Bush promotes health care proposals

Initiatives that encourage U.S. residents to purchase health insurance through the private insurance market are the best way to expand coverage and reduce health care costs, President Bush said Thursday while visiting a Missouri hospital to promote the health care proposals he outlined earlier this week in his State of the Union address, the Washington Post reports (Fletcher/Lee, Washington Post, 1/26).

Speaking to an audience at St. Luke's Hospital East in Lee's Summit, Mo., Bush said, "We believe the private sector is the best delivery of health care." He added, "We know there's a role for the federal government, but it's not to dictate, it's not to be the decision-maker" (Helling, Kansas City Star, 1/25). Bush earlier this week announced two health care proposals, including one that would offer a federal tax deduction of $7,500 for individuals and $15,000 for families who obtain health insurance on their own or through an employer, regardless of the cost of the coverage. The proposal would for the first time levy a tax on the value of employer-sponsored health insurance in some cases. Currently, most employees are not taxed on the value of their employer-sponsored health insurance. Under the proposal, individuals and families with employer-sponsored health insurance plans worth more than the proposed allowable deductions would pay taxes on the difference. The deduction would be available to all individuals and families who purchase health insurance, regardless of the value of their policies or whether they itemize deductions on their tax returns. For U.S. residents who receive employer-based health insurance, the deduction would be offset by the cost of their coverage. The proposal would pose no net cost to the government over 10 years, according to the administration. Bush in the State of the Union also advocated redirecting portions of existing federal funding to create "Affordable Choices" grants that would give states more flexibility to expand health insurance (Kaiser Daily Health Policy Report, 1/25).

On Thursday, Bush said his proposals are part of a larger strategy that would control health care costs and expand access to health insurance through private sector forces, better technology and changes to existing government programs. "The best way to do that is through private health insurance," Bush said, adding, "Therein lies part of the debate we have in Washington" (Washington Post, 1/26). Bush said, "If you work for a company, you get your health care free, in essence. It's part of the benefits package." He continued, "If you're a stand-alone person, you pay your health care on an after-tax basis. In other words, there's discrimination in the tax code based upon who you work for. It makes it harder for individuals or small-company employees to be able to buy health care" (Reynolds, Los Angeles Times, 1/26). Bush said his tax proposal "helps people be able to afford private health insurance, and that is really the crux of good health care." Bush said his proposals would "level the playing field, from a taxes perspective," and "encourage more consumer involvement in order to hold down costs" (McClatchy/Dallas Morning News, 1/26). Bush said, "There is no question in my mind that a proper role for the federal government is to help the poor and the elderly and the diseased get health care. We'll do that." He continued, "If people in Washington are serious about dealing with the uninsured, here is a serious idea for them to consider." He added that the plan's opponents are "just dismissing things because of pure politics; we have put forth ideas that are worthy of debate and we believe will work" (Washington Post, 1/26). "I know Americans expect that the United States Congress will take a look at all ideas," Bush said (Rutenberg, New York Times, 1/26). During his visit, Bush also toured St. Luke's facilities and discussed health care information technology. "Medicine is finally catching up with the rest of America in terms of information technology," he said (McClatchy/Dallas Morning News, 1/26).

Prospect for Proposals
The Post reports that congressional Democrats so far have given Bush's tax proposal "the cold shoulder, characterizing it as a tax on the middle class that would do little for the uninsured" (Washington Post, 1/26). Some Democratic leaders have called Bush's proposals "all but 'dead on arrival'" to Congress, although White House aides have said that response from some Senate Democrats has been more positive than from House Democrats, the New York Times reports. White House aides plan to pressure congressional Democrats to address the proposals "by accusing them of turning their backs ... before truly considering them," according to the Times (New York Times, 1/26). White House spokesperson Tony Fratto said, "The American people are rightly concerned about any plan that will put the government between patients and their doctors," adding, "Good ideas that avoid that pitfall will have a chance to prevail."

Additional Comments
Senate Majority Leader Harry Reid (D-Nev.) said in a statement that Bush's proposal would "prompt employers to stop offering health care." Sen. Barack Obama (D-Ill.) said the proposal was a "halfway measure" that would do "little to bring down costs or guarantee coverage" (Jackson, USA Today, 1/26). Senate Health, Education, Labor and Pensions Committee Chair Edward Kennedy (D-Mass.) said, "I find the plan troubling because it does nothing to help people get insurance, hurts those who already have it and provides a tax break that benefits the wealthiest Americans." Joseph Antos, a health economist at the American Enterprise Institute, said, "The truth is that policy wonks have been talking about this for well more than 20 years, but politicians generally look at it and say, 'This doesn't look like a good deal for me'" (Washington Post, 1/26). Karen Davis, president of the Commonwealth Fund, said, "I definitely think it is fiscal relief" for people in the individual insurance market, but she added that savings would vary among people with employer-sponsored coverage (AP/Richmond Times-Dispatch, 1/26). Davis said, "We've got a mixed public-private system, and I think most people want to stick with it" (McClatchy/Dallas Morning News, 1/26). Merrill Matthews, director of the Council for Affordable Health Insurance, said the tax proposal was a "bold and innovative step" that would help reduce disparities in the tax system (Struglinski/Collins, Deseret Morning News, 1/25).

Broadcast Coverage
Two broadcast programs recently reported on Bush's proposals:

• PBS' "NewsHour With Jim Lehrer": The segment includes comments from Margaret Warner, senior correspondent for "NewsHour"; Susan Dentzer, health correspondent for "NewsHour"; Sara Rosenbaum, chair of the Department of Health Policy at the George Washington University School of Public Health; and Grace-Marie Turner, president of the Galen Institute (Warner, "NewsHour," PBS, 1/25). Audio of the segment is available online. A transcript of the segment also is available online.
• NPR's "All Things Considered": The segment includes comments from Julie Rovner, a health policy correspondent for NPR; Bush; Obama; and Sen. Hillary Rodham Clinton (D-N.Y.) (Rovner, "All Things Considered," NPR, 1/25). Audio of the segment is available online.