Heritage Foundation Leadership for America

It's obvious that today's health-care system -- a patchwork arrangement of public and private care dominated by coverage through one's employer -- needs help. It leaves too many people without basic insurance and even more in fear of losing it.

This won't change, though, until we fix the underlying problems facing the system as a whole -- instead of looking for a quick fix with no lasting benefit.

On the private side, the most important change that Congress could make regards the tax treatment of health insurance. Today, individuals get unlimited tax relief for the value of their health-care benefits, but only if they obtain those benefits through their employer. Those who are unable to get employer-based coverage and must buy coverage on their own -- after rent, food and other financial demands -- enjoy no comparable tax benefits.

President Bush recently proposed giving every American the same tax treatment for buying coverage -- a standard deduction worth $7,500 for an individual and $15,000 for a family. This would be a bold, important step toward curing the basic ills of our health-care system.

On the public side, we should re-examine the role of Medicaid, Medicare and the State Children's Health Insurance Program. These programs are fiscally unsustainable and promise more than they can deliver. Take Medicaid, for example. State budgets nationwide are being drained by this health-care program for the poor. It's the No. 1 item in state budgets, surpassing other critical programs, such as education, law enforcement and transportation. And because of inadequate reimbursement, few health-care providers are interested in participating, leaving families that depend on these programs with fewer providers who are willing to treat them.

The solution is simple: Instead of forcing lower-income families into a second-tier health-care bureaucracy, these programs should provide direct financial aid to enable these families to buy affordable coverage in the private marketplace.

Health care is truly an individual issue, which is why top-down, government-mandated, one-size-fits-all solutions won't work. People have different preferences about the treatment they receive, and they value that care in different ways. That's why we shouldn't have employers or bureaucrats in charge of such personal decisions.

If Americans want a better system, they ought to embrace one that empowers individuals to govern their own health-care decisions, creating a market that will respond according to their needs, not the bottom line of government or employers.

Nina Owcharenko is a senior analyst in the Center for Health Policy Studies at The Heritage Foundation.