W.’s Legacy

In his first term, President Bush and congressional leaders knew there was a strong political imperative to add a prescription-drug benefit to Medicare, and they enacted the Medicare Modernization Act with a squeaker of a vote in November 2003. The law continues to draw criticism from conservatives for adding a $400 billion drug benefit to Medicare. But because the benefit was created by conservatives and not liberals, it relied on competition and consumer choice, not government price controls. It has demonstrated over time that these market forces can drive down government spending (40 percent below estimates) while increasing consumer satisfaction. Medicare Part D was the model and continues to be the model for overall Medicare reform going forward.

The law also created health savings accounts, the fastest-growing health-care option in the private sector (threatened with annihilation under Obamacare). And it saved the private-plan option in Medicare (which Obamacare is also trying to suffocate).

In his second term, President Bush outlined a health-reform initiative to expand coverage to the uninsured that was bold, visionary, and undeniably free-market. It would have solidified the U.S. as the leader in high-quality health care while addressing the growing problem of the uninsured and middle-class anxiety about high health costs. It offered new incentives for consumers that would have made our health sector more efficient, more responsive to consumer needs, and more affordable. (I explained the details in this lecture for the Heritage Foundation.)

The president described his basic philosophy to enthusiastic applause on both sides of the aisle during his 2007 State of the Union Address, saying, “In all we do, we must remember that the best health-care decisions are made not by government and insurance companies, but by patients and their doctors.”

The president won support from theWashington Post, the Wall Street Journal, and experts from think tanks as traditionally divergent as the Urban Institute and the Heritage Foundation. But Republicans had lost control of Congress in the 2006 elections, and his proposal never got a hearing. Had the president pushed harder for health reform earlier in his presidency, the nightmare of Obamacare likely could have been avoided, because Americans would have had access to what they really want: personal, portable, affordable health insurance that they own and control.

Posted on National Review Online, April 25, 2013.

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