In his State of the Union address, President Bush called on Congress to pass a “comprehensive” health care plan, including caps on malpractice awards against doctors and legal changes allowing small businesses or individuals to band together to buy insurance.

The president also voiced his continued support for tax credits to help lower-income families buy increasingly more expensive medical coverage. Many Democrats support the credits, though disagreements over their size and structure and whether or not to pair them with expansions in public health programs prevented them from passing during Bush’s first term.

His remarks come as health care costs continue to exert increasing pressure both on the national economy and on family budgets. National health spending reached $1.7 trillion in 2003, topping 15 percent of the gross domestic product for the first time in the nation’s history, according to recent figures from the U.S. Department of Health and Human Services.

“To make our economy stronger and more productive, we must make health care more affordable, and give families greater access to good coverage and more control over their health decisions,” Bush said to enthusiastic applause.

Bush did not specifically mention the steadily rising number of Americans without health insurance, now numbering approximately 45 million. But he repeated calls for expanded use of tax-exempt health savings accounts (search) and more funding for building community health centers in poor rural counties; two policies that he has long backed as ways to spread health care to more people.

Democrats criticized Bush for failing to control health care costs, which have gone up an average of 9 percent nationally since he took office in 2001. Employer-sponsored health insurance premiums for the average family of four now exceed $9,000, according to the Henry J. Kaiser Family Foundation.

“Health care costs have shot up double digits year after year of the Bush administration,” Senate Minority Leader Harry Reid (D-Nev.), said in a televised response aired after Bush’s speech.

Rep. Nancy Johnson, R-Conn., backed Bush’s call for increased use of health savings accounts, saying they promote restraint by shifting some health costs from the government or employers to individuals. “One way to get costs down is to get people to use their health dollars more wisely,” Johnson, who chairs the House Ways and Means health subcommittee, tells WebMD.

Medicaid Looming

The president did not directly mention Medicaid (search) in his remarks on domestic policy, which instead largely focused his proposal to partially privatize Social Security. Still, Medicaid, the publicly funded insurance program for low-income people, remains a looming and potentially highly controversial part of the coming health agenda in Washington.

Bush administration officials have already left some lawmakers grumbling over reports of likely proposed cuts to Medicaid, which now serves close to 48 million Americans. The soon-to-be-released White House budget is likely to target the program, projected to grow 7 percent per year for the next decade, for cuts in an effort to ease budget deficits.

Health and Human Services Secretary Michael O. Leavitt said at a health policy conference Tuesday that Medicaid is “inefficient” and proposed tighter restrictions on Medicaid nursing home benefits, drug spending, and other areas that could save the program $60 billion over 10 years.

Leavitt also said that states should have more flexibility in setting optional benefits now used by many beneficiaries

But the cut proposals anger Democrats, who tell WebMD that the president’s call to partially privatize Social Security portend similar plans for Medicaid.

“He’s got a political agenda to privatize what has been a very good public health system” says Rep. Sherrod Brown, D-Ohio, the ranking member on the House Energy and Commerce Health subcommittee. “What he says is optional has become very important to the lives of seniors and children alike,” he explains.

Rep. Forney (Pete) Stark, the senior Democrat on the House Ways and Means health subcommittee, called Social Security “a Trojan horse” to launch further plans to privatize Medicare and Medicaid.

Stem Cell Debate Continues

Bush also made what appeared to be at least a partial gesture to a Congress that has so far deadlocked on the question of how to regulate research using stem cells (search) from human embryos. Conservative Republicans have supported attempts to enact outright bans on the cloning techniques needed to do the research, while others have proposed heavily regulating the practice so that it can stay legal for medical research but not for human reproduction.

Bush set a policy in 2001 that limited federal embryonic stem cell research funding (search) to some 70 stem cell lines already in existence at that time, saying he would not support the further destruction of nascent life for the sake of research.

Nearly all of the lines have since proved to be either inadequate for study or contaminated.

That helped spur stem cell research supporters, including a handful of anti-abortion Republicans, to push for allowing embryonic research under tightly controlled conditions.

Bush signaled continuing opposition to using human embryos as a source of stem cells, saying that science should not “take advantage of some lives for the benefit of others.” But he appeared to offer a willingness to consider continued use of cells from embryos not specifically created for research.

“I will work with Congress to ensure that human embryos are not created for experimentation or grown for body parts,” he said. “We should all be able to agree on some clear standards.”

By Todd Zwillich, reviewed by Michael W. Smith, MD

SOURCES: U.S. President George W. Bush. Henry J. Kaiser Family Foundation, Trends and Indicators in the Changing Health Care Marketplace, 2004 Update. Sen. Harry Reid (D-Nev.), Senate Minority Leader. Rep. Nancy Johnson (R-Conn.) chair, House Ways and Means health subcommittee. Rep. Sherrod Brown (D-Ohio), ranking member, House Energy and Commerce health subcommittee. Rep. Fortney (Pete) Stark (D-Calif.) ranking member, House Ways and Means health subcommittee.