Nothing made more of a difference to the
political fortunes of George W. Bush during the election campaign then
his ability to stake out a credible position on health care. Clear and
well-thought-out alternatives on prescription-drug coverage, Medicare
reform, and health-care coverage for the uninsured helped reverse a drop
in the polls and allowed Bush to pull even with Gore.
As president, nothing will be more important to his ability to govern
then staying the course on health care by developing and implementing
the policies he proposed in the campaign and building on them with
significant executive actions. Health care will continue to be an issue
of great concern to constituencies that hold the key to the control of
Congress in 2002. Beyond Medicare and prescription-drug coverage, Bush
will have to come up with and pay attention to other health-care
concerns that will be on the minds of voters in the years to come,
especially those that may weigh most heavily during the time of an
economic slowdown.
Democrats will not cede control of the health-care issue to the new
president. They will still push for price controls on prescription
drugs, a huge new prescription-drug entitlement for all seniors. They
will seek to embarrass Bush on children's health-care coverage by trying
to spend more money on children's health insurance. Meanwhile, the major
health trade groups, the Health Insurance Association of America, the
American Association of Health Plan, the American Medical Association
and the American Hospital Association have bought into a proposal being
pushed by liberal foundations and interest groups that would essentially
kill the private insurance market by using tax credits to move people
without insurance into Medicare or Medicaid.
And for better or worse, he does not have many reliable allies in
advancing an agenda of his own. Despite having a majority, congressional
Republicans did little to shape the party's health-care program. They
lacked interest, treating health care like it was phys ed class and
never displayed or sought to acquire the expertise and tenacity the
Democrats and their interest-group allies have always demonstrated when
it comes to the subject.
Further, Republicans have never been proactive about health-care
reform even when there have been Republican presidents. At the heart of
the GOP drift is a complete lack of interest in the dreary details of
making health care actually work for people. Most of the time,
Republicans merely mumble the word market forces and walk away from the
process of legislating and governing.
President Bush put together a credible health-care agenda during the
campaign. The question is, will he put together a team, consisting of a
Secretary of Health and Human Services and domestic-policy advisers in
the White House who, like their Democrat counterparts, are passionate
about health care, who have actually been involved at the policy and
governing level in actually managing the programs that need to be
reformed. More important, will he put together a team that will not cave
in to the liberal measure of what constitutes "good" health care, which
is always more coverage, bigger programs, no matter the quality of care,
no matter if people use the programs or not.
Ultimately, the president will be the one who will have to push
changes in Medicare and health-care markets through a reluctant
Congress. He will have to overcome resistance from Democrats who will
want to make populist resentment an issue and the reluctance of
congressional Republicans to do anything but what Democrats and the New
York Times make them feel guilty about.
Bush can change all this. He can draw on the policy team he put
together during the campaign and have them develop health-care
initiatives that he can implement through regulatory reforms and
executive actions in such areas as Medicare reform, children's health
insurance, reducing the cost of health care and breaking down barriers
that exists to breakthrough drugs that now exist in several federal
programs. The president-elect will have to lead by example and pre-empt
Democrat efforts on the far left to force Americans in Medicare and
Medicaid as the insurer as a first resort. (As government takes over
more control of health-care dollars, the number of people with health
insurance declines.)
In the process, he will have to work with the private sector and
governors to create other options for saving and investing in
health-care coverage. At the same time he will have to be sure that his
proposals, which will always be attacked by a steady stream of reports
from liberal think tanks and foundations such as Families USA, Kaiser
Family Foundation and the Commonwealth Fund, works closely with more
objective health economists to get the word out about the costs and
benefits of price controls on drugs and paying people to leave private
health plans and join government financed programs. And he shouldn't
depend on congressional Republicans to take the lead. On the contrary,
it will be up to the new president to lead the Republicans and
mainstream Democrats to a new day of common sense health-care reform in
America.
This is a lot to do, but Mr. Bush really has no choice. His political
fortunes sank and rose with his response to the public's concern about
health-care issues. They will continue to do so as president. Arguably,
his health-care policy decisions, starting with who he appoints as
Health and Human Services secretary, will have more impact on his
political effectiveness than any other. Failing to appoint a HHS
secretary with a strong health-care track record would not bode well for
his new administration.
Indeed, Bush will need a strong team to help him create a strong
executive track record on health care and flesh out the initiatives he
will put before Congress and the American people. And he will need to
constantly refute the propaganda that will flow from the left about the
need for greater government control over prescription-drug coverage and
health insurance.
By taking health care seriously the new president will take a
significant step towards increasing his own political influence and
popularity. More so than in any other endeavor he may undertake, good
policy in health care will be good politics. Ignoring health-care policy
or ceding it to Congress is tantamount to placing his political future
in the hands of the opposition.
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