Bush will revisit health care

WASHINGTON — More than 12 years after President Bill Clinton unveiled his plan to remake the nation's health care system, President Bush is moving the issue once again to the top of the national agenda and is expected to push a series of health-care proposals in his State of the Union address on Tuesday.

Where Clinton was driven by a desire to guarantee health insurance for every American, Bush is focusing primarily on health costs, which he says are swamping employers and threatening economic growth. Where Clinton favored a larger role for government, Bush has a fundamentally different philosophy, built on the idea that placing more responsibility in the hands of individuals will create market pressure to hold down costs.

The long-running debate has taken on new urgency as more and more companies find themselves struggling to pay for employee health benefits. Health care costs have been a big factor in the troubles of the domestic auto industry, among others.

But some policy experts, Republicans and Democrats alike, say the Bush proposals, which are built around tax breaks, may further drive up health spending and costs by fueling the demand for health care. Such unintended effects show how difficult it is to apply economic theory to the complexities of the current health care system.

By making health care a prominent theme of his prime-time address to the nation, Bush hopes to regain the initiative on domestic policy. Success with his health care proposals, after the failure of his effort to overhaul Social Security, would allow the president to build political momentum heading into the midterm elections this fall.

The White House has indicated that Bush will propose tax deductions for out-of-pocket medical expenses, rules to encourage the use of health savings accounts, and incentives for small businesses across the country to band together and buy health insurance, exempt from state regulation.

Regina E. Herzlinger, a professor at Harvard Business School, said, "Insuring the uninsured is a fine objective, but how will this control the health costs that are hobbling our global competitiveness? Health savings accounts will increase coverage, and that's great. But they are being touted as a way to control costs, and I very much doubt that claim."