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For George W. Bush and John McCain, health care really is a problem, the one that dare not speak its name. Neither man supposes he can avoid the topic all the way to November, but for now each talks about it with shrugs and mumbles. How to broaden coverage is a tough problem for Republicans to solve within the terms of the conservative taboo against government spending programs. Even when Bush admitted to one audience recently that uninsured working people were "a big problem," he added that "I'm worried about a plan that says we'll just have the national government come up with the answers."
If anything, the issue has taken both of the Republican front runners a bit by surprise. Republican primary voters are more conservative than the general electorate and were not supposed to care as much about health issues. Instead, both men have been getting hit regularly with voter questions about insurance, prescription-drug subsidies and the rough handling that some patients suffer from HMOs.
Bush does have positions on some of those issues, though sometimes vague ones. He favors medical savings accounts, which would allow Americans to buy catastrophic health insurance and set aside other money for health care in private, tax-sheltered savings accounts. He also talks about wanting to strengthen Medicare and improve the access that Medicare patients have to affordable drugs by providing more choice and more private-sector alternatives. What he doesn't have yet is a plan for doing any of that.
And on the campaign trail, Bush is almost grudging in his discussion of health care. In New Hampshire two weeks ago, at a public forum in the small town of Londonderry, a woman stood up and made an impassioned plea on behalf of the uninsured for Bush to put health-care reform at the top of his agenda. Bush's brisk reply bought audible gasps from the audience: "Some of those uninsured are just able-bodied folks who don't want to buy health insurance." In fact, he has a point. But the blunt way he introduced the notion, with the implication that the willingly uninsured are a substantial chunk of the uncovered population, made him sound like Ronald Reagan insisting that trees were a major cause of air pollution.
McCain gave a health-care speech in December in which he proposed to use tax incentives to provide medical-savings accounts. He also said he would spend a billion dollars a year to shore up long-term care and fix the faltering Veterans Administration health system. Like Bradley, McCain likes to cite health care as another reason for campaign-finance reform. "We can sit down in five minutes and come up with a reasonable patient's bill of rights," says McCain. "Why can't we? The Democrats are captives of the trial lawyers, and the Republicans are gridlocked by the HMOs and the big insurance companies."