In a state with one of the nation's worst public-health records, Bush might have used the surplus to deal with stubborn problems:
* Of the 50 states, Texas had the second-highest percentage of adults and children who lacked health insurance. Only Arizona's percentage was higher, according to 1998 figures by the Kaiser Foundation.
* More than 27 percent of adults ages 19 to 65 lacked health insurance compared with about 20 percent nationwide.
* Nearly four of 10 children from low-income families were uninsured.
Bush could have made things better. He could have opened the doors of Medicaid to the hundreds of thousands who are eligible but not enrolled largely because the state's eligibility program is overly cumbersome. Texas is one of the few states that still requires face-to-face interviews with applicants, who typically work.
Instead, on health care Bush was largely silent. Until his presidential campaign, Bush made just two speeches dealing with the topic of health -- in 1995 and in 1998. (Those were to trade associations.) In his 1999 state of the state address, he spoke about fixing courthouses, but said nothing about the CHIP program the Legislature would be considering in the 1999 session to cover uninsured children of the working poor. He never mentioned the 1.4 million children from families too rich for Medicaid but too poor for private insurance coverage.
It was a telling time, his silence on the issue, considering his forceful and welcome stance on getting children to read on grade level by third grade or extending quality education to children stuck in low-performing schools. For such goals to be achieved, children need to arrive at school healthy and ready to learn. In the end, from the statehouse to the White House, compassion has to mean more than words. In the end, Bush's health-care plan requires a more generous tax subsidy for low-income workers to afford health coverage that is out of reach today and not likely to be affordable tomorrow despite the candidate's compassionate words." --Austin American-Statesmen Ediorial, 4/14
"The key element in the new Bush plan is pretty simple. He would give a tax credit worth up to $1,000 to uninsured individuals to help defray the cost of health insurance. Families would get up to $2,000. This means, Bush says, that a family earning $30,000 a year could buy $2,000 worth of health insurance for only $18.50 a month. Great, but where's a family going to find such a plan? On average, families buying their own insurance pay more than three times as much. So even with a $2,000 tax credit, it's a safe bet that relatively few $30,000-a-year households would be able to scrape together the extra thousands." --USA Today
"Families USA executive director Ron Pollack says that a typical family health plan costs $5,000 to $6,000 a year and even with the $2,000 tax credit, that leaves a $3,000 to $4,000 balance that won't be picked up by employers and would be unaffordable for low-wage families. To many health-care advocates, Gore's proposal looked paltry when set beside former Sen. Bill Bradley's plan for getting to universal coverage quickly. But if forced to choose between Bush's plan and Gore's plan, they will side with the vice president. Beyond the issue of how many people would be covered under each plan, Brookings Institution senior fellow Henry Aaron worries that Bush's plan might erode the employer-based coverage by creating a shift toward individual coverage. "If we unwind the system of workplace-based coverage, short of having subsidies larger than anyone is talking about, then we'll discover at the end of the day that we have fewer people insured than more," Aaron contends. Since companies buy health insurance policies in bulk, the process keeps costs down, Aaron said. Without that buying power, the individual market has more overhead and administrative costs." --Salon, 4/14
Another Bush Plan For The Poor Goes Up In Smoke. Part of Bush's "New Prosperity Initiative" for the poor is the plan to get them into college by having special education bank accounts set up in which an individual could deposit up to $300 a year into the account and use that amount as a tax credit, with the bank matching the deposit. While Bush hasn't accounted for where the bank will get the money to match the poor person's deposit, the real kicker is how long it would take the individual to earn 4 years of college for his new-born son or daughter. "At that rate, saving enough for a semester of college could take 20 years," reports Cox News. Gee, thanks, Mr. Bush.
"These are his priorities: Gov. Bush has proposed about $15 in special-interest tax schemes for every $1 of health care investment. What's the priority? Gov. Bush has proposed about $100 in special-interest tax schemes for every $1 in education investment. What's his priority?" --Al Gore, 4/13
BUSH HEALTH PLAN TOO EXPENSIVE FOR UNINSURED POOR.
John Goodman, president of the National Center for Policy Analysis, a conservative research group, has helped numerous GOP lawmakers craft health care tax credits, and now he's done so for Republican presidential candidate George W. Bush. An estimated 44 million Americans don't have health care insurence, and Bush has implied that his new health care plan will cover those people, but that's far from the truth. An analysis indicates that those uninsured earning under $40,000 will remain uninsured and will have to depend upon questionable, congested, expensive, and inadequate emergency room access for their health care needs.
