Health-Care Politics

THE Bush reelection campaign became official yesterday. But a big part of the campaign's initial boost was supposed to have come from the announcement last week of the president's plan for reforming the country's costly, mismanaged heath-care system.

Mr. Bush's plan predictably emphasized the use of market mechanisms to expand health-insurance coverage for Americans. He would provide low-income people with tax credits to enable them to purchase insurance privately. Middle-income people would get either modified credits or tax deductions for their current health-coverage expenses. The cost, as figured by the administration, would be around $100 billion.

The president's program has the advantage of maintaining strong elements in the current system - the employer-sponsored and other private plans that already cover millions of Americans. It doesn't go as far as plans devised by conservative think tanks in putting care decisions squarely in the consumer's hands, but its tax credits are designed to give some options to people who now have to take the minimum they can get through publicly funded programs.

But how are low-income people supposed to make sound decisions in this complex arena? And will the funneling of government money into the current system through tax credits only further pump up the system's rapidly inflating prices? The Bush proposal may in fact pose more questions than it answers. But it's sure to enliven the debate over an issue that strikes very close to home for most voters. The president has made clear what he wants the terms of that debate to be: "socialized medicine" versus a mark et-based approach.

It will be interesting to see how candidates who want a system that entitles all Americans to tax-funded health care, like Sen. Bob Kerrey of Nebraska, defend themselves against the "socialism" charge. Will the appeal of universal health coverage break through the public's leeriness about expensive, government-imposed solutions?