WASHINGTON -- There was a reason George W. Bush's handlers fought some over the hilariously fraudulent health care proposals he eventually made last week. He can't pay for any of them within the context of a balanced federal budget.
So the economic policy types argued for a proposal carefully targeted on uninsured Americans with very low incomes. But the political types won out with an idea essentially twice as large in cost but of no significant consequence for the uninsured.
Both sides down in Austin labor under the illusion that Bush can responsibly offer any domestic policy initiatives other than the income tax cut he proposed last fall, whose independently measured impact over a decade - at a minimum - consumes any possible budget surplus outside the Social Security system. But even accepting that illusion, the governor's health insurance proposal required fraud, which he was happy to perpetrate behind the usual cloud of florid rhetoric.
The first element of the fraud was Bush's repetitive use of a single word: access. Where health insurance is concerned, working families of modest means should hide the silverware when they hear a politician use that word. Working families don't need access to it, they need health insurance, period.
In the ongoing national debate, politicians use ''access'' to disguise proposals that don't actually provide it. In Bush's case, ripping away the facade is easy. All you have to do is keep three amounts of money in mind: four grand, two grand, and one grand.
Four grand, give or take, is the average cost of a group health insurance policy for a family with a breadwinner in a large company that offers such benefits. Of course, where Bush is involved, that is being very charitable because the governor's proposal is designed to give individuals ''access'' to the private (as in, you're on your own) insurance market. In that world, four grand price tags for a family don't exist. They also don't exist in the corporate world anymore, because the average cost figure was for 1998, and guess where costs have gone since then.
But even assuming that was a decent benchmark from which to measure Bush's key proposal, you would start laughing once you thought about one grand and two grand. One grand is the maximum ''value'' of the refundable tax credit individuals could get who are uninsured now and above Medicaid's eligibility level; two grand is the maximum for family coverage. The refundable credit (meaning you get it in cash even if you have no income tax liability) would phase out above $30,000 in income and end at $45,000 for individuals and $60,000 for families.
In short, a low-income, uninsured family would end up with ''access'' but no insurance it could possibly afford. So how do independent experts figure the Bush plan would cost roughly $150 billion over a decade and still reduce the ranks of the uninsured by a few million (the total is nearly 44 million and growing) at the very most? The answer is that Bush wastes gobs of money on middle- and upper-middle income people who already have health insurance and need taxpayer assistance the least. This is the second element of the fraud.
The fraud was disguised by Bush rhetoric last week describing the plan as aimed at people who are not covered by a government program or an employer's insurance plan. To the uninitiated, that is supposed to sound like he's talking about the uninsured; in fact, the proposal includes people who buy insurance on their own in the private market.
That group of Americans - fewer than 10 million today - would not benefit more than a little from the Bush plan. Keep in mind that the median household income is around $39,000, and keep in mind that Bush's income phaseouts for the tax credit begin at $30,000. But the plan is certain to increase the ranks of these hard-pressed families by a lot - still another hidden defect of major proportions.
Remember that the health insurance mess gets worse daily. That's because firms that now offer it continue to drop it and because new businesses typically don't offer coverage. But now comes a conservative politician with a dreadful record on health care in Texas who is offering new tax breaks to people who are already struggling to buy insurance on their own. If you are an employer with a coverage plan, how are you supposed to react?
Simple. The obvious incentive will be to drop workers from health insurance coverage, your conscience (if you have one) assuaged by the availability of Bush's subsidies. The governor, in short, has come up with a plan his business executive pals and campaign contributors will love because it encourages them to add to the ranks of the uninsured.
And to the already uninsured, Bush offers a tax credit of no use to working families of modest means for the dubious freedom to shop in an unregulated market that at times is more racket than business.
Bill Bradley at least tried to offer much larger tax credits for direct use within the multiple-choice federal workers' insurance plan. But even he failed to provide a real choice within that system, especially when compared to what is offered under Medicaid, which he would have abolished. What Bush has offered is by comparison absurd.
Thomas Oliphant is a Globe columnist.
