For his first trick as Senate Majority Leader, South Dakota Democrat Tom Daschle made 44 million Americans disappear. Those without health insurance remained essentially out of sight and out of mind before the Senate passed the Patients’ Bill of Rights 59-36 on June 29.
The uninsured once marched at the front of the Democrats’ parade of the downtrodden. “It is a national scandal that lack of insurance coverage is the seventh leading — and most preventable — cause of death in America today,” the Bill’s co-sponsor, Sen. Ted Kennedy (D., Massachusetts), said last July 21.
“As we improve health coverage for those who already have it,” Daschle said in February 2000, “we can’t forget the 44 million uninsured Americans.”
Well, forget them they did.
The Democrats’ Bill gives tender loving care to the Association of Trial Lawyers of America who donated $3,637,450 in the 2000 election, 90 percent to Democrats, the Center for Responsive Politics reports. While these attorneys could sue HMOs for profit, the uninsured would get nothing. In fact, some one sixth of America’s population would stay helplessly trapped in the proverbial doctor’s waiting room. For them, this measure is a Patients’ Bill of Wrongs.
When the GOP House considers this legislation, it should remember those the Democratic Senate ignored. House Republicans should pass a competing Patients’ Declaration of Independence to empower both uninsured and insured Americans with tax-free funds to choose from among expanded health-care choices.
Proposed by Steve Forbes during his 2000 presidential campaign (for which I served as a communications consultant), a Patients’ Declaration of Independence would allow individuals to deduct 100 percent of their health insurance premiums from their taxes. Companies already do so while the self-employed can write off 60 percent of insurance costs. Employees rarely have this option.
This new deduction would help employees flee HMOs, if they wish, for more desirable plans. A tax credit against tax liabilities would be an even more powerful tool to help Americans opt out of their employers’ health plans.
A Patients’ Declaration would include universal access to Medical Savings Accounts. MSA owners may spend their own or their employers’ tax-free money on routine care while holding high-deductible insurance for catastrophic coverage. They may save and earn tax-free gains on whatever they don’t spend. This gives account holders strong incentives to shop around and demand reasonable prices for drugs and medical procedures.
MSAs were hobbled before their 1997 launch by Sen. Kennedy who apparently feared this free-market threat to his dream of socialized medicine. He pushed restrictions on the number of MSAs (750,000 nationwide), their availability (Congress extended the original 2000 deadline for opening accounts to 2002) and eligibility (exclusive to companies with fewer than 50 employees). While only about 100,000 Americans own MSAs, one third of them previously were uninsured.
New Jersey Republican gubernatorial nominee Bret Schundler successfully implemented MSAs as Jersey City’s mayor. Fifty-six percent of municipal employees chose MSAs in a 1995-1998 experiment. By 1998, compared to the cost of traditional plans, taxpayers saved $997 to insure families with children, $1,123 for childless couples and $1,002 for singles. “Our MSA option,” Schundler said, “achieved this cost saving while preserving full employee choice relative to health-care providers and services.”
A Patients’ Declaration also should free seniors to pay private doctors for treatment without costing those physicians access to Medicare patients. The Republican Congress inexcusably passed this impediment to “private contracting” in 1997. GOP lawmakers should scrap Medicare Section 4507 and permit seniors to visit whichever doctors they wish without punishing providers who see such patients. If Daschle and Rep. Dick Gephardt (D., Missouri) believe this would give the Greatest Generation too much freedom, let them stand up and say so.
These reforms could pass the House where Speaker Dennis Hastert (R., Illinois) has kept his majority largely loyal and obedient. Senate Minority Leader Trent Lott (R., Mississippi), meanwhile, has no grip on his caucus of unguided freelancers, nine of whom joined unanimous Democrats in adopting the Patients’ Bill of Rights.
House approval of a Patients’ Declaration of Independence (and President Bush’s endorsement of same) would send it to a conference committee where House Republicans could fight for a reasonable agreement with Senate Democrats. To date, though, this mess portends future legislative headaches. Senator Tom Daschle’s victory shows what can happen when disoriented and leaderless Senate Republicans tangle with focused and disciplined Democrats.