Is Health Care Reform Fading As An Issue?

As the nation enters a new year and its quadrennial bout of temporary insanity, the latest polls show the economy has eclipsed health care as the most important domestic issue among voters. Even the health care-oriented Kaiser Family Foundation's latest poll shows the number of Americans who name health care as their primary concern fell to 30 percent in early December from 38 percent just two months earlier. When offered a list of possible issues the candidates ought to address, the economy had pulled even with health care.

The escalating fear that the nation may be heading into a recession because of the sub-prime mortgage meltdown and sky-high gas prices has certainly played a role in the turnabout. In that sense, 2008 is beginning to look a lot like 1992. The year before that election, health care dominated the national discussion after Harrison Wofford used the issue to win a surprise victory in a special Senate election in Pennsylvania. But by the time Arkansas Gov. Bill Clinton stormed to victory in the primaries, "it's the economy, stupid" had become the Democratic standard bearer's watchword.

That appears to be the way things are shaping up in Iowa and New Hampshire, which will hold caucuses and cast the first ballots over the next week. On health, the Democrats have coalesced around a common strategy to pursue safe, incremental reforms that rely in the insurance industry to get everyone insured. Meanwhile, the Republicans have become the radicals in the debate by calling for subsidies and tax breaks for individuals so they can "go it alone" as consumers in the dysfunctional individual insurance market.

These policies will mark a clear differentiation between the parties that should favor the Democrats come the general election. But the fine distinctions between the various Democratic plans, which are worthy of debate, are lost on the general public, and as things stand now, won't play much of a role in the primaries.

This, of course, is bad news for wonks like me who would like nothing better than to debate the fine points of the competing Democratic plans. Are individual mandates really the best way to go or is it a political trap? Should employers who don't provide their workers with health insurance be required to pay a payroll tax into a common fund to cover the uninsured? Should the government expand Medicare to people under 65 who lose their health coverage? Should the government set up another "Part" to Medicare to cover the uninsured and compete directly with the insurance industry plans?

A debate over these fine points would set the stage for political battles to come. Given the entrenched special interests that earn their living from the status quo, reform ain't going to be easy. If nothing else, the debate would educate the public about the complexities of the issue. Wouldn't it be nice if single-payer advocate Dennis Kucinich got a chance to explain to the public that having the government run a single, common insurance pool (sort of like Medicare) is not the same thing as socialized medicine?

Alas, it hasn't happened in Iowa and New Hampshire and probably won't elsewhere. One reason is that covering the uninsured and outsized health care costs simply aren't big issues in those early voting states. In the Commonwealth Fund's latest ranking of states' performance in covering the uninsured and delivering affordable health care, the two states ranked second and third in the nation, trailing only Hawaii.

In Iowa, fully 88 percent of the adult population has health insurance compared to a national average of 82 percent. In New Hampshire, the number was 86 percent. Moreover, both states did extremely well in quality measures such as delivering preventive care and treating adult diabetics. And both states had below average costs for Medicare enrollees, fully 20 percent below the national average in Iowa's case where the first blood in the presidential race will be drawn on Thursday.

If the candidates emerge from Iowa and New Hampshire in a dead heat as some polls now indicate, it's still possible that we will have a debate in the Democratic primaries about what is the best approach to health care reform. But if, as some pundits are predicting, Sen. Hillary Clinton's strategy of going for the early knockout proves successful and Super Tuesday in early February seals the nomination, then it looks like health care reformers come November are going to have to rely on the pol and not the plan.

Posted by gooznews at January 1, 2008 01:43 PM