"Under Bush's plan, poor families earning up to $30,000 would get tax credits for buying private health insurance," according to an AP story. "The aim is to give them the freedom to choose their own coverage and provide tax relief to families that have already bought private insurance, said Goodman, who has helped GOP lawmakers craft similar tax credit proposals. He estimates that the $2,000 credit would cover about half of what a family would spend to buy a basic health insurance policy from a private insurer."
The problem with Bush's plan is that research suggests his health care proposal would not work, even if he had enough money to administer it, which he doesn't. "Coverage for a family costs at least $6,000 a year. At that rate, families earning $30,000 would have to spend $4,000, or more than 10 percent of their earnings, to buy insurance. Karen Davis, president of the Commonwealth Fund, says studies show that people won't buy health insurance if their out-of-pocket costs exceed 5 percent of their income. "This is really not affordable for anyone below $40,000," said Davis.
Once again, we have a Bush plan with weasel words. "Goodman said those who don't buy insurance will be taken care of by "safety net" providers such as public hospitals and free health clinics. He said that Texas families who have no insurance get about $4,000 of free care from these providers each year. Yet studies have shown that many safety net providers have curtailed services and are under severe financial strain because of budget cuts and the loss of paying patients to private hospitals and clinics."
Bush should know by this time that whenever he alludes to his Texas record to prove his point, he's probably in trouble. In this instance what conservative adviser Goodman calls "safty net providers" is what Bush's Commissioner of Health Care, Dr. William Archer, calls "emergency rooms." Dr. Archer is presently under fire for Hispanic slurs he made in relation to comments about the uninsured poor. As for using emergency rooms to treat the uninsured poor, the NYT's Bob Herbert believes that " Dr. Archer's easy acceptance of this wretched method of delivering health care mirrors that of Governor Bush. Referring to a hypothetical uninsured mother of two, the governor said in a television interview last month: "She's got accessibility, in my state at least, to health care in emergency rooms and clinics." He admitted that wasn't the "most affordable" or "the smartest way to run a health system." But it was, you know, access."
"Answering a question about health care on a Fox News program in January, the governor said: "You go to emergency rooms in my state. . . . They're full of people. They're full of people. There's access." Mr. Bush said affordable insurance was his health care goal, his "mission," but he saw the crowded emergency rooms in Texas as proof that his constituents already had access to health care. This is not good. The governor appears to be clueless about health care, both unaware and unconcerned." Yet, Bush says his new health care plan will provide insured coverage for the poor. This is not true.
Because Bush doesn't have enough money to finance it. George W. Bush's proposed $4.3 billion tax credit for the poor to buy helth insurance will fail because the money isn't there, and Bush and his advisors know it. What voters who need health care insurance will be faced with is voting for Gore, who plans to set aside enough money in the federal coffers to finance an adequate plan, or voting for Bush, who plans to provide an anti-federal philosophy rather than the needed cash. As conservative economist and Bush adviser Grace-Marie Arnett put it the other day, "The visions are very different. It sets us up for a good policy debate." One suspects most of the uninsured poor will shout, "Show me the money!" So why isn't Bush coming across? Because he's spent most of his proposed budget on tax cuts, 60% of which will benefit the top 10% of the population, Bush's well-off backers. It's the same thing he did as governor of Texas, so we shouldn't be surprised.
But it isn't as though Bush's health care advisers didn't try. "The strains are rippling through the Bush camp," reports the Wall Street Journal. "Developing a health-care policy was a long and turbulent process, involving numerous advisers with competing points. Last week, the campaign was considering a tax credit half as generous as the one unveiled Tuesday. More low-income health initiatives are expected when Mr. Bush tours a St. Louis community health clinic" today. However, it's all smoke and mirrors, as the Bush economists know. Most of the money has already been spent on tax cuts, so 50% of nothing is still nothing. But don't take our word for it, let's look at the numbers.
In order for the Bush budge proposal to work, we're asked to believe that the federal government is able to collect substantially less taxes, give back the lion's share of the surplus collected in the form of tax cuts, and still launch new, costly programs. "Budget projections of the nonpartisan Congressional Budget Office also show why fitting health care into the Bush budget is a squeeze," opines the WSJ. "The most commonly accepted CBO projection, which assumes no new programs or tax cuts and builds in increases only big enough to maintain programs' current services, forecasts a $3.2 trillion surplus through fiscal 2010. Of that, $2.3 trillion comes from Social Security taxes that both parties now agree won't be touched for other purposes. That leaves $893 billion. But Mr. Bush's tax cuts, which mainly would replace the current five-tier income tax rates with four lower rates, would reduce revenue more than $1.3 trillion over 10 years."
