Bush On Health Care: A Farce Or A Force Of Destruction?

Passing the Buck on Health Care

The issues involved in providing health care in our nation has created some very strange bedfellows. Recent announcements by Wal*Mart and one of the fastest growing unions in the world that shared the same goals on providing health care coverage under a model other than the employer-provided insurance model. However, Wal*Mart's interest in changing the model is purely self-serving. It would eliminate a lot of the criticism aimed at the way Wal*Mart has historically mistreated its workers, as well as provide a latent subsidy of its retail efforts in the US.

But the biggest health care surprise was the announcement by President Bush that he was looking at the potential for a national health care program in the State of the Union address. Some of my liberal friends had their jaws dislocated by the mere fact that anyone in the ultra-conservative wing of the GOP would even consider the issue. But those of us with wisdom waited for the other shoe to drop... and it has.

The Bush approach to national health care still promotes the profiteering, gouging and fraud that has been the mainstay of the industry of medicine since just after World War II. The hospitals, doctors, and the insurance companies have all had a turn steering the profiteering ships of medicine. Until the 1970s, when managed care organizations were held up as a godsend solution to the rising costs of medicine, the doctors were is the catbird seat, driving the costs of medicine. In the passenger seat of this drive were the various hospitals, all of which claimed the title of "not-for-profit corporations," which continued to strive for more revenues, research funding, revenue driven programs, and the acquisition of more technology rather than more ability to deliver needed health care.

The fact that managed care approaches have failed miserably in reducing, or even controlling, the costs of medicine is no surprise to anyone that understands human behavior, economic realities experienced by real people, or the greed that possesses the insurance industry. While the theory offered by managed care approaches is sound, the manner of execution has been seriously flawed and driven by greedy corporate types that lack even an inkling of compassion for the human condition. While the movie, "John Q," was a bit of an exaggeration, it does not miss the overall truth of MCO experiences by much.

But the Bush approach to health care is nothing but a smoke screen that will benefit the insurance companies further. Big business is still the focus of the approach and the average American will be getting sodomized in the process.

Given the number of cuts offered by the Bush gang on programs related to health, family stability, and social services, not to mention education, the likelihood of any GOP/Bush-proposed health care plan being effective is almost nil. After all, where will we find the funds for taking good care of our citizens when we have trillions of dollars to spend on, and pay off over the next century, exporting regime change, democracy and fascism? We have to remember where Bush's... er, our... priorities lie.

President Bush’s new budget would extend the administration’s warped priorities deep into the realm of federally supported health care programs. The administration long ago sacrificed any meaningful domestic agenda to finance tax cuts for the wealthy and its reckless war in Iraq. The White House’s reckless determination to make the tax cuts permanent is now driving it to slash domestic spending in health and other vital programs.

Instead of trying to address the underlying problems of escalating health care costs, Mr. Bush’s strategy is to cut services or shift more of the bill to states, health care providers and individuals.

In the Medicare program, which covers health care for Americans aged 65 and over, the administration would find most of its savings by slowing the annual increase in reimbursements for services, forcing hospitals and other providers to absorb the burden. Given Medicare’s precarious financial straits, the package appears broadly acceptable.

The real outrage is that the administration has not proposed comparable reductions in the large overpayments — roughly 12 percent more per patient — made to private managed care plans that enroll Medicare beneficiaries. The budget would also phase out Medicare bad-debt payments, forcing hospitals to swallow beneficiaries’ unpaid bills.

The budget also looks to save money by eliminating inflation indexing so that as incomes rise, so would the number of people required to pay higher premiums. Although this is a sneaky way to raise premiums, it is hard to argue with the notion that better-off beneficiaries should pay more to help rescue a financially strained program.

What seems counterproductive is Mr. Bush’s plan to lower federal matching funds for Medicaid administration — forcing the states to find more of their own funds or sacrifice good management and oversight. More worrisome is his plan to cut back on state programs that insure the young.

The most shortsighted restrictions would come in the highly acclaimed State Children’s Health Insurance Program, which uses federal matching funds to provide coverage for low- and moderate-income children who are not quite poor enough to qualify for Medicaid. The program has been enormously successful in reducing the number of uninsured children. Yet now the administration wants to reduce its matching rate and limit enrollment to children in households earning no more than twice the federal poverty level. That would undercut programs in 16 states that have expanded coverage to children above that level.

Although the administration’s budget would grant the children’s program a small $5 billion increase spread over five years, that’s less than half, and possibly only a third, of the amount needed just to maintain current enrollments and participation rates. This is too high a price to pay for more tax cuts and Mr. Bush’s ill-managed presidency.