President George H.W. Bush called it "The Vision Thing." It's one of the factors that voters and historians use to judge a president. Those presidents whose foreign or domestic policy agendas are coherent are usually viewed well by at least the latter if not by both sets of judges.
Since 9-11, discussion of the current President Bush's vision has been primarily limited to foreign policy and the Bush doctrine of "preemption." But while foreign policy has legitimately dominated, President Bush has quietly pieced together a domestic policy vision that has just as much chance to be revolutionary.
Many conservatives have faulted the administration's domestic policies because the government has not been a model of spending restraint under his leadership. Some have even started labeling him a "big government" Republican. This is a legitimate complaint. Bush clearly does not worship at the alter of a balanced budget.
Yet judging his policy vision solely by this measure misses Bush's larger goal. While FDR had his "New Deal" and LBJ had the "Great Society," it is becoming increasingly clear GWB wants to create an "Ownership Society."
Ownership, in Bush's worldview, is more than just the dream of owning one's own home, although he is successfully working to help with that as well – homeownership rates are at their highest point in our history and new home construction at its highest point in almost 20 years. To Bush, the principle of ownership can take many forms and solve many problems. From healthcare to retirement, the goal appears to be to move people from being dependent on the state to owners of their own security. If successful, this patchwork of policy initiatives will dramatically reshape the relationship of people with the economy.
One of the prime examples of this philosophy is Bush's approach to retirement. On this, President Bush has shown the courage to address one of the single most important issues – Social Security. Once thought to be untouchable, he appears to grasp that the fundamental flaw of the program's pay-as-you-go structure cannot be sustained with the demographic realities of longer life expectancies and lower birth rates. Without reform our children face a $25 trillion unfunded liability. Bush's answer is to give all workers a stake in the future of our economy and the ability to increase retirement savings by establishing assets that can be passed on to their heirs.
The idea of increasing access to ownership in retirement is not limited to Social Security. Bush has also proposed the creation of Retirement Savings Accounts, which will benefit Americans at all income levels, but especially low- and moderate-income families. They will extend the benefits of Roth IRAs, in which deposits are made with after-tax dollars, so withdrawals are tax free.
Nowhere is Bush's ownership vision more revolutionary than on the issue of healthcare. For decades the left has dominated the healthcare debate, and the answer has always been the same – more government. Whether it be Medicare, Medicaid, S-CHIPS or the liberal nirvana of a national government-run single-payer system; whatever the problem, more government control is their answer.
If anything, the Medicare prescription drug debate should have settled this issue forever. The only reason prescription drug coverage was an issue is that Medicare, a program so riddled with holes that the government wouldn't allow any private insurer to offer a similarly designed policy on the open market, literally takes an act of Congress to change the benefit package. Instead of seeing this as a ridiculous way to provide healthcare, the left would like to cover everyone in a similar fashion.
Bush sees things differently. Rather than making everyone reliant on government, Bush appears to believe the government should create the environment whereby everyone can own their own private insurance policy. To do this means reforming the tax law that has shaped and molded our healthcare system. The tax law penalizes people who purchase their own insurance. If the tax law treated employer-sponsored plans and self-insurance the same, we would see an immediate, sharp reduction in the uninsured population. Thus his proposal for healthcare tax credits.
But owning your own policy is not enough. Many of the other problems in the healthcare system, from rising costs to rationing of care, derive from the fact that most patients are disconnected from the cost and decision making of most treatments.
This is why the creation of Health Savings Accounts, an evolution of the medical savings accounts idea conceived by NCPA President John C. Goodman , was so important; they have the potential to revolutionize our health care system. HSAs should appeal to those who want an alternative to both government and HMO rationing, and to every individual who suspects that impersonal bureaucracies care less about us than we care about ourselves.
HSA holders will be able to manage some of their own health care dollars to pay expenses not paid by third-party insurance, including the cost of out-of-network doctors and diagnostic tests, or they can use the funds towards their deductible. And they will be able to profit from being wise consumers by having account balances grow tax free and eventually be available for nonmedical purchases.
Patients will make better choices if they can rely on doctors who put their interests first. In a managed care world, doctors too often view insurers rather than patients as their customers. With HSAs, however, physicians will be free to act as the agents of their patients.
This country was built on the principal that we were all endowed by our Creator with the unalienable rights to life, liberty and the pursuit of happiness. This was a rephrase of British statesman Edmond Burke's declaration that we all have the right to life, liberty and property. Since the time of FDR however, our nation's leaders have seemingly argued that it should be life, liberty and entitlement. The Bush domestic policy vision represents a sea-change from administrations past. It is one of empowerment; one that seeks to restore notion of ownership.