February 23, 2004

February 23, 2004 | Commentary on Health Care

Resuscitating Health Care: Bush Plan a Good First Step

What's the best way to help Americans who lack health insurance because they can't afford it? Some say universal health care is the answer. But there's a far better solution, especially for those wisely skeptical of one-size-fits-all remedies from Washington.

It would allow individuals to make their own health-care decisions. It would encourage subsidies for those in need while promoting personal responsibility. President Bush has made it one of his health policy cornerstones, and now, even Sens. John Kerry and John Edwards have included some elements of it in their health-care proposals.

The concept is the refundable health-care tax credit. This is how it would work: The government would provide a credit (i.e., subsidy) for those who need help paying for their health insurance. It would be available specifically for lower-income individuals and families without health insurance. Since it is "refundable," even those who don't owe taxes would still receive the credit. And the credit could go directly to the insurer, eliminating any tax forms and leaving only the balance of the premium (if there is one) for the individual or family to pay.

In the Bush version, this tax credit would be offered to individuals and families without access to health-care coverage through an employer. It would provide for a 90-percent credit that could cover the cost of an insurance premium, up to $1,000 per individual and $3,000 per family. The full credit would be available for individuals making $15,000 and would be phased out gradually and stopped at an income of $30,000. For families, the full credit would be available for family incomes at $25,000 and would also be phased out gradually and stopped at $65,000.

Some may say that the President's tax-credit approach is too small. But polls show that Americans are leery of a costly program for the uninsured. And they don't want a massive upheaval of the health-care system or any disruption for those who have coverage now. Kerry's plan, for example, would completely reshuffle the health-care system and is projected to cost taxpayers $895 billion over 10 years (or $72 billion each year, as estimated by Kerry). Policymakers should have learned from the fate of "HillaryCare" that Americans are resistant to change forced on them by the government.

So while the President's tax-credit approach may be small, it does take the first steps toward an alternative for those who fall through the cracks of the existing health-care system. Other proposals, such as expanding the choice and availability of new insurance products, would also build on the core principles of consumer choice and helping those most in need. So would proposals to give workers, rather than employers, the right to choose what plans are available to their families.

A new health-care system can be achieved over time, with small steps now that set a better course for the future. A future in which government's role is not in choosing or dictating the type of coverage Americans can have, but in helping those who can't get coverage. A future in which individuals wouldn't be shackled to their employers for health-care coverage.

Americans don't rely on their employers to decide their car insurance or their home mortgages. Why rely on their employers for their choices of health coverage? Employers, however, could help make it easier to enroll for health coverage and even offer a contribution on behalf of employees for the cost of coverage.

Gradually creating this alternative to the current health-care system means individuals would have more power to make their own health-care decisions. We could encourage greater innovation in the market to give individuals more say, and therefore more satisfaction in the choices they make. Finally, we would allow for the development of a seamless health-care system in which (regardless of one's job or status) individuals and families would be able to keep their chosen coverage.

Tax credits are the starting point to help us get there.

Stuart Butler is vice president for Domestic and Economic Policy Studies at The Heritage Foundation and Nina Owcharenko is a health-care analyst in Heritage's Center for Health Policy Studies.

About the Author

Nina Owcharenko Director, Center for Health Policy Studies and Preston A. Wells, Jr. Fellow
Center for Health Policy Studies

First appeared in the Philadelphia Inquirer