President
Bush famously disdains "small-ball" policymaking, preferring
to swing for the long ball. But, with the exception of big new
tax cuts and his competitiveness initiative, his 2006 domestic
agenda aims at scoring singles, not homers.
The gigantic
tax cuts, costing at least $2 trillion over 10 years if Congress
merely extends current reductions, plus a Republican desire to
appear fiscally "responsible" are preventing Bush from
undertaking ambitious efforts on health care, education and energy.
He will extend
health insurance to only a fraction of the 45 million Americans
who lack it, make only modest investments in health information
technology, postpone extension of his No Child Left Behind education
reforms to high schools and fall far short of a "Manhattan
Project" for energy independence.
And Bush's
2005 failure to gain traction for his long-ball Social Security
reform plan has forced him to push the enormous problem of the
baby boom generation's retirement - a challenge made worse by
his tax cuts - onto yet another commission.
The competitiveness
initiative, costing $136 billion over 10 years, is a departure
from the small-ball pattern and is being praised, deservedly,
by sometime critics such as former Lockheed-Martin CEO Norm Augustine
and former Speaker Newt Gingrich (R-Ga.).Augustine, who chaired
a National Academy of Sciences study that Bush cited in his State
of the Union speech, told me that he was "extremely happy"
with Bush's proposal to double funding for research in the physical
sciences over 10 years, to permanently extend tax credits for
research and development and to upgrade science and math education.
The NAS study
warned that the United States is in danger of losing its traditional
comparative advantage in high technology to China and India, two
countries that are making huge investments in research and science
education.
One item
on the Augustine agenda that's not included in Bush's program,
because he doesn't want to spend the money, would fund 25,000
undergraduate and 5,000 graduate scholarships in science and engineering
and 10,000 scholarships for science teachers.
Gingrich
told me that Bush is "modestly breaking with the past, but
it's nonetheless real. It starts a new dialog." He noted
that a bill sponsored by Sens. Lamar Alexander (R-Tenn.) and Jeff
Bingaman (D-N.M.) that incorporates the NAS proposals now has
60 co-sponsors, 30 from each party, and he recommended that the
White House and House Republicans push for bipartisan action,
too.
On the health
front, Gingrich said he was "puzzled" by the fact that
"they keep talking about electronic health records, but they
don't act decisively. I think it's very dangerous for the country
to not go to electronic health records as rapidly as possible."
It's "dangerous,"
he said, "because paper kills. We kill between 44,000 and
98,000 Americans in hospitals every year from mistakes. If things
like that were happening in civil aviation, you'd have an absolute
rebellion. But people just shrug off these deaths."
He said it
would cost less than $10 billion but would save much more in the
long run because of reductions in litigation costs and recovery
from unnecessary medical errors. And, Gingrich said, the federal
government should be doing more than Bush proposes to advance
medical "transparency," providing information to patients
about drug costs and hospital and physician performance.
Gingrich
noted that in Florida, Bush's brother, Jeb, has introduced Web
sites called FloridaCompare, where patients can punch in their
ZIP code and the drugs they take and get readouts on drug prices,
saving as much as two-thirds. They can also get information on
hospital costs and quality performance.
Information
is key to Bush's No. 1 health reform idea, health savings accounts,
which aims to put more power and responsibility into the hands
of consumers, who will "shop" for health care and reduce
overall costs.Bush proposes to increase the amount of money that
people can deposit on a tax-favored basis into HSAs to use to
pay out-of-pocket medical costs and to buy high-deductible insurance
policies that cover catastrophic medical costs.
Critics contend
that, in medical crises, sick people and their families aren't
able to "shop around" and that, in any event, accurate
information isn't available. They also contend that lower-income
people don't have money to invest in HSAs and derive little tax
advantage from setting up accounts because they pay so little
in taxes.
Moreover,
they charge, HSAs could encourage employers to stop providing
insurance coverage to their workers, thereby increasing the ranks
of the uninsured. Administration officials have no estimate yet
of how many of the uninsured - 45 million of whom lack insurance
during part of a year and about 20 million who lack it all year
long - might become newly covered under Bush's plans, but it's
almost certain to be fewer than the 6 million who would have been
newly covered by proposals he made in 2004 and 2005.
The administration
claims that the number of HSAs has jumped from 1 million to 3
million in the past year, but critics point out, correctly, that
this is the insurance industry's estimate of the number of high-deductible
policies sold, not HSAs created. In a White House briefing, Bush
economic adviser Al Hubbard said that just 37 percent of those
with such policies were previously uninsured and that 40 percent
had incomes under $50,000, seemingly validating criticism that
HSAs are attractive mainly to "the rich, the young and the
well."
On energy,
former oil man Bush has definitely taken a turn by declaring that
the United States is "addicted" to oil and proposing
upgrades in research on alternative fuels including clean coal,
"cellulosic" ethanol, hydrogen and lithium car batteries
and nuclear power.
Still, the
investments are mainly in the millions of dollars, not billions.
The administration admits that human activity might cause global
warming, but it has yet to come up with answers on how to stop
it, and it refuses to mandate energy efficiency for SUVs to protect
domestic automakers. It also adamantly opposes gasoline taxes.
I agree with
Gingrich: Bush is "modestly" breaking with the past
and is addressing "the right topics." But "small
ball" won't solve America's big problems.
Mort
Kondracke is the Executive Editor of Roll Call.
