When Values Are in Play, Republicans Have the Edge : Politics: Outfoxed at almost every turn, the Democrats grasp at the health-care issue to revive their sagging appeal among voters.

Consider the case of Rep. Marty Russo (D-Ill.).

In March, Russo introduced a bill in Congress that would do away with private health insurance and replace it with a government insurance program, paid for by higher taxes. That’s about as radical as you can get in U.S. politics without being investigated by the FBI.

Last Wednesday, Russo was one of three Northern Democrats who voted against the civil-rights bill sponsored by the House Democratic leadership. That’s about as conservative as you can get and still stay in the Democratic Party.

Russo represents a white, working-class district in Chicago. And he is “very good at reading his district,” as one political consultant said.

Russo illustrates an enduring truth about U.S. politics: Populism has two faces. On economic issues, like health care, populist sympathies run in the liberal direction: Everyone should have access to quality medical care, no one should go broke because of health problems and doctors and hospitals should not get rich from people’s misfortunes. On social issues like race, populist values are conservative: People don’t like government telling them how they must live and whom they must hire.

Economic populism has kept the Democratic Party in business since the 1930s. Democrats claim to devote themselves to the needs of average working people, while the Republicans are the party of the rich. For 25 years, Republicans have been using social populism, particularly white racial backlash, to undermine the Democrats’ economic populism. Richard M. Nixon ran as the candidate of the “silent majority” against George McGovern in 1972. George Bush used the Willie Horton ad against Michael S. Dukakis in 1988. Republicans see themselves as the party of mainstream American values, while the Democrats are elitist liberals.

Both strategies were on display in Washington last week, as each party tried to seize control of the nation’s domestic agenda and position itself for 1992. Senate Democrats introduced a bill to reform the nation’s health-care system. The White House effectively stopped the civil-rights bill by denouncing it as a “quota bill.”

Republicans have the advantage on both issues. That’s because on social issues, people usually vote their values. Which tend to be conservative. But on economic issues, they usually don’t vote their values. They vote their interests. Which, now, tend to be conservative.

The Democrats tried to put together a broad coalition of interests on civil rights. They included damages for women, disabled people and religious minorities in the bill. Then they put caps on the damages to satisfy business. They reached out to conservatives by banning quotas that force employers to hire unqualified people. They prohibited race norming, the practice of adjusting job applicants’ test scores by race.

It didn’t work. The Democrats ended up with the same number of votes for the civil-rights bill this year as last year. President Bush simply made it a values issue. He called the Democratic bill “a quota bill, regardless of how its authors dress it up.” He added, “You can’t put a sign on a pig and say it’s a horse.”

What doomed the Democrats’ effort was the fact that few voters had any interest in a new civil-rights bill. There was no public outrage over racial discrimination as there was in 1964--when the first civil-rights bill was passed. Last month, one poll asked, “If the civil-rights bill becomes law, do you think it will or will not affect your job or the job of someone in your household?” Most whites and blacks said it would have no effect.

On civil rights, the Republicans’ appeal to values works better than the Democrats’ appeal to interests. As a frustrated Democratic congressman put it, “The opposition to civil rights has a political constituency, and with subtle words and gestures, can be mobilized successfully in national politics.”

On health care, Democrats have values on their side. Senate Majority Leader George J. Mitchell (D-Me.) offered this appeal to economic populism when he introduced his party’s proposal: “Access to affordable, quality health care should be a right for all Americans, not merely a luxury for those who have the economic means to purchase health insurance.”

Senate Democrats have spent almost two years preparing their health-care plan. They have consulted business and labor leaders, health-care providers and consumer organizations. Moreover, they have settled on a proposal far more moderate than the Russo plan. Instead of a government-run, tax-supported national health insurance program, Senate Democrats are proposing a “pay or play” system--businesses would be required to offer health coverage to their employees or else pay a special tax to the government to finance a new public health-care plan for people without insurance.

The Democrats’ proposal would set up a government commission to recommend annual health-care spending targets, including targets for specific categories of spending, such as hospitals, physician services and drugs. The proposal also offers tax breaks to small businesses and self-employed people, to reduce the burden of paying for health insurance.

The fact is, the United States needs health-care reform more than it needs a new civil-rights law. The United States now spends almost $700 billion a year on health care. That figure has doubled in the last eight years. We spend far more on health care per person, and far more as a percentage of our national income, than any other industrial nation. Nonetheless, the United States ranks lower in life expectancy than 15 other countries, and lower in infant mortality than 22 other countries. Some 34 million Americans have no health insurance at all.

The Bush Administration says it is studying the issue. But it has not come up with any plan. “We challenge the President to demonstrate similar leadership,” Sen. John D. Rockefeller IV (D-W.Va.), one of the co-sponsors of the Democratic proposal, said last week.

Actually the Administration does have a plan. Its plan is to make the Democratic proposal a target. For example, the Democrats do not say how they expect to pay for their program, but it will almost certainly involve new taxes. The Administration will make that clear, and the taxpayers will scream.

The Democrats also fail to say how they would control medical costs. What if actual spending exceeds the targets? There will have to be some sort of enforcement mechanism to make the system work. Mention cost controls, and health-care providers start to scream.

Bush says he will veto any legislation that places a new burden on business. Small businesses are already screaming that they cannot afford either compulsory insurance premiums or a new tax.

Somehow or other, health care has to be rationed. We ration it now--by price. Americans who have good insurance coverage get good health care. The rest get abuse and indignity. The situation is outrageous. But what’s the alternative?

The alternative is bureaucratic rationing. That means more government control over benefits and more limits on choice. Doctors and patients will have to become more cost-conscious. Payments will be denied for certain benefits. Non-essential treatments will be postponed. Expensive new technologies will be monitored for cost-effectiveness. Difficult questions will be asked, like, “Is it worth spending $100,000 to keep someone alive on Monday so he can die on Thursday?”

Other countries ration health care. But this is America, and Americans are accustomed to getting the most and the best when it comes to health care. Are we going to tell people, as they do in Britain or Germany, that they have to wait two years to get a hip operation?

Americans don’t take rationing well. We had gas lines in the 1970s, and they nearly caused a revolution. In the end, the price of gasoline went up. People complained, but they found price rationing more tolerable than gas lines. If we try to ration health care, you know what will happen. People will scream. That’s what the Republicans are counting on.

For most voters, health care is more of a national problem than a personal problem. One out of every seven Americans has no health insurance. But the other six do. They are the ones who vote. And they are going to wonder whether the Democrats are asking them to pay for something they already have.

For health care to become a real crisis, Americans will have to see premiums rise out of sight or their coverage endangered. Until then, the Republicans’ appeal to interests is likely to work better than the Democrats’ appeal to values.

A leading congressional Democrat described his party’s problem after the civil-rights vote: “I watch focus-group tapes and I listen to town meetings in my district, and it’s the same thing, over and over. They think blacks have an unfair advantage in the job market. They think politicians are crooks, trying to steal everything they can get their hands on. They think teachers should stop asking for more money and do a better job. The only issue we have an edge on is health care. But overall, the people are just not there. They’ve had 10 years of Reagan and Bush, and it’s begun to sink in.”