By Peter Schrag
Sacramento Bee
Published Wednesday, January 31, 2007
Was it just imagination or were there unmistakable echoes of Arnold Schwarzenegger in President Bush’s State of the Union speech last week — health care, climate change, bipartisanship? Hadn’t we just heard this in the State of the State? Arnold wanted national influence: Is he getting his wish quicker than he thought?
Schwarzenegger and Bush got polite applause for touching on two subjects that not long ago had been unmentionable. Even last week, the closest Bush got to global warming was “global climate change,” no comfort to dispossessed polar bears, but at least getting warmer. His version of improved health care boiled down to getting 3 million off the rolls of the nation’s 47 million uninsured: the 6 percent solution.
The respective Schwarzenegger and Bush proposals on reducing use of fossil fuels and covering more people with health insurance have one principle in common: As advertised, neither would cost a dime in additional taxes for the average taxpayer. OK, so quibble about Arnold’s “fees” or about Bush’s proposal to tax high-cost employer-paid health insurance.
Can you track all those peas under all those shells? Since all this is supposed to be “revenue neutral,” who gains and who loses? You might think the Bush scheme to tax only gold-plated health plans would affect only corporate fat cats, but it’s likely to hit many ordinary workers, especially the public employees with lush health plans, even harder.
Schwarzenegger’s people put out a document last week comparing the Bush health plan with Schwarzenegger’s, which makes the two sound even more like Rube Goldberg devices than they probably are. But Arnold at least wants to go for the whole enchilada. Yet since both health plans have so many moving parts — a dump of responsibility by the state on the counties, big-bucks fiddles with Medicaid and Medicare, employer mandates, fees/cum taxes on doctors and hospitals — a lot of things will have to change before either plan becomes more than a puff in the headlines. Ditto for the global warming-energy independence proposals: higher motor fuel economy standards; ethanol, biomass, hydrogen, solar, nuclear, clean coal.
Given that the Bushies had been doing nothing for so long on fuel efficiency, just the mention of it was worth a nod. (If you watched the Bush speech, you might have also noticed the corny delight on the face of Sen. Charles Grassley of Iowa when the president mentioned ethanol.)
A lot of those new technologies are dubious or distant, or both. What would not be dubious is the quick efficiency gains and lowered demands resulting from higher taxes on carbon fuels. Schwarzenegger induced Californians to approve a mega-buck transportation bond issue last year — and may yet again — without a cent in additional fuel or other use taxes. Which is to say that even as we struggle with crowded, crumbling roads we do nothing to reduce demand, and so keep chasing our tail.
Because neither the health proposal nor the energy proposal asks for fundamental changes, either from taxpayers or from corporate interests, both rest on the rickety structures of the existing national health systems and energy policies, which are the source of the problems to begin with.
Schwarzenegger’s health plan ambitions are commensurate with the challenge of covering everybody (except maybe the state’s illegal residents who are adults). But his failure to attack the costly and inefficient private insurance system to which he wants to graft his fixes almost assures that the mess will continue. Still that beats Bush, who tinkers only at the margins.
As long as we have a profit-based health care system in which 21 cents or 22 cents — some studies say as much as 27 cents — of every dollar goes to the bureaucracies that manage it to protect industry profits, we’ll spend more for care and get less for it than any other modern nation.
The governor wants to force insurers to spend 80 cents of every dollar on actual care, which would be a marginal improvement. But it doesn’t get within shouting distance of eliminating the 3-to-1 difference in administrative costs between the United States and Canada, which, like most of the civilized world, has a single-payer system in which everybody is covered.
The governing message both in Washington and Sacramento is that the voters can have it all — energy independence, clean air, a thick ice cap, open roads, big cars, good health care (for some) and other quality public services — at no additional cost and, as in the Iraq war, no sacrifice or imposition on anyone except the troops.
According to the latest surveys of young Americans, 80 percent regard getting rich as their top goal in life. Nothing is being asked of them — or of their elders — except maybe in the future. We could be developing alternative energy technologies and an efficient single-payer health system. Instead, we tinker at the margins and pretend that we can fix it all for nothing. Won’t the kids be surprised.
