FEBRUARY 1, 2006 -- Although tax breaks dominated health care coverage of President Bush's State of the Union address, the speech wove in other health-related issues that allow GOP candidates in the midterm congressional elections to talk the talk on health care this fall regardless of whether they can walk the walk.
Bush, for example, called for the creation of a new bipartisan congressional commission on Social Security, Medicare, and Medicaid. Military and other spending priorities and Bush's goal of cutting the federal deficit in half by 2009 put pressure on the president to cut Medicare and Medicaid entitlement spending again this year.
A new commission could give him some cover and reduce the political fallout, according to Daniel Mendelson, who was in charge of federal health care budgeting in the White House Office of Management and Budget under President Bill Clinton.
Elevating the entitlement issue now also gives Republicans a shot at turning Medicare cuts into a political virtue when the cuts are normally seen as a political liability. With the enormously expensive era of baby boomer Medicare looming, the need for painful changes in entitlement programs must be confronted, they can argue.
"We need to put aside partisan politics and work together to get this problem solved," Bush said in his speech Tuesday night.
Any moves to trim Medicare and Medicaid spending exposes Bush to attacks that he is undermining health coverage at a time of rising uninsurance. But Bush can counter by saying health savings accounts are proving to be a popular and affordable health care option, and that his tax breaks will make them even more affordable, Mendelson added. Mendelson now heads Avalere Health, a Washington-based consulting firm.
Bush also can argue that the accounts have the potential to tame another big health care problem bedeviling Americans, that of rising costs.
On that front, Bush called attention to two other proposals Republicans say will restrain rising health care costs: overhauling the nation's medical malpractice laws and spurring adoption of health care information technology.
Bush appealed to social conservatives with a call to pass legislation that would "prohibit the most egregious abuses of medical research." Bush specifically called for an end to "human cloning in all its forms; creating or implanting embryos for experiments; creating human-animal hybrids; and buying, selling or patenting human embryos."
Bush tied his appeal on medical research to religious morals. "Human life is a gift from our creator, and that gift should never be discarded, devalued, or put up for sale," he said.
Bush also sought to build on the good will he has built up among African Americans with his record of increased spending to counter HIV/AIDS. While his increases have focused more on global HIV/AIDS, his emphasis Tuesday evening was on domestic spending.
"A hopeful society acts boldly to fight diseases like HIV/AIDS, which can be prevented and treated and defeated," he said. "More than a million Americans live with HIV, and half of all AIDS cases occur among African Americans," he said.
"I ask Congress to reform and reauthorize the Ryan White Act and provide new funding to states so we end the waiting lists for AIDS medicines in America," Bush said. "We will also lead a nationwide effort, working closely with African American churches and faith-based groups, to deliver rapid HIV tests to millions, end the stigma of AIDS, and come closer to the day when there are no new infections in America."
Missing from the speech was any reference to specific dollar amounts Bush plans to spend on any of the initiatives. Health care lobbyists aren't holding their breath.