The Bush financial shell game of using CBO budget projections which are based upon non tax cuts and no new programs and then going beyond the projections is predicated upon assumptions that fly in the face of historical fact. "Mr. Bush typically uses the $483 billion, five-year cost projection for his tax plan, but that understates the price tag since the tax cuts aren't fully effective until after 2006. Still, the $483 billion is $236 billion more than the CBO figure suggests will be available in non-Social Security surpluses. Both Mr. Bush and the GOP Congress rely on a second CBO estimate showing bigger federal surpluses ahead, yet that figure assumes the president and Congress will abide by spending caps set in 1997. They haven't done so yet, and both sides concede they won't this year again."
Now we come to Bush's version of Reagan's "trickle-down" theory. "At the same time, the booming economy has caused the CBO to underestimate recent years' surpluses; the Bush camp insists that Mr. Bush's tax cuts will stimulate so much economic growth that more revenues will flow into the Treasury....Still, the CBO projections show why budgeting for health care is a tight fit despite the economic good times. Moreover, it isn't only health programs that Mr. Bush is trying to squeeze in. In recent days, he has proposed two education-spending increases, bringing his education total to about $19 billion over five years. He has called for $20 billion more over five years for defense research and development, and $1 billion more annually for a military pay raise."
Here's where we are to date, then. With Bush spending most of his budget money on tax cuts and with the Gore-Tex promise to protect Social Security, there isn't enough money available to fund the governor's health care proposals, his education plan, and all of his other more "compassionate" programs that he claims separates him from those other Republicans. Further, his optimistic surplus projections are based upon faulty assumptions and his "trickle-down" approach to the poor has been found to be a sham a long time ago. Even his father has admitted that. The only unknow in this equation is what Bush plans to propose as spending cuts, but any reasonable observer knows that there are no possible spending cuts deep enough to cover Bush's pie-in-the-sky budget even if, as he said in one debate, he planned to "make the pie higher." It appears that Bush wants to win the votes of the poor, the minorities, and families in general by promising them what he clearly can't deliver.
Chart. Wall Street Journal
In 1998 the Texas comptroller's office reported that "health conditions in the Texas-Mexico border are among the worst in the U.S., so distressful that reports on health conditions suggest a remote country in need of medical missionaries, not a part of Texas....Cases of hepatitis A, a gastrointestinal virus borne by contaminated food and water, are four times as common in the Rio Grande Valley as in the rest of Texas." (note) A story in the NYT concludes that Texas "ranks near the top in the nation in rates of AIDS, diabetes, tuberculosis and teenage pregnancy, and near the bottom in immunizations, mammograms and access to physicians."
Yet, Texas Governor George W. Bush has never even given a speech on Texas' health care problems and his plans for dealing with them. "George W. Bush became governor in 1995, he has not made health a priority, his aides acknowledge. He has never made a speech on the subject, his press office says. His administration opposed a patient's bill of rights in 1995 before grudgingly accepting one in 1997, and fought unsuccessfully to limit access to the new federal Children's Health Insurance Program in 1999." For a man who is trying to convince the nation's voters that he is a new kind of Republican, a "compassionate" conservative, his actions are singularly lacking in compassion when it comes to the health needs of his fellow Texans, particularly Hispanics.
"The worst health in Texas, with disease rates at Third World levels, is on the Mexican border. Almost a fourth of the state's population lives in 43 border counties along the 1,264 miles of the Rio Grande from El Paso to Brownsville, and as far from the river as San Antonio, about 125 miles. Except for San Antonio, it is a poor area. El Paso, Laredo, McAllen and Brownsville are four of the five poorest cities in the country. About a third of the population lives below the poverty level. All but two of the counties have a shortage of doctors."
Nearly all the leading health care professionals, administrators, and officials agree that the key to better health care for Texans is better insurance, and the statistics show that things have gotten worse under Bush. "Health insurance coverage in Texas has been stagnant for years. According to the Kaiser Commission on Medicaid and the Uninsured, among Texans 19 to 65 years old, 27.5 percent were uninsured in 1998, compared with 19.7 percent for the nation. In 1994, before Mr. Bush took office, the Texas percentage was 27.8 and the national figure 18.6 percent. Among poor children the coverage was much worse. In 1998, 39.1 percent of Texans under 18 living at no more than twice the poverty level lacked insurance, compared with 25.7 percent nationally. In 1994, 36.7 percent of poor children in Texas and 22.8 percent of poor children nationally were uninsured."
