Back to Basics
When President Bush addressed the nation Tuesday night, he had two related problems -- one political, the other conceptual. His political problem is that he has negligible support among Democrats and his support among independents has fallen sharply, so he must continue to govern with narrow victories secured by the cohesion of his conservative base. His conceptual problem is that although election results indicate this is a somewhat conservative era, it is more rhetorically than operationally conservative.
There is a broad consensus that government has a duty to assuage two perennial fears and a modern anxiety. The two fears are illness and old age -- particularly illness in old age. The modern anxiety is that educational deficits will leave rising generations of Americans ill-equipped to compete in a world in which few social structures can temper the winds of competition.
Furthermore, Americans are uninterested in the question of which level of government addresses those fears and that anxiety. Five decades ago, the new interstate highway system was officially named the National System of Interstate and Defense Highways. And when the Soviet Union's Sputnik produced anxiety about educational standards, the federal government produced the National Defense Education Act. Note the recurring word: "defense." That was partly a verbal tic of the time -- a Cold War reflex to impart momentum to any proposal by presenting it as integral to national security. But it also represented a vestigial impulse to connect any federal action with a clear -- meaning constitutionally enumerated -- federal power.
That impulse is gone in a nation in which it seems quaint to suggest that some things are beyond the federal government's proper purview. Today's default position is: Washington should do it.
So the president must fashion policies that are responsive to this national consensus but that will not cause fissures in his conservative base. Hence health savings accounts. The president proposes to allow people to buy, with pretax dollars, high-deductible health insurance policies outside of work. They can then pay for out-of-pocket expenses with tax-free dollars in their accounts.
HSAs are a distilled essence of the conservative agenda of giving individuals incentives to augment their own security, thereby reducing the demand for, and hence the supply of, government. HSAs offend Democrats who understand the threat HSAs pose to the "progressive" agenda of maximizing equality, understood as shared dependence on a government-defined ethic of common provision.
HSAs, a partially redeeming feature of the 2003 legislation that established the Medicare prescription drug entitlement, already have already found a constituency of more than 3 million people, about a third of whom were previously uninsured. And Wal-Mart and General Motors are among the large employers that this year will begin facilitating employee participation in HSAs, most of which are comprehensive, covering the costs of visits to doctors or emergency rooms, prescription drugs, lab tests and hospitalization.
There is evidence that HSAs reduce health care costs by making patients more judicious in their use of physician visits, and inpatient and lab services. In a study of one HSA plan, 50 percent of the participants had some funds left over at the end of the year to roll over into the next year's account.
The president's headline-grabbing assertion that America is "addicted" to oil is wonderfully useless. If it means only -- and what else can it mean? -- that in the near term we will urgently need a lot of oil, it is banal. The amusingly discordant word "addicted" couched censoriousness -- the president as national scold; our use of oil as somehow irresponsible -- in the vocabulary of addiction, which is the therapeutic language of Oprah Nation.
Not to worry. The president says that by 2025 America will "replace" -- a certain ambiguity there -- "more than 75 percent of our oil imports from the Middle East." Replace with what? Other oil? Never mind. Such recurring goals, located safely over the horizon, resemble Soviet agricultural quotas, except that no one will be shot when they are not met.