This page has criticized the Bush administration’s weak performance on many important health care matters: its failure to address the problem of millions of uninsured Americans or stem the rising costs of health care, its refusal to expand eligibility for the State Children’s Health Insurance Program, its devious maneuvers to cut Medicaid spending, its support of unjustified subsidies for private health plans, to name a few.
It is only fair to note that President Bush can also lay claim to some signal achievements in health care – achievements that we urge President-elect Barack Obama to continue and develop further.
As we have argued in the past, Mr. Bush deserves high praise for significantly increasing American support for the global effort to control AIDS. We were pleased that Congress has now authorized even more money than Mr. Bush proposed: almost $50 billion to fight AIDS, malaria and tuberculosis around the world over the next five years. But there is little doubt that the president has played a key role in providing drug treatments or supportive care to millions of patients who would otherwise have gone untended.
It is a remarkable record for the leader of a party that had been reluctant in the Reagan era to deal with a disease whose victims at the time in this country were primarily gay men and injection drug users.
Equally remarkable was Mr. Bush’s decision to push through a costly new prescription drug benefit under the Medicare program for older Americans despite stout opposition in his party to government-run health care. It was the largest expansion of Medicare in decades and it dragged the program, at long last, into the modern medical era, in which drugs are a cornerstone of treatment.
We have objected to many features of the program – the refusal to allow the government to negotiate with manufacturers for lower prices, shortfalls in providing subsidies to low-income Americans, a failure to protect many patients from high out-of-pocket costs. Still, it has achieved its main goal by reducing the percentage of older Americans who lack drug coverage, from 33 percent before the program started to only 8 percent in 2006.
Less heralded was the Bush administration’s willingness to grant Massachusetts a Medicaid waiver to redeploy federal funds to help start a universal health insurance program. The program took the controversial step of requiring all citizens to obtain health insurance or pay a penalty, precisely the sort of government mandate that drives many conservatives wild. By many measures it is off to a promising start and could become a model for other states or the federal government.
Another substantial health achievement came in the form of bricks and mortar, through the president’s vigorous support of community health clinics. As Kevin Sack reported in The Times last week, Mr. Bush has doubled direct federal financing for community health centers, enabling the expansion or creation of almost 1,300 clinics in areas short of other medical resources. For many residents of poor urban neighborhoods and isolated rural areas, this is the only source of care other than possibly a costly hospital emergency room.
The program has its blemishes. It still falls far short of its goal of doubling the number of patients served. Almost half of the country’s medically underserved areas still lack a health center site. Many clinics are short of staff members and do poorly at managing chronic diseases. And they typically find it difficult or impossible to refer uninsured patients, a large part of their clientele, to other health care providers for diagnostic tests like mammograms and colonoscopies or visits to cardiologists and other specialists.
And Mr. Bush has done almost nothing to shore up the public insurance programs, notably Medicaid and the State Children’s Health Insurance Program, that provide the bulk of the clinics’ funding through the patients they cover.
That is another reminder that despite these solid achievements, the country needs to do a lot more. It needs full-fledged health care reform that will improve the quality of medical care, reduce its overall cost and provide insurance for everyone, at affordable prices.