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Giuliani Recycles Bush Health Care Plan

July 31, 2007

While the field of 2008 GOP White House hopefuls continues to distance itself from President Bush, Rudy Giuliani today endorsed the moribund Bush health care plan lock, stock and barrel. And speaking on the eve of the President's looming veto of the State Children's Health Insurance Program (S-CHIP) expansion, Giuliani made it clear he shares the same blighted market-driven philosophy as Bush.
In New Hampshire today, Giuliani like Bush made a $15,000 family health care tax deduction to purchase private insurance the centerpiece of his health care reform program. Giuliani has yet to produce a price tag for his program, claiming "I don't think the plan would cost a great deal." (Given his recent distortions about his tax cutting record, Americans would do well to question his sincerity on any issue of the tax code.) And thus far, Rudy is unwilling to help fund his scheme by capping employer health care deductions, as Bush has advocated. But in his religious zeal for a free market, consumer-driven health care model, Giuliani is singing from the same hymnal as the President:

''Government cannot take care of you. You've got to take care of yourself. As more of us do that, the cheaper it will become and the higher in quality it becomes."

Sadly, there is little empirical evidence to support Giuliani's claims. As I wrote 18 months ago ("Unhealthy Trends"), the trend towards consumer-driven health care (CDHC) is not just shifting the financial burden to from employers to workers and the healthy to the sick, it's failing in its basic missions to control costs as well:

In one the first evaluations of consumer-driven health care plans, a joint study by the Employee Benefit Research Institute and the Commonwealth Fund found much lower satisfaction, higher costs and more missed health care with CDHC plans than traditional employer health packages. Americans utilizing new high-deductible CHDC health plans such as health savings accounts (HSAs) and health reimbursement accounts (HRAs) experienced dramatically higher out-of-pocket costs, with over a third paying more than 5% of their income towards health-related expenses, versus just 12% of those in traditional plans. Worse still, CDHC participants, especially those making under $50,000 a year, were much more likely (35% versus 17%) to skip or defer needed health care. The key to the new wave of consumer-driven plans, it would seem, is to be healthy, wealthy and lucky.

More disturbing is the go it alone, "opt-out" philosophy underpinning the so-called Giuliani health care plan. Just days after Mitt Romney likened Hillary Clinton to Karl Marx, Rudy deemed Democrats' incremental health care proposals "socialized medicine." Whereas Democrats including John Edwards, Hillary Clinton and Barack Obama seek to dramatically expand health care coverage while hoping to control costs, Giuliani like Bush advocates that Americans and their government abdicate their commitment to shared responsibility - and each other.
On health care as with so many issues, Rudy Giuliani will have a tough time escaping George W. Bush's gravitational pull. At the 2004 Republican National Convention, Giuliani said of Bush's approach, "Some call it stubbornness. I call it principled leadership." And in a GOP debate just this June, he again reaffirmed his support of Bush's invasion of Iraq and his terror war strategy.
And with his health care announcement today, Rudy Giuliani gave more one more indication that Harper's may be right in worrying that he just might be worse than Bush.

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Jon Perr
Jon Perr is a technology marketing consultant and product strategist who writes about American politics and public policy.

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