Bush's 200-word health plan

To say that most conservatives were initially less than overwhelmed with last week’s State of the Union speech (or at least those parts of it devoted to the Bush domestic agenda) is to state the obvious, but like many others they may have focused on the wrong parts of the speech.

It is true that several of the president’s suggestions were goofy or downright wrongheaded and smacked of the sort of thing one got every January from Bill Clinton during his eight years as wonk in chief, but hidden in the saw grass were some ideas that shouldn’t be dismissed as either silly or as “small ball.”

The first and most obvious, of course, was the president’s assertion that he will fight to make his earlier tax cuts permanent. Many big-government types were hoping that he’d just forget about his commitment to letting people spend their own money so that they might spend it instead, but that isn’t happening. In fact, Office of Management and Budget Director Josh Bolten re-emphasized the administration’s commitment to lower taxes as he prepared to testify on the new budget this week, and there is no reason to believe either he or the president is kidding.

Before President Bush took to the podium last Tuesday, the president’s people were suggesting to reporters that he would propose healthcare reforms that could benefit millions of Americans and ultimately transform our healthcare system. The fact that he devoted fewer than 200 words to healthcare and didn’t propose either a Clintonian takeover of the system or commit untold billions of new spending apparently convinced many observers that the pre-speech hype was wrong.

The problem is that in Washington any suggestion that doesn’t involve massive new spending isn’t taken very seriously, but in this instance those who so cavalierly dismissed those 200 words may be underestimating the potential impact of what he so concisely proposed.

Back in 2003, most conservatives rightly opposed that year’s Medicare bill because of the outrageous future costs of the administration’s prescription-drug benefit plan, but the legislation also authorized the creation of limited health savings accounts, for which conservatives had been fighting for years. This, as the president recognized last Tuesday, has opened the door to a new approach to health insurance that could empower healthcare consumers and thus rein in the spiraling cost increases that have characterized it for so many years without the overregulation and one-size-fits-all solutions that were so well typified by the old Clinton plan.

Health savings accounts, or HSAs, are conceptually simple. They allow one to save tax-free dollars in a special account to pay out-of-pocket healthcare expenses up to the point where a high-deductible, comprehensive insurance policy kicks in. Such a policy typically costs substantially less than other insurance options. They also give healthcare consumers more control over what they buy, save them money in the short term and actually allow them to accumulate money in the longer term.

Bush wants to make them more widely available and to let those who opt to open them put more money into them. He would allow such plans to be purchased across state lines and let those who utilize them move from job to job without forcing them to start over or lose their insurance.

What’s more, he wants to give those who buy their own insurance the right to deduct its cost from their taxes — a deduction currently available only to employers who pay for insurance for their employees. The self-employed and small-business owners have fought for this in the name of fairness for more than half a century.

Although only available today in more limited forms, health savings accounts are catching on. More than 3 million Americans already have them, including as many as a million of the previously uninsured.

Opponents of such accounts have always argued that they favor the rich and healthy at the expense of the old, the poor and the sick, but it turns out, according to a recent Blue Cross Blue Shield survey, that this just isn’t the case.

So while Bush’s proposal doesn’t threaten these folks, it could threaten the dreams of those who seek a governmental takeover of the U.S. healthcare system and, in the process, improve the lives of million.

And that’s not “small ball.”

Keene, chairman of the American Conservative Union, is a managing associate with Carmen Group, a D.C.-based governmental-affairs firm (www.carmengrouplobbying.com).