President Bush's veiled unveiling of his health care reform proposals marks the official beginning of a hot political debate that will enliven the election year but leave one of the nation's most costly and pressing social problems unsolved.
Neither Republicans nor Democrats are willing to come clean on the high price tag of delivering health care to all citizens. Instead, they indulge in grandiose schemes for universal health care that reveal both a wide philosophical gap and yet some wiggle room (unused) for practical compromise.
Mr. Bush's market-oriented approach would rely on making the private health insurance sector accessible to everyone -- not just to the wealthy or to workers whose employers provide coverage but to poor people, the unemployed, the self-employed and to workers in mostly small companies that do not now provide coverage. He would do so by providing tax-credit vouchers to the poor and tax deductions to the middle class that will enable them to buy into basic health insurance plans. Tax incentives would be offered to encourage small businesses to pool their resources so they can negotiate from strength with health insurance providers.
The Democrats counter with two alternatives, both of which project a much larger government role. One would be a form of national health insurance roughly modeled on Canada's existing arrangement; the other a "play or pay" plan in which employers would be required to provide coverage or pay into a government-controlled insurance pool.
Philosophically the differences are virtually unbridgeable, which is one reason why successive administrations have not been able to get a handle on budget-busting costs or widespread gaps and inequities in the American health care system. Yet citizens more interested in progress than politics should insist that public officials pay attention to opportunities for modest compromise.
One opportunity target we detect lies in the pooling of risk to provide health care insurance for the 34 million workers not now covered. Both the administration and the "play or pay" plans include such pooling on the part of small businesses. While the GOP stresses a private sector approach that contrasts with the Democrats' greater reliance on government, they might find common ground in offering powerful tax incentives to encourage small businesses to provide for their workers.
In this political year, however, compromise is for Pollyannas; bombast is for pols. Democrats will charge that the administration is once again being indifferent to Americans who are hurting. The president will accuse his adversaries of promoting socialized medicine. One is left to hope that American citizens will become so sensitized to the issue, both in terms of cost and fairness, that something will be done once the election is behind us.