In a crowded field, Edwards' health plan sets him apart

Rob Christensen
McClatchy Newspapers (MCT)

RALEIGH, N.C. - Even before his wife, Elizabeth Edwards, learned that her cancer had returned, John Edwards had made health-care reform one of his signature issues in his quest for the White House.

Edwards mailed a DVD to every active Democratic household in the critical state of Iowa in March, outlining his plan to extend health insurance to every American. He has said health-care reform would be one of the first issues he would tackle as president. And Edwards has defied conventional political wisdom, saying he would raise taxes to pay for it.

"What we have is a dysfunctional health-care system in the United States of America," Edwards said at a recent Democratic presidential forum on health-care reform. "We need big, bold, dramatic change, not just small change."

But what kind of plan is Edwards putting forward? Who would it help? Who would pay for it? And does it have any better chance of getting through Congress than the plan backed by the Clintons more than a decade ago?

Edwards is not alone among the Democratic presidential hopefuls in advocating universal health insurance. His chief Democratic rivals, Sens. Hillary Rodham Clinton of New York and Barack Obama of Illinois, have both voiced support for the idea.

But Edwards is the only major candidate who has laid out a specific plan for making sure that everyone is insured. (Ohio Congressman Dennis Kucinich, a Democratic presidential candidate, has proposed extending Medicare to cover everyone.)

Democrats had largely avoided dramatic health insurance changes since President Clinton's proposed reforms crashed in 1994 amid strong opposition from the insurance industry and Republicans. The insurance industry attacked the Clinton health plan with its famous "Harry and Louise" TV ads - commercials featuring a middle-class couple complaining about its bureaucratic nature. Republicans ridiculed the plan, dubbing it "Hillarycare," in recognition of the leading role played by the then-first lady.

Since then, Democratic candidates, including Edwards during his 2004 presidential run, have offered politically safer, incremental proposals such as extending the insurance coverage of children.

But the political climate has rapidly changed. The insurance issue was once mainly the province of those concerned about the poor. Spiking health-care costs have become a major problem for businesses seeking to provide insurance and for employees who are paying higher premiums for skimpier benefits.

Health care ranks second to Iraq as an important problem for the government to address, according to a recent national poll by the Kaiser Family Foundation, a California-based nonprofit that focuses on domestic health-care issues. Respondents ranked health care ahead of terrorism and jobs.

"Health-care costs have been rising far faster than people's ability to afford them," said Larry Levitt, vice president of Kaiser. "Insurance premiums are up 87 percent over the last six years, far eclipsing wage increases. The uninsured have been rising consistently.

"Politicians are starting to catch up with voters' concerns. The combination of John Edwards pushing it on the campaign trail and a couple of prominent governors pushing it, particularly Mitt Romney of Massachusetts and Arnold Schwarzenegger of California, have helped make it a front-burner issue."

Schwarzenegger and Romney, a GOP presidential candidate, have pushed through health-care plans in their states.

The changed environment has emboldened Edwards, who has also been moving to his political left on such issues as poverty and the war in Iraq to attract liberal primary voters. Emphasizing health insurance also helps Edwards' courtship of organized labor.

In doing so, Edwards is resurrecting the ghosts of past presidential campaigns. Among the Democrats who have pushed for universal health coverage were Harry Truman in 1948, George McGovern in 1972 and Ted Kennedy in 1980.

The Edwards plan would require every American to have health insurance by 2012 - the last year of Edwards' first term if he were elected. The plan would first make health care available to everyone and then require people to carry health insurance, just as motorists must have liability insurance.

The plan is a mix of public and private strategies. Employers would be required to either provide insurance to their employees through a company policy, or to help fund coverage for their workers by contributing to regional nonprofit government entities that Edwards calls health markets.

"Everyone in America will be required by law to be covered by this health-care plan," Edwards said.

The health markets would use the economy of scale to negotiate affordable policies through insurers. Uninsured individuals could obtain coverage through a health market. So could employers seeking to provide group policies for their employees.

Insurance companies would be required to sell coverage at a fair price regardless of a person's medical history or pre-existing condition; what constitutes a fair price has yet to be determined. Insurers would also be required to offer mental health benefits.

Health markets would offer traditional plans from private companies such as Blue Cross-Blue Shield, Aetna and Cigna, as well as a government-run plan similar to Medicare, the federal health-insurance program for the elderly. The public-sector plan would resemble Canada's single-payer system, in which insurance is publicly funded to control costs but doctors and hospitals remain private.

"The idea is to determine whether Americans actually want a private insurer or whether they would rather have a government-run ... single-payer plan," Edwards said. "We'll find out over time where people go."

The mix of market and government initiatives makes Edwards' plan much harder to attack than Clinton's early 1990s plan, said Leif Wellington Haase of the Century Foundation, a liberal-leaning think tank.

"In this plan, the changes happen much more gradually," Haase said. "Each element has a market element that deflects the attack. I think it's a very smart political document."

Although Haase thinks the Edwards plan does not go far enough, conservatives fear it would take the country too far toward government-run care.

"It sets up a slippery slope to move toward a single-payer, government-run health care system," said Mike Tanner of the Cato Institute, a conservative-leaning think tank. "He realizes that Americans are not going to take that in one bite."

Tanner contends that under Edwards' parallel system, private insurance would be unable to compete with a taxpayer-funded system.

The single-payer system, Tanner argued, sounds good. But it would not be popular with citizens because it would ration treatment for expensive and long illnesses, and would discourage pharmaceutical companies from developing new drugs.

"Single-payer systems are good if you are not sick," Tanner said. "They provide routine care at low cost. But they don't provide intensive, expensive medicine for people with serious illnesses."

Edwards argues that the current system needs fixing. His campaign reports that 18,000 Americans die each year because they lack access to medical care. An estimated 47 million Americans are uninsured. In addition, he adds, businesses are struggling with medical costs, and people are finding it harder to change jobs because of the lack of affordable insurance.

Edwards is also proposing tax credits to make it easier for people of modest means to buy insurance through the health markets. His plan would expand Medicaid, the government health program for the poor, and State Children's Health Insurance Program, also known as SCHIP. Edwards says his plan would sharply reduce health-care costs because administrative costs for health markets would be lower than those of insurance companies.

Conspicuously missing from Edwards' plan are such Republican-backed ideas as individual Medical Savings Accounts or tort reform to reduce lawsuits against doctors.

Edwards is the only candidate to put a price tag on his health reforms - $90 billion to $120 billion per year - which he proposes to pay for by repealing the tax cuts pushed through by President Bush on families with a taxable income of more than $200,000 per year.

"I do not believe you can have universal health care without finding a source of revenue," Edwards said.

Everywhere he goes on the campaign trail, Edwards talks about his health insurance plan. He notes that his wife, Elizabeth, does not have to worry about insurance or the cost of drugs.

"One of the reasons that I want to be president of the United States," Edwards said, "is to make sure that every woman and every person in America gets the same things that we have."

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