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A Guide To Bushspeak On Healthcare

This column from The New Republic was written by Jonathan Cohn.


At this point you have to wonder: Why should Democrats even bother fielding a candidate if President Bush is determined to run against somebody else? Yesterday the Bush campaign released two wonderfully crafted television spots attacking John Kerry's health-care plan – or, to be more accurate, what they claim to be John Kerry's health-care plan. Visually, both ads feature a mind-numbing chart, with all sorts of arrows, boxes, and unfamiliar acronyms, that's supposed to represent the complexity of Kerry's proposal. As words like "IRS," "Addl. Health Care Plan Content Regulation," and "Premium Rebate Pool Policy," move past the screen, an announcer delivers the bad news:

"John Kerry and liberals in Congress have a health care plan for you. A big-government takeover. One-point-five trillion dollars. Rationing. Less access. Fewer choices. Long waits. And Washington bureaucrats, not your doctor ... make final decisions on your health. So if you need treatment ... all you have to do is ... [at this point the screen moves back-and-forth quickly over some of the boxes] ... You get the picture ... John Kerry and liberals in Congress: Big government-run healthcare."

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Feel like you've seen this before? You have. Back in 1994, the Republicans deployed a similarly designed chart and similarly dire warnings of a government health-care takeover as they waged their fight against the Clinton health-care plan. "More cost, less choice, more taxes, less quality, more government control, and less control for you and your family," then Senate Majority Leader Bob Dole said in his televised response to Clinton's State of the Union address, "that's what the President's government-run plan is likely to give you."

Of course, the Clinton health care plan really was a government-run health plan (albeit one that was hardly the menace its critics warned it would be). That's simply not the case with Kerry's health plan, for reasons that I (among many others) have already written about. Today, in fact, a group of 68 health care policy experts led by Mark Peterson at the University of California at Los Angeles, released a petition calling upon the Bush campaign to end its gross distortions of Kerry's plan. "Although Senator Kerry's proposals should be subject to a full analysis of their cost and impact, any claim that they amount to 'government-run health care' or a 'government takeover' of the health care system or of health care decision-making is simply inconsistent with the facts. We are not aware of any expert in health care or health care finance, whatever his or her political orientation, who believes otherwise."

So why would Bush produce an ad like this – and continue to raise the specter of "government-run health care" – even though the charges are now widely known to be false? Because he keeps getting away with this dishonesty. Just last night, NBC Nightly News led its broadcast with a piece about the candidates' duel on health insurance issues. The piece quoted Bush's attacks on Kerry, then ran a perfunctory response from the Kerry campaign saying the charges were false, leaving a viewer who didn't know better to think this was another one of those times when neither campaign was fully right or wrong. And, as Zachary Roth observed over at the Columbia Journalism Review's Campaign Desk, an Associated Press story filed yesterday portrayed the debate over health care in almost precisely the same way:

[Bush] said Kerry's proposed changes would put millions of people looking for health care into "a government program."

The Kerry campaign says Bush's criticism of the Democrat's domestic programs is based on studies that are misleading and have been shown to be factually dubious in estimating the costs.

As Roth notes, it's a safe bet we'll hear the government-run health care line, or some variation of it, during tonight's debate. And, sadly, it's also a safe bet that many, perhaps most, journalists will not call Bush on this obvious dishonesty. Indeed, even when a reporter does document just how false the charges are – like Howard Kurtz's fine story on the Bush ads today – editors feel compelled to blunt the impact with headlines like "BUSH HEALTH CARE ADS NOT ENTIRELY ACCURATE." Not entirely? How about not remotely? (I suppose you can't say quite the ads are "not accurate at all," since I'm sure President Bush really does approve these messages, as he says at the end.)

So just in case the punditocracy falls down on the job again, here, for viewers of tonight's debate, is a quick guide to Bushspeak on health care:

"Less access." Right now 45 million people have no health insurance. Senator Kerry has a plan to provide more than half of these people with coverage while subsidizing employers in order to stabilize the private coverage many working Americans already have. That certainly seems like more access, doesn't it?

"Less access" would be something like implementing a plan that reaches just a few million people, while creating new insurance mechanisms that segregate healthy people from the unhealthy and make traditional insurance even harder to afford. Which, as it happens, is a fair reading of what President Bush proposes to do. (Funny how you never hear about that.)

"Fewer choices. Long waits." The theoretical basis for throwing these words around is that as the government offers Medicaid or the State Children's Health Insurance Program (S-CHIP) to more people, some private companies will stop offering coverage to their workers. These people will effectively shift from private to public coverage – which, the Bush campaign says, will restrict their choices and give them longer waits. But plenty of people with private insurance have restricted choices and long waits already. (When was the last time you tried to get a quick appointment with an HMO doctor?)

More important, the vast majority of people getting Medicaid or S-CHIP would be people who currently have no health insurance at all. That would surely mean more choices and shorter waits, since right now they are completely dependent upon overwhelmed public hospitals and charity institutions. If you truly want to see a "long wait," hang out in the emergency room of a beleaguered institution like the University of Southern California-Los Angeles County Hospital, where the reception areas are literally overflowing with uninsured people who've been waiting eight or ten hours to see a doctor or nurse.

"The largest expansion of government-run health care ever." Bush has been using this line in his stump speech lately. But "ever," in this case, does not seem to include 1965, the year President Johnson signed Medicare and Medicaid into law. Within ten years, those two programs had enrolled some 45 million between them. (See here and here.) Kerry's plan, as both he and his critics agree, would end up enrolling around 25 million people in government programs over the first ten years.

Besides, Medicare radically changed the entire system for financing medical care in this country, forcing changes in accounting and, eventually, the way treatment actually got delivered. Kerry's would do no such thing (even though, in my opinion, there's a good case for such radical change nowadays).

Note that Medicare, although one of those dreaded "government-run" programs, is actually more popular with its beneficiaries than most private insurance plans.

"Washington bureaucrats, not your doctor ... make final decisions on your health." Here's what's funny about this line. Right now, somewhere at the Department of Health and Human Services, a bunch of Washington bureaucrats are making decisions about health care for millions of Americans – specifically, they are creating the parameters for the new Medicare prescription drug program. That's the very same Medicare prescription drug program that President Bush signed into law and regularly boasts about on the campaign trail as a major accomplishment.

Why Kerry's plan, which introduces no similar micromanagement into medical decision-making beyond what exists already, empowers Washington bureaucrats more than Bush's Medicare bill isn't readily apparent. What is apparent, though, is that Bush's Medicare plan is supposed to encourage seniors to switch from traditional Medicare to private managed-care plans, in which different sorts of bureaucrats - insurance company bureaucrats - really will insert themselves into medical decision-making, whether it's through restricting access to treatments or choice of doctor. Maybe Bush thinks insurance company bureaucrats are smarter or more sensitive than government bureaucrats. I'm not so sure he's right, but that'd be an interesting debate to have - one with a far closer relationship to reality than anything we're talking about right now.

Jonathan Cohn is a senior editor at TNR. He is currently writing a book on the U.S. health care system.
By Jonathan Cohn
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