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Candidates test pulse on health care

Hillary Rodham Clinton gets her second chance at reform with her new plan Monday.

By ASSOCIATED PRESS
Published September 16, 2007

WASHINGTON - It has been 14 years since first lady Hillary Rodham Clinton's health care reform plan sank like a stone, swallowed by fears of a big-government power grab. In the years since, wary presidential candidates at first avoided the issue altogether, then gingerly dipped one toe, then another, back into the pool.

This year, no self-respecting presidential candidate wants to be without a health care overhaul plan, and talk about "universal coverage" is back.

There is a stark difference between the medicine being prescribed by Democrats and Republicans.

Democratic candidates argue it is the government's job to make sure everyone has health insurance they cannot lose. Republicans are pushing more limited incentives and subsidies to help people obtain affordable coverage.

Both sides are trying to steer clear of anything resembling the 1993 plan. Clinton - now the candidate rather than the spouse - comes out with her own plan Monday, adamant that "we're going to get it done this time."

Democrats in general and the New York senator in particular approach the debate this time with better bedside manners than in the last major go-around.

Even defenders of Clinton's 1993 effort to change the system say the process scared the patient - namely, middle-income people who may want a better way, but have insurance and do not want to step into the unknown with health care.

Those fears were embodied by a middle-class couple named Harry and Louise, characters in an advertising campaign sponsored by the health insurance industry. The ads, targeting mainly opinionmakers in Washington and New York, showed the couple fretting over having to get their insurance through a "billion-dollar bureaucracy" that would include mandatory health insurance purchasing alliances.

This time, the candidates are all "being very careful to say that, look, if you have health insurance today, you can keep it," said Kenneth Thorpe, a professor of health policy at Emory University. He has helped the top four Democrats crunch the numbers of their plans and was involved in Clinton's 1993 effort.

Already, the GOP candidates are branding Democratic proposals as a step on the road to socialized medicine while they offer incremental steps such as tax breaks to expand coverage and make it more affordable.

"Let me tell ya, if we don't do it, the Democrats will," warns Republican Mitt Romney. "And if the Democrats do it, it'll be socialized medicine. It will be government-managed care."

Polls indicate health coverage ranks high with voters as a concern and that people are willing to pay higher taxes to ensure those without coverage get it.

Two-thirds in a Pew poll this year supported government-financed health insurance for all. But that is absent the sticky details of how it would work or how much it would cost.

Robert Blendon, who directs the Harvard Program on Public Opinion and Health and Social Policy, said the current climate favors Democratic activism on health care but that could change quickly if the insured believe there is a threat to what they have.

"The Democrats have tried to tone it down," Blendon said, and for the most part are trying to avoid alienating insurers, physicians and hospitals. John Edwards, whose plan is the boldest among the top tier of candidates because it mandates universal coverage, has not been shy about taking on the industry.

"But I think you will find Clinton reaching out to these groups with plans that many find quite acceptable," Blendon said.

Clinton has said she wants to "figure out how we provide universal health care without putting billions more into the system." Her goal has been universal coverage in eight years.

And what might Harry and Louise think of all this?

The health insurance association that sponsored the ads has since merged into a new trade group called America's Health Insurance Plans. Chief executive Karen Ignagni strikes a conciliatory tone, saying there is greater consensus this time to move toward universal coverage - and a better understanding of the political realities in getting there.

"We're in a different place than we were," she said. "I think that both sides are going to have to be very, very careful.

"The sweet spot in the middle is trying to create a workable program that individuals who currently have coverage believe is the right direction and will not cause them to lose coverage."

Where they stand

Democratic presidential candidate Hillary Rodham Clinton rejoins the health care debate in earnest Monday with a plan to expand coverage. Positions of other presidential candidates:

Democrats

Delaware Sen. Joe Biden: Expand health insurance to cover all children and to make catastrophic care available for all; look to states for ideas on moving toward universal coverage.

Connecticut Sen. Chris Dodd: Expand coverage by offering insurance that could be taken from job to job, with premiums based on ability to pay. No cost estimates offered for plan. Offer coverage similar to that in plan for federal employees.

Former North Carolina Sen. John Edwards: Achieve mandatory universal coverage by 2012 with a system of expanded federal health insurance, family tax credits and coverage requirements on employers, insurance companies and individuals. Increase taxes to pay for program's cost of up to $120-billion a year.

Ohio Rep. Dennis Kucinich: Favors national health insurance program covering medical, dental, mental health and long-term care for all, as well as prescription drugs. "My plan doesn't provide for a role for for-profit insurance companies."

Illinois Sen. Barack Obama: Require employers to share costs of insuring workers and ensure all children are covered. Offer coverage similar to that in plan for federal employees. Says package would cost up to $65-billion a year after unspecified savings from making system more efficient. Raise taxes to pay the cost.

New Mexico Gov. Bill Richardson: Tax breaks for businesses and for people who pay for their own coverage. Lower the eligibility age for Medicare to 55 and expand programs for poor and children. Package could cost up to $110-billion a year. Would seek savings in medical care by expanding spending on preventive care.e_SClBRepublicans

Kansas Sen. Sam Brownback: "Market-based solutions, not government-run health care."

Former New York Mayor Rudy Giuliani: Income tax deduction of $7,500 per taxpayer to defray insurance costs. Tax credit for poorer workers to supplement Medicaid and employer contributions, as part of "market-driven" expansion of affordable coverage. Expanded use of health savings accounts.

Former Arkansas Gov. Mike Huckabee: Favors market solutions, state innovation. "We don't need universal health care mandated by federal edict or funding through ever-higher taxes." Spend more on prevention and research.

California Rep. Duncan Hunter: Supported expansion of health insurance through tax breaks, not government-sponsored universal coverage.

Arizona Sen. John McCain: Has a record of promoting prescription drug coverage for older people and expanded insurance for children, but not universal coverage.

Former Massachusetts Gov. Mitt Romney: Incentives for states to expand affordable coverage. As governor, he signed health care law aimed at ensuring universal coverage through a mix of subsidies, sliding scale premiums and penalties for those who do not get insurance.

Colorado Rep. Tom Tancredo: Market reforms instead of more federal spending to expand health coverage.

Former Tennessee Sen. Fred Thompson: "Market-driven" expansion of affordable coverage.

[Last modified September 15, 2007, 23:43:31]