President Bush gave short shrift to health care in his State of the Union speech. And what little he did propose would just make a bad situation worse.
Here's the problem in a nutshell: The United States spends on health care for each individual more than twice the median for the industrial world, with costs rising yearly well above inflation. Inefficiency, administrative costs and profits in the private part of our system -- not better health care -- account for much of the difference.
But 46 million people don't even have health insurance. And the amount of care people receive, as well as the condition of their health, is, on average, below that in most other rich countries.
Yet in response to this mess, Bush proposed mainly to strengthen health savings accounts. These plans are based on the assumption that Americans' big problem is that they consume too much health care -- as if people were indulging in kidney transplants just for the fun of it, even if they didn't need the operation.
Introduced three years ago, health savings accounts are something like individual retirement accounts (IRA). People can put money in these accounts -- up to a limit (now $5,450 a year for a family) that Bush is likely to propose raising. This money is not taxable. The accounts can be used to pay for expenses not covered by a relatively low-cost catastrophic health insurance policy with a high deductible -- at least $2,100 for a family. In theory, with their own money on the line, people will shop for better deals and not frivolously consume health care.
These health savings accounts are ideological cousins of the disastrous privatized Social Security accounts that Bush failed to get through Congress last year. They will benefit primarily the very healthy and wealthy, who can save the money tax-free and will face few expenses -- until some crisis hits.
By contrast, the health savings accounts would increase risk and hardship for those less affluent or more sick.
Research by MIT Health Economist Jonathon Gruber strongly suggests that these accounts will help very few uninsured people get coverage. (Tax breaks do little or nothing for those with low incomes and tax rates.) And they are likely to lead many employers to switch from traditional insurance plans, which could ultimately increase the number of people without insurance.
Since about 10 percent of individuals -- with critical illnesses, major accidents or end-of-life care -- account for 70 percent of spending, overall health costs won't be reduced much.
However, when they're forced to pay more out of their own pocket, people are likely to avoid preventive care, delay going to the doctor and ultimately suffer more severe problems (and avoidable deaths). As a result, they also may increase their visits to emergency rooms and need more invasive treatments, thereby actually raising overall health costs.
With healthy, wealthy people abandoning the traditional insurance plans, the pool of people sharing the risks will be sicker, and that will drive up the cost of insurance. But the well-off, who are the only ones likely to have enough income to salt away the maximum amount permitted under a health savings account, will have a new tax shelter.
The theorists behind Bush's plan are obsessed about "moral hazard" -- the claim that if people aren't directly paying for a service like a cancer check-up, they'll consume too much.
But Bush's health savings accounts would intensify the real moral hazard -- call it "guaranteed immorality" -- in our present system, such as people not getting care they need because of economic inequalities or the bad luck of accidents, faulty genes or environmental catastrophes.
The country needs to go the opposite direction of Bush on health care. We need to include everyone in a universal, comprehensive insurance system, like Medicare, that would drastically cut overhead, encourage preventive care, spread the risk, cut costs and, most of all, help keep everyone in better health.
David Moberg is a senior editor at the Chicago-based In These Times magazine (www.inthesetimes.com) and writes widely on workplace issues. He can be reached at firstname.lastname@example.org.