Issue of healthcare heats up
HEALTH CARE IS staking a claim to center stage on the national political and issue agenda for the first time since the great debate about the Clinton health reform plan in the early 1990s.
States like Massachusetts have shown that the ideological gridlock on health reform in Washington can be broken. The Democrats in Congress have placed a new emphasis on expanding health insurance coverage.
The Democratic presidential candidates have started to feature health in their campaigns and to lay out their health reform plans. Some Republican candidates are beginning to talk about health. Even Michael Moore's new film, "Sicko," is getting people talking and giving voice to the personal worries about the affordability of health care that Americans are all too familiar with.
All of these developments are turning up the heat on health. In a short period of time health has gone from an issue that was not even included on the list of seven issues voters were asked about on the national exit poll in last November's election to the number one domestic issue and the number two issue overall behind Iraq on several recent polls. Health is rising on the national agenda, but at least four things need to happen for this debate not to end in failure in the new Congress in 2009, as the last debate did in 1994.
First, the pace-setting states with comprehensive health reform plans need to achieve at least some measure of success, or substantial momentum nationally will be lost. All eyes are on Massachusetts because it is a comprehensive plan being implemented in the real world just as interest in health reform nationally is taking off. It is also the first test in the nation of a so-called individual mandate, a requirement that all residents purchase health insurance as they do for auto insurance in many places.
This summer, California will decide the fate of a similarly ambitious plan in its Legislature, concluding a debate kicked off when Governor Arnold Schwarzenegger put his health reform plan on the table. California is important because the state is so large and politically significant, and has 6.5 million people without health insurance. We can't reform health care state by state because too many states lack the resources and the political will, but a few states can show the nation that it may be possible to break through the impasse between right and left on health reform with an amalgam approach that spreads the responsibility of paying for expanded coverage and builds a broad coalition strong enough to pass legislation.
Second, business, largely a paper tiger on national health reform in the past, has to engage for real this time and add its muscle to the debate when it is joined in Congress in 2009. Business can be a counterweight to the influence of the insurance and drug companies, but in the past business leaders have complained about their health care costs but not actively supported national legislation.
Third, there will no chance at legislation in the Congress in 2009 unless there is a big national debate about health reform in the presidential campaign.
The leading Democratic candidates are already talking about health. For the debate to be joined, the leading Republican candidates need to do the same. They almost certainly will as the field narrows and they get closer to the general election and need to woo independent voters. Such voters place a higher priority on health than the Republican base the candidates are fighting over in the primary generally does, though health is rising as a concern for Republican voters too.
Fourth, when we get to 2009, our political leaders will need to show a willingness to compromise to achieve consensus, much as has been done in the cross-ideological approach in Massachusetts. No matter what the outcome of the election, whether we have divided government in Washington or somewhat larger or smaller margins between Democrats or Republicans in the Congress, it is unimaginable that the underlying ideological and policy divisions will have been transformed enough to produce support for a health reform plan that would fully satisfy the political right or left. It will be a centrist bargain or no bargain at all in 2009.
No matter what health reform approach you prefer, let the candidates know you won't contribute to their campaigns unless they address the issue. Then we can again have a real national debate, and the new president and Congress will feel that this next time around health reform is an issue they cannot duck.
Drew Altman is president and CEO of the Kaiser Family Foundation, a nonpartisan health policy research organization in Menlo Park, Calif. 