Yet, when Bush had an opportunity to reverse the trend of more uninsured Texans, he actively fought against providing insurance to the needy. "Of the 1.4 million to 1.5 million children without health insurance, the number may drop sharply in the next year when Texas finally starts enrolling children in the children's health insurance program, known as CHIP, which was enacted by Congress in 1997. Mr. Bush let the question wait until the 1999 legislative session, and fought to limit its coverage to children with family incomes up to 150 percent of the poverty line, although the federal law allowed covering children up to 200 percent of the poverty level. The Bush approach would have excluded 200,000 of the 500,000 who became eligible when the legislature insisted on the higher level."
"The reason given at the time for the Bush position, legislators said, was a fear that a big new program would be costly by itself and turn up a "spillover" of many thousands who were already eligible for Medicaid, which has an income ceiling of 100 percent of poverty." This scenario suggests Bush sacrificed uninsured Texans to his tax-cut package, which gives the state's surplus to his wealthy, property-owning financial backers rather than to poor Hispanics in the Texas border counties. Another reason offered by legislators at the time was that the Theocrats didn't want federal health care money to include care for teen age pregnancies, including abortions, and Bush supported their position.Even after the Dems in the legislator insisted on a 200 percent CHIP rate, the Bush-Theocrat faction attempted to split the rate, keeping the 150% rate for kids between 11 and 18 years old. This scenario suggests Bush sacrificed uninsure Texans to satisfy his Christian conservative backers.
When it became time to appoint a new state Commissioner of Health in 1997, Bush found an anti-abortion advocate, Dr. William Archer, who was willing to assert that, in spite of Texas' terrible health statistics, providing insurance to the uninsured would not change anything. "Archer, the son of retiring U.S. Rep. Bill Archer, R-Houston, has been a longtime proponent of abstinence-based sex education. As a midlevel federal official under former President George Bush, he was the chief defender of a now-defunct regulation -- the so-called gag rule -- that barred workers at tax-supported health clinics from discussing abortion with pregnant clients," writes Scott Greenberger
Archer was the perfect do-nothing appointee for Bush, because his past record suggested he was more interested in calming the fears of the anti-abortion Theocrats than getting the uninsured better health care through insurance. As Archer recently said, ""If I were to go to a Hispanic community and say, `Well, we need to get you into family planning,' they say, `No, I want to be pregnant.'. "It doesn't work very well." Archer's sub-text to this comment is don't bother to spend money on a culture that doesn't use it as he sees fit. "Society values pregnancies in teen-agers as bad, but certain communities within society may feel differently," he said. Apparantly, Bush's idea of a health care czar is one who worries about health care spending for abortions and family planning, rather than for health care needs across the board.
Bush's national health care plan promises more of the same--a plan that is created by economists after the tax-cut budget is in place, a plan that has been formulated by those who represent the financial interests of the wealthy Bush backers. (see Kondracke10/6) . Deborah Steelman, his major health care adviser is a lobbyist for the health care industry. Ms. Steelman earns a living as a Washington insider, a lobbyist representing the interests of Cigna, Pfizer, Aetna, United Healthcare Corporation, the Healthcare Leadership Council, and Prudential. Her interests dovetail nicely with Bush's, since he has received maximum campaign contributions from many executives at Prudential, Cigna, and Aetna, and he has many close friends with close financial ties to the Health Care industry, such as Richard Rainwater, his billionaire friend and number one financial mentor.
Steelman identifies herself as his "senior advisor" on the five member Bush dream team. In a story in the Albion Monitor, Jeremy Breningstal describes the other members: "The team is composed of John Goodman, from the National Center for Policy Analysis, a conservative think tank; R. Glenn Hubbard, a market-leaning economics professor at Columbia University; Donald Moran, president of a health care consulting group, Timothy Muris, a law professor and recently a consultant for Aetna in an anti-trust case; and William Roper, senior vice president at Prudential HealthCare before becoming dean of the School of Public Health at the University of North Carolina-Chapel Hill. None are practicing physicians or consumer advocates, and their philosophy is decidedly not patient-oriented." (more)
Steelman chaired a Medicaid committee for Poppy during his presidential tenure. Even then, consumer groups chided her selection because she so clearly favored the industry over the consumer. As one GOP observer recently said about a report she made to the House Republican Conference, she was like, "the NRA coming in and writing gun legislation, except with her there was no disclosure." Breningstal: "Bush is staying miles away from any sweeping reform of the health care industry, and the needs of 45 million uninsured Americans -- a number expected to rise to as high as 60 million in the next decade." ---Politex, 4/11/00
Note The Comptroller's report referred to was "Bordering the Future: Challenge and Opportunity in the Texas Border Region," researched by John Sharp's staff and written by Kelly Fero. Among other things, the analsysis found that if the 43 Texas border counties (in itself, a new way to define the border region) were the 51st state, it would rank first in poverty, first in unemployment, first in adults without a high school degree, second in death rate from hepatitis per-capita personal income. Lt. Governor Rick Perry's response when "Bordering the Future" was released? "It should be called 'Bordering on the Obvious.'" Indeed... which makes it even more unfortunate that the report's 50+ specific recommendations have thus far been ignored.
