Another day, another detailed preview of George W. Bush's State of the Union health care proposals. This morning's iteration comes from the LA Times’ Peter Gosselin, one of the best social policy reporters in the country. But even the best reporters are hamstrung and hogtied by demands for objectivity and spacial constraints, so though Gosselin's tour through the proposals is sure-footed and clearly-written, it doesn't offer much in the way of context or analysis. So we'll do that here.
Setting aside the miscellanea of medical malpractice and various portability tweaks, Bush's major proposals encourage the spread of Health Savings Accounts and render most out-of-pocket spending tax deductible (attentive news junkies will note the dissonance with the November recommendations of Bush's tax commission, which sought to limit health care deductions). This is a rethink of the entire health care system: no more risk pooling; instead, you sock away cash in tax-advantaged accounts, spending it only when you get sick. So no (or very low) premiums. But when you fall ill, there'll be no insurance company defraying the costs, not until you've spent $10,000 or so.
The idea here is simple. Conservatives believe Americans have too much health insurance, that they spend heedlessly and wastefully on care, procedures, and medications they would simply forego if insurance plans didn't pick up the tab. Ergo, HSA's, which end risk pooling, forcing care to come directly from pockets. Newly responsible for their medical bills, consumers will be spurred by the Magic of the Market to make smarter decisions, show more prudence, lead healthier lifestyles, smile more often, and smell springtime fresh. It's gonna be awesome.
http://www.prospect.org/weblog/archives/2006/01/index.html#008934
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