Experts Offer Examination of Bush Health-Care Plan
TONY COX, host:
From NPR News, this is NEWS & NOTES. I'm Tony Cox in for Farai Chideya, who's on vacation.
President Bush vows his plan to provide health care for 47 million uninsured Americans is a bold new step in the right direction. In essence, the plan promises to give tax breaks to those who buy health insurance on their own. It would also tax those who do not.
But critics say the president's proposal is dead on arrival and does nothing to make health care available to everyone. So what is the best remedy? And how will those who can't afford coverage get it without going broke?
Two public policy experts will weigh in. Joseph Antos is the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the American Enterprise Institute, and Dr. Ivan Walks is chief executive officer of Ivan Walks and Associates and the former chief health officer of the District of Columbia.
Mr. JOSEPH ANTOS (Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute): Welcome.
Dr. IVAN WALKS (CEO, Ivan Walks and Associates): Good to be here, Tony.
COX: Before we get in to the specifics of the president's plan, let's do this. It's hard to separate the medical aspects from the political and financial ramifications of providing health care. Some would say it's impossible, but let's try. With cost as a reasonable factor, what kind of coverage should be made available to achieve the maximum medical benefit? Dr. Walks, you first.
Dr. WALKS: If we're going to look at achieving the maximum medical benefit, then we have to look at early and preventive care. We focus a lot in our current health care system on high-end care, and we do a great job after someone is very sick in helping them to recover some semblance of health or in prolonging their life.
As a matter of fact, life expectancy continues to increase in America. The problem is, we don't have a healthier country. So cost effectiveness would go towards early and appropriate care.
COX: Joseph Antos, what do you say?
Mr. ANTOS: I - of course, I agree with Dr. Walks. In addition to those high-cost patients, we need to do a better job of managing their care. There's a lot we don't know about treating high-cost patients in the most efficient and effective way, and we need to work on that.
COX: Well, let's talk now about the president's plan. There are two big aspects of that plan to re-jigger tax deductions for health insurance. One, he wants to remove the tax-exempt status of employer-sponsored health insurance and treat it as income. And number two, beginning in 2009, he wants to give a tax deduction to people with health insurance of $7,500 for an individual income tax filer and $15,000 for a couple filing jointly. Let's break it down, Joseph Antos. What basically does the president's health care plan seek to accomplish and what do you make of it?
Mr. ANTOS: Well, I think it has several goals. First of all, the current system, which provides much greater tax benefits to people with higher incomes and good jobs and expensive health insurance and essentially nothing for low-income people and workers who can't afford to buy health insurance, it levels that out. It makes it more fair.
Right now, we have higher income people receiving tax benefits that are essentially paid for by low or middle class workers. So that's going to be adjusted in way that I think will promote more workers getting health insurance, but will not in fact force higher income people to make decisions that they don't want to make.
COX: Dr. Walks, we've had employer-supported health insurance for workers for years, but it seems, at least from my reading of the president's proposal, that he would like to move away from that system. Is that your interpretation, and is that a good idea?
Dr. WALKS: Well, that is my interpretation. And I'm not sure that it's a good idea. In fact, what we - what I think it really says is that the president wants us to move towards individual choice and folks deciding what's the best care, making decisions about how they spend their money.
I don't know that we have a lot of evidence that if you give folks who don't have a lot of money to spend the choice between spending that money on food, shelter, et cetera, and buying health insurance that they will do that. In fact, with the tax deduction, it will absolutely favor those who have higher incomes over those who have lower incomes.
And probably the most concerning thing is that of the 47 to 50 million people who we believe are uninsured, it will put only a very small dent in that uninsured population and encourage them to get health insurance. So I think that we can look for some ways to make this better.
COX: Let me bring up a term that has been used a great deal with regard to health care, and I'm not sure how many people really understand what it means. And I include myself in that group. The term is universal health care.
Now we've heard Senator Hillary Rodham Clinton say recently that she will take on health care again, despite the political problems it caused her in the 1990s. She says that she would soon propose a plan about how we get to -there's that word again - universal coverage.
Now we've also seen Illinois senator - and expected presidential candidate -Barack Obama push for universal health care. And it seems to mirror an initiative proposed back in 2004 by vice presidential nominee John Edwards.
So here's my question: What are the dynamics of universal healthcare, and how would you compare it to the Bush proposal for reform? Joseph.
Mr. ANTOS: Universal health care is a loaded term. As the state of Massachusetts or the state of California are attempting to prove to us, you don't necessarily need a 100 percent government program in order to assure health insurance for everybody in their states. And the same lesson I think can be learned for the United States.
We have a mixed system now, and the question is how do we make it better. Those who argue for universal health care in the most extreme form are really talking about a government single-payer system. That is to say, the government makes the decisions. There's one type of health plan. And while that offers the promise of full coverage for everybody, in fact the reality that we've seen in Europe, in Britain in particular, is that the disparities in health treatment that we now see among lower income people, among minorities and so on, those types of problems persist in those universal health care systems.
COX: We have less than a minute left, Dr. Walks, for you to chime in on your interpretation of what universal health care actually means.
Dr. WALKS: I think Mr. Antos just did a wonderful job in explaining it. I want to muddy the waters a little bit. We're talking universal health care. What we really mean is universal health coverage, where everyone has access to health care. Universal health care would mean that we would be more aggressive in getting out into our communities and do what's called social marketing to help people to focus on health maintenance and maintaining the kind of health that many of us start out with.
So the coverage is one piece. And all of the things that were just explained are right, including the fact that just doing it doesn't give us a healthier lower income and those at highest risk, as we find in England. I've done some studies over…
COX: I'm sorry, Dr. Walks, we going to have to stop, because our time ran out. I apologize for that. Joseph Antos is a health care and retirement policy expert at the American Enterprise Institute in Washington, where he joined us. Dr. Ivan Walks, chief executive officer of Ivan Walks and Associates.
Gentlemen, thank you very much.
Mr. ANTOS: Thanks for having us.
Dr. WALKS: Thank you.