Prizes and advancing the frontiers of discovery. But when it comes to basic care (beginning with infant survival) the picture is far less commendable.

Many Americans are uncared for, and even Americans of substantial means face hazards that citizens of other advanced industrial societies need not worry about _ ruinous, bankrupting medical bills; the abrupt and arbitrary cancellation of insurance policies; the loss of coverage with job changes. And underlying the whole sorry business is the demeaning suggestion that decent health care, at an affordable price, is not a civilized right (unless you're old and retired, and sometimes not even then) but a privilege deriving from the charity and good nature of medical professionals and insurers. And this is the system that President Bush would simply tidy up at the edges.

American individualism serves us well, by and large. But when it comes to health care, it is not an acceptable paramount value. When he makes himself the uncritical spokesman of that individualism, the president is making himself more the apologist of special interests than the protector of the public interest.

Washington Post Writers Group

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