For Democrats, health care has long been a merciless minefield. Hillary Clinton's disastrous effort to transform the system in her husband's first term nearly cost him the presidency. After that, politicians pretty much stopped talking about the subject except to offer marginal and politically unassailable fixes, like covering more children or requiring insurance companies to accept people with pre-existing health conditions.
Not anymore. Every Democrat in the 2008 presidential field has promised to provide health coverage to all the estimated 47 million Americans who lack it and to curb costs that have sent premiums soaring four times as fast as wages. On March 24, seven candidates showed up for a health-care forum that I moderated in Las Vegas, sponsored by the University of Nevada, Las Vegas, the Service Employees International Union, and the Center for American Progress Action Fund. (Though all the Republican contenders were invited, none accepted. Senator Joe Biden was the only Democrat to decline.)
There was no disagreement over the need to fix health care, only over how fast it could be done. New Mexico Governor Bill Richardson said he could accomplish it in his first year in the White House; New York Senator Clinton said it might take until the end of her second term; everyone else was somewhere in between. There was some dispute over whether reforming the nation's health-care system would require new taxes. Former North Carolina Senator John Edwards said it would; Richardson said it wouldn't; others were equivocal.
Why the political climate change on what had been an untouchable subject for more than a decade? For one thing, the problems of high cost and inadequate coverage have gotten a lot worse since Clinton's plan crashed and burned. As employer-provided insurance has become skimpier and skimpier, the problem has turned nearly every American into an "expert" on health care with ideas on how to fix it. For another, the corporations that were Clinton's chief adversaries in 1994 are now among the loudest voices clamoring for something to be done about health-care costs. In the meantime, some states--among them, Massachusetts, California, Maine and Vermont--are moving ahead to guarantee all their citizens coverage.
But while health care for all is now a popular slogan, Edwards is the only candidate offering a plan that would actually get to universal coverage. His proposal is much like a model that is being tried or considered in several states and that includes a combination of features. For example, it requires employers who don't insure their workers to pay into a fund for the uninsured, and individuals who don't get coverage from their employers to buy it, and provides subsidies for those who can't afford the premiums.
Illinois Senator Barack Obama disappointed many who attended the forum. Obama says he is thinking big when it comes to health-care reform, but he was noticeably uncomfortable when pressed for details. Morgan Miller, a young woman in the audience, told Obama that she had searched his campaign website for specifics and hadn't found them. "What really are your top issues when you want to talk about health care?" she asked him. "Are you going to address the pharmaceutical companies? Are you going to address the insurance companies?" Obama, pleading that his campaign was only eight weeks old, promised to answer those questions in a few months.
Clinton doesn't have a plan yet either. But she says her proposal, when it comes, will contain the most controversial element of her failed earlier effort--an employer mandate requiring all businesses to provide health insurance for their workers. "No more free riders," she declared. "No more companies that don't insure everybody and shift their costs onto other companies that do and onto the taxpayer." Clinton warned that her plan will spark a "big political battle" because it will mean "taking money away from people who make out really well right now." And who might those people be? "Well," she answered, "let's start with the insurance companies." Let the battle begin--again.