TOPICS > Politics

Health Care Becomes Key Political Issue for Candidates

May 29, 2007 at 6:40 PM EDT

JUDY WOODRUFF: Today, it was Barack Obama who stood up on the campaign trail in Iowa to lay out his health care proposals. The Illinois senator followed Democratic rivals John Edwards and Hillary Clinton in laying out ideas to create universal health care coverage, particularly by making coverage available and affordable for 45 million uninsured Americans.

Obama wants all Americans to be able to buy into a combination public-private health insurance system. Government subsidies would help cover those who couldn’t afford the whole tab, and employers would be required to pitch in.

SEN. BARACK OBAMA (D), Illinois: If you’re one of the 45 million Americans who don’t have health insurance, you will have a new plan after this plan becomes law. You will have health insurance that’s available to you. No one will be turned away because of a preexisting condition or illness.

JUDY WOODRUFF: Polls show that health care is a top issue among potential voters, ranking second to the war in Iraq. And the three leading Democratic candidates have all focused on lowering health care costs as instrumental to providing universal care.

Other key components of Obama’s plan: create a new National Health Insurance Exchange to strengthen the private health insurance market; no one could be denied health coverage based on their underlying health conditions; require parents to make sure their children had health coverage, either public or private; and relieve businesses of the high cost of covering the chronically ill.

Senator Clinton’s work on the issue goes back to the failed attempts early in her husband’s administration to come up with a plan for universal coverage.

SEN. HILLARY CLINTON (D), New York: I have tangled with this issue before, and I’ve got the scars to show for it.

JUDY WOODRUFF: Last week, nearly 15 years later, she began to roll out her own plan in phases.

SEN. HILLARY CLINTON: Our health care system is plagued with under-use, overuse, and misuse. It is, simply put, broken. As president, I will make it my mission to fix it.

JUDY WOODRUFF: In the first phase of her plan, Clinton would: create a computerized health information system to help reduce medical errors; end insurance discrimination against people with preexisting health conditions; and create a new Best Practices Institute to help determine which drugs and medical intervention are cost effective.

Former North Carolina Senator John Edwards was the first to make a major pronouncement on health care.

FORMER SEN. JOHN EDWARDS (D), Presidential Candidate: There are many millions more who are worried about losing their health care or worried about the cost of it. So I think there’s a huge groundswell for Americans to change the health care system.

JUDY WOODRUFF: Edwards would require all Americans to have health insurance. To help them obtain coverage, Edwards would: require employers to insure workers or assist in paying for coverage; issue tax credits or subsidies to make insurance affordable; make insurance available through new regional health markets.

Most of the other Democratic candidates also support universal health coverage but have yet to supply the details.

Among the Republican presidential candidates, health care has not yet become a major issue. Former Governor Mitt Romney did help create a universal coverage plan for Massachusetts but has spoken little about it since announcing his candidacy.

Why a Democratic issue?

JUDY WOODRUFF: For a closer look at health care as a political issue, we're joined by Robert Blendon, professor of health policy and political analysis at Harvard's School of Public Health and the Kennedy School of Government, and Susan Dentzer of our Health Unit. The unit is a partnership with the Robert Wood Johnson Foundation.

Good to have both of you. Thank you very much.

Robert Blendon, to you first. Why are the Democrats, as we just said, talking more about this issue than the Republicans? Why are the Republicans talking less?

ROBERT BLENDON, Harvard's School of Public Health: Because people don't understand how important this issue is to Democratic voters. It's one of the top domestic issues, if not the top. But for Republican voters, immigration and terrorism is much more important, so you won't win the Republican nomination by addressing the uninsured issue or cost issues.

But the Democrats really care about this year, and you have to have a serious proposal to be considered as a real front-running Democratic presidential candidate. They really feel this issue. Their voters are hurt by these problems.

JUDY WOODRUFF: Susan, just quickly, on the Republican voters, why isn't it as high on their list of priorities?

SUSAN DENTZER, NewsHour Health Correspondent: Well, I think, to add to what Bob just said, some of the Republican pollsters would underscore that it's also the Republican primary voters who matter here, and the people who are mobilized to get out and vote in primaries tend to be the base, the so-called -- even sometimes the radical right.

And as Bob said, what they really care about are taxes, spending. And even when you talk about health care for them, they very quickly begin to worry that, when you talk about changes in health care, you're talking about more government in health care. That's anathema for many of them. And that's why they really would much prefer to talk about the issues Bob talked about as opposed to the health care problems.

Broken health care system?

JUDY WOODRUFF: We noticed a comment that Rudy Giuliani made a few weeks ago. He said the Democrats -- he said, "Just wait, they're soon going to be talking about, all of them, about socialized health care," socialized medicine. Bob Blendon, how do Democrats, these Democratic candidates see the health care system in this country? Do they see it -- do they all see it as broken?

ROBERT BLENDON: Well, they see it as broken, but what's important is the proposals that they've made are much more centrist than, for instance, Senator Clinton's original proposal of 1993. They build on what we have. People who have private insurance from their employers would still have private insurance.

So they're building around the system. This is not Canada. This is not Medicare for all. This is not a new system. This is fixing an existing system by adding pieces that people have agreed to. And there's been a lot of effort, if you listen to these plans, to avoid some of the most controversial things that might lead to rationing or people being forced into plans they don't want to join.

This is a much more moderate Democratic approach. It doesn't mean Republicans will like it, because they're asking businesses to contribute for their employees and raising taxes on upper-income people. But the rest of the plans are things that many established groups have talked about over the last 10 years.

