Health Care as a Winner

The Democratic presidential candidates have figured out that universal health care is now a winning hand. They just have to figure out how to play it.

Last month, the Kaiser Health Poll Report found that Americans were more worried about rising health-care costs than about losing their jobs, losing their retirement savings or being a victim of a terrorist attack. A New York Times poll released Wednesday found that 81% of Americans thought that Washington should pay for health care before enacting the latest Bush tax cut plan.

The knotty problem that’s left is how much to spend and how to distribute care. The $200-billion-a-year health reform plan proposed by Rep. Richard A. Gephardt (D-Mo.) is too much like President Clinton’s failed 1993 health reform. Its requirement that employers offer insurance, for instance, angers small businesses that claim they couldn’t afford it even with its tax incentives, and offends traditional liberal groups that see the incentives as a multibillion-dollar sellout to big business.

By contrast, more modest plans -- costing $80 billion to $88 billion a year -- rolled out this week by former Vermont Gov. Howard Dean and Massachusetts Sen. John F. Kerry are both more affordable and less alarmingly revolutionary.

The chief virtue of Dean’s plan -- unveiled Wednesday in a “lunch-box Democrat” stronghold, the New York headquarters of the Service Employees International Union -- is its simplicity. Dean proposes to cover most of the 41 million Americans without insurance simply by expanding the state and federal Children’s Health Insurance Program to include young adults, the working poor and seniors who fall through Medicare’s cracks. Payment would be on a sliding scale.

The key strength in Kerry’s plan, made public Thursday, is its emphasis on reining in health-care costs, which are rising at well above the rate of inflation. Kerry proposes computerized safeguards that would slash the $350 billion now spent on administrating health-care benefits, and reduction in medically dubious care. He would repeal laws that prevent low-cost generic drugs from competing more vigorously with brand-name medications. The strengths and flaws of both plans need to be hashed out in more open Democratic debates.

The Democrats, however, should all work together on at least one task: relentlessly pressing President Bush to offer a comprehensive alternative of his own to the clearly broken U.S. health-care system well before the next election. The Republican Party has scheduled its 2004 convention unusually late in the year, no doubt hoping to avoid such demands. Voters, however, should judge Bush by whether he addresses their most pressing concern sooner and seriously.

Agreement on universal health care -- an ideal envisioned by President Truman in the 1950s -- is growing universal. But planning has never gone beyond empty promises. Public opinion threatens to change that now, if the candidates have the courage to flesh out their plans and defend them.