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Jewish World Review April 17, 2001 / 24 Nissan 5761

Morton Kondracke

Kondracke
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Consumer Reports


Congress Should Boost Bush
Budget For Health Programs


http://www.jewishworldreview.com -- PRESIDENT Bush may go down in history as an education president and a tax cut president, but he won't make it as a health care president without pressure from Congress.

Bush's new budget contains some worthy health initiatives, but it's woefully unambitious and underfunded in two major areas: aiding the uninsured and providing a prescription drug benefit for Medicare recipients.

One way in which Bush has shown vision is with his proposed 13.5 percent, one-year increase for the Agency for Healthcare Research and Quality, which is on its way to giving health care providers, consumers and policymakers accurate data on treatment outcomes, costs and provider performance.

Bush also deserves credit for a patients' rights proposal that offers an independent review of HMO coverage decisions and a right to sue, but caps legal damages to keep insurance rates affordable.

Moreover, he has proposed a $2.7 billion increase for the National Institutes of Health - although the Senate saw fit to raise that number by $700 million in order to stay on track to double the medical research budget by 2003.

However, Bush's health budget, like his proposals for energy funding, transportation and non-medical research, demonstrates the effect of trying to hold down spending to make room for his $1.6 trillion, 10-year tax cut.

Originally, Bush's Office of Management and Budget called for slashing support for pediatric teaching hospitals from $235 million last year to just $40 million. Health and Human Services Secretary Tommy Thompson fought for and won $200 million, but that still represents a cut.

Much more dangerously from a political standpoint, Bush's budget calls for a mere $156 billion over 10 years for a prescription drug benefit and reform of the Medicare system. Last Friday the Senate voted to establish a "reserve fund" of $300 billion for prescription drugs.

Democrats also attacked Bush on the grounds that he plans to pay for the drug benefit out of Medicare surpluses - rather than by reducing the tax cut - which would hasten the time when the Medicare system goes bankrupt.

Bush argues that his forthcoming reform plan for Medicare, creating incentives for seniors to enter managed-care plans, would extend its solvency. The President also intends to reshape the overstressed Health Care Finance Administration, which runs Medicare.

Still, no expert believes that the amount he budgeted for Medicare is anything close to adequate. Rather, it is thought that the figure was mandated to make room for his top priority, the $1.6 trillion tax cut.

For the nation's 42.5 million uninsured, Bush is proposing a one-year increase of

$124 million for community health centers to provide primary care and preventive services for about 11 million people, about 4.4 million of whom are uninsured.

For the long run, however, Bush is calling for tax credits worth only $71.5 billion over 10 years, which would help fewer than 5 million people - and only those whose employers do not provide insurance.

During the budget debate, the Senate approved another $7 billion, but it has the opportunity to pass a bipartisan proposal - admittedly expensive - that would cut the ranks of the uninsured in half.

Originally put forward last year by the "New Democrat" Progressive Policy Institute, the $400 billion plan has been introduced by Sens. Jim Jeffords (R-Vt.) and John Breaux (D-La.), with Sens. Bill Frist (R-Tenn.), Olympia Snowe (R-Maine), Tom Carper (D-Del.) and Blanche Lincoln (D-Ark.) as co-sponsors.

Unlike Bush's proposal, the Jeffords-Breaux measure would provide tax credits to help lower-income workers participate in employer-provided health plans, thereby encouraging the employers not to drop coverage.

As first described by columnist Matthew Miller, the concept behind the proposal is a amalgam of the traditional liberal idea of eventual universal health coverage and conservatives' refusal to put the government in charge of health care.

Bush, the New Democrats and the Jeffords-Breaux group all accept the idea of tax credits as the vehicle for expanding coverage. In fact, one of Bush's new White House health advisers, Mark McClellan, formerly of Stanford University, helped draft the Progressive Policy Institute proposal.

That plan also calls for the creation of voluntary purchasing groups to bargain with insurance companies, state oversight of the plan and retention of existing "safety-net" programs, such as Medicaid and the Children's Health Insurance Program.

An ABC News poll released this week reveals that by 52 to 42 percent, adults prefer providing health care coverage to the uninsured to receiving an income tax cut.

That indicates that Congress would be on safe ground shifting Bush's priorities - and that he'd benefit by this action. In fact, the Senate began that procedure by shaving his tax cut by $400 billion and applying the money in part to health care. The House should go along.



JWR contributor Morton Kondracke is executive editor of Roll Call, the newspaper of Capitol Hill. Send your comments by clicking here.

Up

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