In the George W. Bush lexicon the word "reform" means to pass whatever bill he's pushing. Here's how he would use the word in a sentence: "I'm going to reform that bill when it comes to my desk." When he tells the Washington Post's Terry M. Neal that he's "the reformer with the results," Houston citizens start laughing but end up coughing. The way Bush "reformed" Houston's air, making it ground zero of the nation's smog center, is he called in lobbyists and other representatives of Texas' pollution causing energy corporations, who happen to contribute a lion's share of cash to the governor's political campaigns, and had them help draft a new energy bill for possible passage in the next legislature. The resulting bill grandfathered in the offending polluters so that they would not have to follow the most recent environmental guidelines and jawboned them to do better in the future, but in the long run it was up to them. Since it was up to the polluters to clean the air, the air remained dirty, thrusting Houston into the lead as the nation's smoggiest city. Now Bush wants to do the same thing with the nation's health care system. Deborah Steelman, his major health care adviser is a lobbyist for the health care industry.
Ms. Steelman earns a living as a Washington insider, a lobbyist representing the interests of Cigna, Pfizer, Aetna, United Healthcare Corporation, the Healthcare Leadership Council, and Prudential. Her interests dovetail nicely with Bush's, since he has received maximum campaign contributions from many executives at Prudential, Cigna, and Aetna, and he has many close friends with close financial ties to the Health Care industry, such as Richard Rainwater, his billionaire friend and number one financial mentor. Steelman identifies herself as his "senior advisor" on the five member Bush dream team. In a story in the Albion Monitor, Jeremy Breningstal describes the other members: "The team is composed of John Goodman, from the National Center for Policy Analysis, a conservative think tank; R. Glenn Hubbard, a market-leaning economics professor at Columbia University; Donald Moran, president of a health care consulting group, Timothy Muris, a law professor and recently a consultant for Aetna in an anti-trust case; and William Roper, senior vice president at Prudential HealthCare before becoming dean of the School of Public Health at the University of North Carolina-Chapel Hill. None are practicing physicians or consumer advocates, and their philosophy is decidedly not patient-oriented."
Bush's Texas record of Health Care in Texas is market-driven and rewards those with the money. As Professor Hubbard has said, ""We have the best health care in the world and we pay a lot for it." Answering attacks from Democrat Gary Maura in the last governor's race, Bush said he felt every citizen had the right to go outside his HMO for the doctor of his choice if he had the money to pay for it. Meanwhile, Texas has one of the highest uninsured health care rates in the country. And there are 600,000 uninsured children in Texas who are eligible for Medicaid. It's only a matter of proper administration, since the money comes from the feds, not Texas. Hospitals throughout Texas are cutting their services and closing their doors because of Federal cutbacks, and Texas has not picked up the slack. Yet, Bush brags about his $2 billion tax cut, a tax cut that has not reached most citizens in Texas. He also brags about the Texas Patient Protection Act, which was passed during his watch, but Texas observers say that his input was negative.
And what Health Care "reform" does Bush propose on the federal level? Bush's " limited list of goals -- privatizing Medicare, providing pharmaceutical drug benefits, and limiting a patient protection legislation -- all mesh closely with policies Steelman has been advocating in her lobbying capacity on the Hill all year," writes Breningstal. A National Observer article had Bush proposing that tax cuts be given to the poor who can't pay for insurance, but Breningstal reports that Poppy suggested the same thing during his administration and it didn't work, partly because the tax reduction in the income bracket of the poor hardly covered medical costs.
Getting back to Dubya's Health Care Senior Advisor, it turns out she chaired a Medicaid committee for Poppy during his presidential tenure. Even then, consumer groups chided her selection because she so clearly favored the industry over the consumer. As one GOP observer recently said about a report she made to the House Republican Conference, she was like, "the NRA coming in and writing gun legislation, except with her there was no disclosure." Breningstal: "Bush is staying miles away from any sweeping reform of the health care industry, and the needs of 45 million uninsured Americans -- a number expected to rise to as high as 60 million in the next decade." Bush is a reformer? You've got to be kidding. ---Politex, 2/9/00
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