And what's important about Senator Obama is, he put himself in the middle of the Democratic presidential proposals. He's not to the left or the right. He's in the middle. He's got a credible proposal. And for most of the supporters who are Democrats, it will make them feel comfortable that he cares about an issue that's very important to them.

JUDY WOODRUFF: Susan, help us understand, what are the important distinctions between what Obama's saying, what Senator Clinton -- she's only rolled out a portion of what she said she's going to say here, we've got some sense of it -- and on the other hand, Senator Edwards?

SUSAN DENTZER: Well, the biggest difference is how they would propose to get to universal coverage. And would they, in fact, really get there?

They have all said that they're going to get there. But if you look at the mechanism, there are really two things you need to do to get to universal coverage. First of all, you knew a pool, a structure, through which everybody can buy insurance. And then you have to decide who pays into that pool, who pays for people to be there?

If you look at what John Edwards says, for example, he's requiring employers to offer coverage to their workers or pay into that pool. Senator Obama today said the same thing. You have to offer a meaningful contribution as an employer to coverage or pay into that pool. Senator Clinton, we don't know yet, but she certainly has said things that sound like she's going to talk about going the same way.

But Obama, for example, did not say that individuals have to buy coverage, whereas, in fact, John Edwards did. And some experts today were saying that could mean that his plan could leave as many as 5 million to 10 million people without insurance. If you don't require people to buy into a pool, many will elect not to do it.

The other thing I think is to talk about the dimensions of the pool. And here, again, it can get a little technical. But what Senator Obama was talking about was essentially taking the federal employees health benefits system, which covers about 8 million workers and their dependents, and allows them to buy private health plans, Blue Cross Blue Shield, Kaiser Permanente, HMOs, et cetera. He's talking about opening up that and making that available for all Americans to buy into, again with these dollars, some of which will come from employers and some from the federal government.

So if you look at the pooling mechanisms, they're all talking about slightly different approaches to getting to this large pool of health insurance.

Giving people choices

JUDY WOODRUFF: Just quickly, Bob Blendon, is that an approach that might be acceptable broadly to Democrats, to other Democratic candidates?

ROBERT BLENDON: Yes, I think the emphasis they have on making a group insurance policy available to everyone, giving them lots of private choices is extremely acceptable. So what is appealing to average people is that they would have a lot of choices. The government doesn't pick the plans.

But also what's appealing is, they would get a rate that was much lower, because it's a large group offering it. So I think this has a lot of staying power. And you'll see pieces of this in Governor Schwarzenegger's proposal and, in fact, Governor Romney's proposal.

JUDY WOODRUFF: Bob Blendon, one other question. Last time, we know -- certainly when the Clinton health care proposal came out in the early '90s, this was a factor. But what role today do you see the large interest groups out there, whether it's the pharmaceutical industry, the health insurance industry, hospitals, physicians, nurses, what role do they play today?

ROBERT BLENDON: If a plan came forward and every group you listed was against it, it'd be very hard to enact it in this country. I think what a lot of these proposals are doing is offering things that are acceptable to physicians, the group of insurers. They are harshest at the moment on pharmaceutical companies for this.

But I think they're trying to find a middle way so we won't replicate every group wanting to buy "Harry and Louise" ads and trying to destroy moving ahead. And these are much more compromised proposals this round than it was in 1993.

JUDY WOODRUFF: Susan, how do you see these important, these powerful groups, and the role they're going to play in all this?

SUSAN DENTZER: It's a much different environment than it was in 1993 and '94, as Bob suggests. And a lot of these groups, frankly, have been sitting around tables for the last dozen years talking about how to avoid what happened then, by coalescing around proposals that they can agree on.

And almost all these groups come down believing that, to get more Americans into coverage, you have to expand private coverage, and you have to expand public coverage. Certain groups of people are never going to be able to afford pure private coverage, or the market won't ensure them, so you've got to expand programs like the State Children's Health Insurance Plan.

Others believe very strongly that some of the greatest policies available today are in the private side and we have to shore those up, make them affordable, and, as Bob just said, get everybody into the pool to equalize the costs across large groups.

So they coalesce around those things. As people always say, though, the devil is in the details. And as we see more details coming out of these plans, surely many of these groups will begin to peel off, at least some of the proposals.

Political climate

JUDY WOODRUFF: Well, do both of you see then a more accepting political climate for the kinds of plans we hear these candidates talking about, Bob Blendon?

ROBERT BLENDON: I think, absolutely, these proposals are much more acceptable to not only the interest groups, but to Middle Americans. I think the biggest problem would be, after the election, is, do we have the resources to invest in covering the people and moving ahead?

But I think the outlines of these plans really are much more acceptable than they were in 1993 and provide a framework for where we can go. And the fact that Governor Schwarzenegger and Governor Romney back in Massachusetts have a lot of these provisions in their bills shows the possibility of bipartisanship, something that just disappeared in this issue in 1994.

JUDY WOODRUFF: And, Susan, quickly, even before we get to the election, you've got a different climate between the primary voter audience compared to the general election voters.

SUSAN DENTZER: That's right. And also 250 million Americans have coverage, and a lot of these proposals are aimed at improving coverage for people who already have it, making it more efficient, more cost-effective, getting better value for the health care dollar.

So these are plans deliberately tailored to appeal to people who do have coverage, recognize that they're paying 80 percent more in health insurance premiums than they were at the beginning of this decade, and want a better value for the buck. And I think bringing those people into the tent to recognize that there are things that can be done to improve health coverage for them is very important in this political process.

JUDY WOODRUFF: Well, thank you both, Susan Dentzer, Robert Blendon, for helping us understand all this. We appreciate it.