President Bush is widely expected to address health care in tonight's State of the Union address by pressing for an expansion of Health Savings Accounts and a new tax deduction for health insurance purchased on the non-group market. As Jonathan Cohn points out, Bush is tinkering around the edges here--and with misguided policies to boot--given the severity of the health care access and affordability problems we face as a nation. Americans are stressed out about paying for and keeping health insurance, and they are about to hear from their President that taking on more individual responsibility for the cost of health care is the answer.

Among the many lessons learned from President Clinton's doomed effort to reform the health system over a decade ago is that the policy development process tends to favor incrementalism. Restructuring the entire health care system proved so complex and impacted so many stakeholders (insurance companies, small businesses) that it became impossible to explain and all too easy to vilify. So President Clinton turned his focus to smaller initiatives such as the popular and successful State Children's Health Insurance Program (SCHIP). It appears that conservatives learned that lesson as well, as HSAs have their origin in a 1990's pilot program (in which they were known as Archer Medical Savings Accounts or MSAs), and were sweetened and expanded in the 2003 Medicare drug bill.

To be sure, there is a conservative, free-market grand vision behind President Bush's anticipated health care laundry list, as codified in the AEI publication Healthy, Wealthy, and Wise. It will be interesting to see if Bush parrots this vision tonight, claiming that his proposals are the solution to our health system's woes, or if he will frame the proposals as merely modest, harmless, incremental steps on the road to individual empowerment. Either way, there appears to be much evidence that they are neither.