In the 1987 movie The Untouchables, Sean Connery plays a veteran Chicago Irish cop known as Malone who winds up as reluctant mentor to Treasury agent Eliot Ness, portrayed by Kevin Costner. Ness burns to end Al Capones reign of terror, but lacks sufficient drive and skill to get the job done.
What are you prepared to do? asks Malone, who then instructs Ness on hardball law-enforcement tactics that are barely lawful. Ness takes the advice and winds up crushing Capone, although at considerable psychic cost.
Watching President Bushs State of the Union address last week, I was struck by the similarity in predicaments. Lets take it as our premise that Mr. Bush is sincere and really wants to solve the underlying problem in healthcarehelping expand coverage to the 46.6 million Americans who lack it. Listening to his proposals, however, made me think that he isnt really prepared to do what needs to be done.
His basic planspeaking of premisesis based on the idea that health insurance lies outside the grasp of many Americans because other Americans have generous plans. People with gold-plated plans, as Mr. Bush stated it in an earlier address, are driving up the cost of insurance for everyone else. This hardly seems to be the central problem with the U.S. healthcare system, which is also influenced by technology, provider fees and uneven risk pools.
The president proposes to give everyone a standard tax deduction for health insurance. But people with employer-sponsored health insurance would have their employers contribution counted as taxable income. This creates an incentive for companies to drop employee coverage, especially in places where premiums are high, where workers are older or in small businesses. Creating a disincentive for corporations to provide coverage seems unwise at this point.
Moreover, the tax benefit wouldnt do much for low-income Americans. For people who dont make much money, a tax break is worth very little and certainly not enough to buy a decent policy. That is to say, buy a policy if they could get one.
Anyone who has shopped for nongroup insurance will tell you its easier to win the lottery than get a policy, let alone a good one. Private insurers want to screen out anyone who might actually file a claim. If they do offer a plan, its at a prohibitive price and unlikely to cover much beyond hangnail removal. Mr. Bush has not indicated that he is willing to force insurers to cover all people who want policies and at a price they can afford.
Beyond the tax proposal, Mr. Bush restated his support for health savings accounts and association health plans. Both of those, as discussed on this page, have considerable deficiencies and are unlikely to make a serious dent in the ranks of the uninsured. Again, tax changes wont help people with little money. Giving people coverage that may be substandard will only leave them with huge out-of-pocket costs.
And providers are understandably worried about changes that might leave them on the hook for bills patients cant pay.
Mr. Bush so far has shown a willingness to embrace only proposals that fit with the most rigid solutions of the market-oriented think tanks. Unfortunately, he is faced with a new Congress that has different ideas. Most Democrats and many Republicans oppose his plan. If a spirit of bipartisanship is to prevail, as Mr. Bush has called for, then its time for the president to negotiate over his plan with the other branch of government. Its time for all sides to give a little, and that includes providers and insurers.
The questionfor everyoneis what are you prepared to do?