Callous About Health Care?

By Matt Miller

Republicans hate it when Liberals call them callous on health care--though when President George W. Bush says he'll veto Congress's boost in Uncle Sam's popular kids'-health plan and tells the uninsured to stop whining since they can go to the emergency room, you can see why folks might get that impression. Mitt Romney recently got a taste for why polls show health care topping voters' concerns when, while he was stumping in a New Hampshire diner, a self- described working-class waitress with three sick children kept upbraiding the polished multimillionaire for not feeling her pain.

Even when conservatives offer a decent health-care idea, the left is suspicious, sensing that the fine print gives poorer, sicker Americans the shaft. For the most part, however, this liberal loathing has been based on instinctive mistrust, with no scientific way to assess GOP indifference--or to separate those Republicans with whom liberals can do business from the hard-hearted monsters they should shun.

Until now. Thanks to the Health-Care Callousness Assessment Test (or HCCAT, for short)--a test I've devised as a supporter of universal coverage enacted in economically rational ways--the guesswork and knee jerk can be taken out of the equation. With three simple questions--the kind that can be dropped casually in conversation or on national TV during a debate--anyone can discern whether a Republican's approach to health care is truly pitiless or merely unsympathetic. A look at how the HCCAT scores Romney's Massachusetts plan and the health-care tax deduction just announced by Rudy Giuliani shows how easy it is to use.

Question 1: Do you believe the government should ensure that every American has basic health coverage? In the 21st century (as opposed to the 19th), the noncallous answer is yes. It can't be sidestepped with Giuliani-style language about making insurance so affordable that everyone will buy it. You either have a commitment to universal coverage--as Romney did in Massachusetts and Schwarzenegger does in California--or you don't. Rudy doesn't. (No wonder he won't say how many of the 45 million uninsured his health-care tax cut would cover.) Note that this question lets Republicans embrace universal coverage without supporting a Canadian- or British-style single-payer system. Michael Moore aside, there are different ways to skin the cat here. Liberals should insist on Republicans who explicitly share their goal; how we get there can be negotiated.

Question 2: Do you believe individuals' buying their own solo health insurance can be the answer to the problem of the uninsured? The only noncallous answer is no. The problem with the individual market, as anyone with the most innocuous ailments can attest, is that profit-seeking insurers want to cover only younger, healthier people who don't need insurance. The very idea of individual insurance is an oxymoron, since insurance is about spreading risks across a group. Group coverage creates little socialized-health republics in which the young subsidize the old, and the healthy the unwell, with all those in the group paying the same premiums.

In Massachusetts, Romney made sure that individuals who are now mandated by law to buy coverage have access to groups, get subsidies if they're low earners, and can't be turned away because of existing conditions. (He fudged the financing, but it's the principle that counts.) Giuliani has called for none of this. If he really thinks the individual market is the answer, let's see this uninsurable prostate-cancer survivor try to buy a solo policy himself.

Question 3: Do you support limiting a family's annual exposure to medical costs to some reasonable percentage of its income? The noncallous answer must be yes. It is scandalous that in one of the richest nations on earth, millions go broke because they get sick. The failure to include income-related caps on medical spending is precisely why liberals view the right's fetish for high-deductible, consumer-directed health plans as nefarious, since these plans are sure to shift costs to unlucky sick folks who can't afford them. But if a Republican insists that such plans limit annual medical expenses to some fair portion of income, liberals should be willing to find common ground. Romney didn't do this in Massachusetts--a failing. But Giuliani actually boasts of an approach certain to hurt people. His health-care tax deduction, he gushed in Iowa recently, "allows you to go out and buy cheaper and cheaper policies [because] you can have higher and higher deductibles." When Americans earning $25,000 a year get sick and end up paying $10,000 or more in hospital charges, their "affordable" insurance courtesy of Giuliani will become a ticket to bankruptcy.

Bottom line: Romney's 2-out-of-3 noncallous score means liberals can work with him, though there's room for improvement. But Rudy's strikeout on the HCCAT means one of two things: The man hasn't thought through his own health plan. Or--sad to say--he just doesn't care.

Miller, author of The 2% Solution, is a senior fellow at the Center for American Progress