If the next president decides to attempt it, health-care reform will be the space program of the early 21st century, a massive government undertaking, but this time with earthbound targets and no big heroes. No glamorous moon to go to, no John Glenn. All the same, in a nation where 44 million people don't have medical insurance, and where a lot of the insured aren't happy with the care they get, there are probably more people rooting for an HMO fix than were ever waiting for a lunar landing. When voters tell pollsters that health care is among their top election-year concerns, that's because the frailty of the body is one issue that touches everybody--aging baby boomers, their vulnerable children, their fragile parents.
Because of its universal reach and its complexity, the problem of health care is a useful way to measure the political temperaments of the four major candidates. For Al Gore and Bill Bradley, the issue is irresistible but also bewitched. The good news for them is that Democratic primary voters want to hear about health care, which means Gore and Bradley can get an early start on identifying a big issue for November. In a sense, when Bill Clinton last week offered his own 10-year, $110 billion plan to extend coverage to more of the uninsured, he extended coverage to Gore as well. Whatever fate his plan meets in Congress, where the patient's bill of rights languishes in conference, Clinton's proposal guarantees that health care will be part of the public conversation through the spring, and that is a discussion in which Democrats know how to talk the talk.
As a sign that the talk is already well under way, the Health Insurance Association of America, which sponsored the "Harry and Louise" ads that helped derail the Clinton plan for universal coverage in 1994, rolled out a new series of ads last week. But now the fictional couple is in favor of an insurance-industry initiative that would expand coverage of the uninsured through broadened federal programs and changes in the tax code. "It was important to get this advertisement out there at this formative stage of the election year," says HIAA president Chip Kahn, a former legislative aide to Newt Gingrich.
But voter expectations also require Gore and Bradley to make concrete proposals, so each of them is providing the other with a target to shoot at. The two Democrats have offered big, detailed plans, but each has a different emphasis. Bradley's is big but not so detailed. In its main element, it would abolish Medicaid, which provides coverage for the poor, and channel them instead to enroll in the insurance program already available to federal employees. Bradley would also offer the poor tax breaks and subsidies to help pay for insurance. Gore's plan is detailed but not so big. He aims to provide every child with health care by 2005, but he proposes to do that mostly by expanding the existing Child Health Insurance Program (CHIP), a federal program for uninsured children of low-income families. Both men would offer a prescription-drug subsidiary to everyone on Medicare.