A Man With a (Non-)Plan

I'm supposed to be writing about Rudy Giuliani's health care plan today. And I would, if Rudy Giuliani had a health care plan. But Rudy Giuliani doesn't have a health care plan. What he has is a pretext with which to attack the Democrats. Indeed, just about all you need to know about Giuliani's thoughtfulness on the issue can be summed up by the following: In the speech introducing and detailing his new health care proposal, Giuliani refers to the "Democrats" six times. "Single-payer" is said eight times. "Socialized medicine," or some variant thereof, makes nine appearances. "Uninsured" is never uttered -- not once.

But we'll get to the speech in a moment. First, it's worth wondering why anyone is even crediting Giuliani with a health care plan. The New York Times headlined their story "Giuliani Seeks to Transform U.S. Health Care Coverage," before telling us, in the tenth paragraph, that "Mr. Giuliani's speech offered very little in the way of specifics. He said his goal was to outline his 'vision,' with more details to come in the fall." I guess the headline "Giuliani Seeks to Transform One-Seventh of Economy, Couldn't Be Bothered to Offer Details on How" wasn't snappy enough?

Failure of the press aside, let's examine this "vision." What Giuliani offered is this: A tax exclusion of up to $15,000 for families, and $7,500 for individuals, to help pay for health care. What Giuliani is relying on is people reading those numbers -- $15,000 and $7,500 -- without noticing that they don't denote the amount of money he's offering them, but the amount of money he's not taxing them on. And when we plug it into my magical Rudy Translation Machine (constructed with the help of friendly neighborhood economist, Dean Baker), we can watch how $15,000 can easily become … zero.

Let's stipulate a family of four -- a mom, a dad, and two children. The type of family Republicans like. And let's say your household income is $30,000 a year. Giuliani's tax exclusion will save you … nothing. Your income isn't taxable anyway. Bring it up to $40,000 … and it's still nothing. Your child tax credits are crossing out your taxable income. Indeed, according to the Center for Budget and Policy Priorities, 55 percent of the uninsured don't earn enough money to have any taxable income. This proposal -- unless changed from a straight exclusion to a refundable tax credit -- will do literally nothing for them.

Don't get me wrong, some families will save a few bucks. If you make $50,000, Giuliani's exclusion will save you $1,220. And if you make $70,000, you'll get a whopping $2,250. And the higher up the income ladder you go, the more our hypothetical family unit will save. Meanwhile, here's the kicker: According to the Kaiser Family Foundation, in 2006, premiums for family coverage amounted to, on average, $11,480. Giuliani's giveaway barely makes a dent.

So it's no surprise that Alan Cohen, head of Boston University's Health Policy Institute, looked at Giuliani's "vision" and said, "I don't think it's likely to increase coverage of people to any great extent, and I don't think it's going to get a handle on health care cost inflation in this country."

In addition to the mismatch between the paltry amount of help Giuliani's proposal will offer most families and the skyrocketing costs of insurance, the idea suffers from deeper problems. Schemes based around tax subsidies just don't work. The RAND Corporation – no loony lefties, last I checked – recently conducted a study examining whether government subsidies could solve the problem of the uninsured. They researched the health care decisions of nearly 25,000 new health care subscribers in California. Their conclusion? "Government subsidies that cut health insurance premium prices in half for people without insurance would reduce the number of uninsured Americans by just 3 percent."

So Giuliani's proposal -- if it were more generous than it actually is, and would really cut premiums in half -- might reduce the ranks of the uninsured by three percent. I think the only word for such vision is "Kennedyesque."

But of course, the "plan" is not the point. It's the pretext. As NBC reported, "Giuliani laid out few specifics on an actual health care plan today in New Hampshire, and instead took shots at Democrats and Michael Moore on the topic." Lucky listeners were treated to such cutting bon mots as "Hillary, and Barack, and John Edwards are on an airplane headed to France," and "Michael Moore wants to take you to Cuba for your health care. Anyone want to sign up? I didn't think so. Maybe the Democrats will sign up."

Giuliani's plan exists to facilitate those attacks, not reform health care. As I mentioned earlier, Giuliani's speech afforded scare-mongering about "socialized medicine" vastly more time than it did the nation's 45 million uninsured, who didn't even merit a mention. Nonetheless, the New York Times and many other publications treated it as if it were a thoughtful proposal. It took Newsday to call a spade a spade. "Guliani," they wrote, "seeks to convince Republicans leery of his moderate social stances that he is conservative enough on the economic and national security fronts to make them comfortable. [The health care proposal] allows him to bash Democrats such as Hillary Rodham Clinton and John Edwards for promoting 'socialist' policies."

The twice-divorced, pro-choice, pro-gay Giuliani knows he's not conservative enough for the Republican base. But if he cannot erase his ideological heterodoxies, he can at least demonstrate some partisan reliability. Attacking Democrats as socialists and blasting Michael Moore ably demonstrates Giuliani's commitment to the vilification of liberals. Hating the right people is almost as good as believing the right things And having something that looks kinda sorta like an actual health care plan gets the press to cover his attacks on the Democrats as if the two sides were engaged in something worth reporting on -- say, a discussion of how to reform the American health care system. It's a smart political strategy for Giuliani, and comforting, in a way. At least we know he's got a plan for something.

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