MEDICAL CARE in this country already costs too much -- more than $1 of every $10 Americans spend. Yet about an eighth of the population gets much less care than it should because it lacks all health insurance. The uninsured are disproportionately young (Medicare covers the elderly) and poor; the government's costly program for the poor, Medicaid, covers fewer than half of them.
Few societal problems are more serious. The Bush administration has acknowledged the seriousness; the president in his State of the Union address asked his health and human services secretary, Dr. Louis Sullivan, to study the issue. But mainly the administration's approach to the problem thus far has been to defer and to say which solutions it does not like, not which ones it does.
In a speech the other day, Dr. Sullivan suggested -- no surprise -- that the administration is opposed to national health insurance. Some say that is the only way to make sense of the current patchwork. He said it would be a great mistake to scrap the present mixed public-private insurance system in favor of starting over -- not an unreasonable position. He emphasized the importance of market incentives in making the system more efficient.
In the same speech he also indicated -- again no surprise -- that the administration would be opposed to a second major departure under discussion -- having businesses pick up a greater share of the cost by mandating health insurance for all or most employees. "By adding overly burdensome mandates on business, we could retard economic growth," he said.
A fair question then is what the administration is for. Dr. Sullivan says that "more Americans should be able to obtain health insurance," presumably meaning mainly private insurance. Who could be against that? But what he hasn't yet done -- and he's not meant to report until later in the year -- is to close the circle and say how. The reason most don't have insurance now is that they don't have the money for the premiums. Will the government subsidize these? Might it help low-income people not now eligible to buy into Medicaid, as the president suggested in the campaign?
Either alternative would help, but where in a tight budget might the government get the money? At least one possibility is redistributional. The government now spends about $40 billion a year on the health care of the poor through Medicaid; that's the federal share. It spends about $30 billion a year on the health care of the middle class and well-to-do through the tax code, by excluding from taxable income employer-paid health insurance premiums. A limit on the exclusion would generate funds that could be spent on the uninsured. Would that be a partial answer to the problem?