Health specifics could backfire on candidates
By Susan Page
USA TODAY
Some observers warn that cost of Dem plans may give Republicans ammo in 2004 WASHINGTON -- The Democratic presidential contenders are detailing ambitious health care plans to cover the uninsured, the most substantive debate ever at this stage in a presidential campaign.
Admirably specific? Sure.
Politically smart? Maybe not.
Political analysts in both parties warn that the rush to stake a claim to an issue that will help candidates compete with one another in the early Democratic contests could boomerang and force the eventual nominee to defend an expensive and controversial promise against Republican attack in the general election next year.
The biggest Democratic plans being proposed are ''Karl Rove's dream come true,'' says Bruce Reed, a senior aide to President Clinton who now heads the centrist Democratic Leadership Council. Rove is President Bush's top political strategist.
An estimated 41 million Americans lack health insurance, and the issue routinely ranks near the top of voter concerns. In the past two years, the crisis has gotten worse because of job layoffs, spiraling health care costs and health program cutbacks by states that are struggling to close budget deficits.
But the problem has defied solution so far, in part because the majority of voters who have health insurance are reluctant to pay the considerable costs or accept the compromises that expanding coverage to everyone involves.
Political analysts say some of the Democratic contenders are overlooking that lesson and others that were learned the hard way in 1994, when Clinton's proposal to overhaul health care flopped. The repercussions wounded his presidency and were blamed for Democrats losing control of the House of Representatives and Senate.
Tax cuts targeted
Missouri Rep. Richard Gephardt has proposed a plan that would cost the Treasury more than twice as much as Clinton's plan, although it involves fewer structural changes in the way health care is delivered. He would require employers to offer coverage to workers and would pay for it by rolling back all of President Bush's tax cuts: $1.35 trillion over 10 years, enacted in 2001, and $350 billion over 10 years, enacted last week.
All the candidates who have outlined health care plans would repeal at least a share of the tax cuts to finance them. They are making the most unalloyed campaign promises to raise taxes since Walter Mondale's declaration in 1984. He lost 49 states.
Commerce Secretary Don Evans, who was Bush's campaign chairman in 2000, says the debate between Bush and the Democrats on health care will come down to whether voters want their taxes raised. ''I sure think Americans want tax cuts as opposed to tax increases,'' he says.
Democratic strategists argue that Americans want reliable health coverage even more. An NBC News-Wall Street Journal poll during the tax-cut debate last month found that 55% of those surveyed said they would rather see the government use that money for health coverage, compared with 36% who preferred tax cuts. After the nation's loss of jobs during his tenure, Democrats say, Bush's failure to deliver on health care is his biggest political vulnerability.
''The time has come to provide access to high-quality, affordable health care to every American,'' Connecticut Sen. Joe Lieberman declares. Gephardt calls it ''the moral issue of our time.'' Massachusetts Sen. John Kerry says expanding coverage is ''my passion.''
None of the plans comes cheap
Kerry, Gephardt, former Vermont governor Howard Dean and Ohio Rep. Dennis Kucinich have unveiled full-scale proposals. Lieberman says expanded coverage is one of four ''pillars'' of his approach to health care. He promises details later. North Carolina Sen. John Edwards, Florida Sen. Bob Graham and former senator Carol Moseley Braun say they're drafting plans now. The Rev. Al Sharpton, who doesn't have a specific plan, wants a constitutional amendment establishing health care as a right.
Kucinich backs a government-run, Canadian-style system to cover everyone, a fundamental change in the American approach to health coverage. Even advocates of action on Capitol Hill give that idea no chance in the foreseeable future. The other Democrats have proposed plans that build on the current system, which includes coverage through employers plus government programs for the poor, disabled and elderly.
Even Kerry's plan, the least expensive one on the table, would cost three times as much as the one outlined by Democratic nominee Al Gore in the 2000 campaign.
Kenneth Thorpe, chairman of the department of health policy and management at Emory University in Atlanta, has analyzed the detailed proposals. He places the annual cost of Gephardt's plan at $240 billion, Dean's plan at $93 billion and Kerry's at $89 billion. He says Kucinich's plan would be more expensive than any of the others.
In comparison, Gore's proposal in 2000 would have cost nearly $30 billion a year in current dollars. Clinton's plan in 1994 would have run just over $100 billion a year.
What's more, the details the Democrats are offering -- premium reinsurance pools, small-business mandates, COBRA provisions -- mean the plans are complicated to explain and easy to demonize.
''With all these proposals, the devil is in the details, and the more details that are out there, the more devilish a time these candidates are going to have,'' says a senior strategist to a campaign that has issued one of the plans. He and skeptics in two other Democrats' camps would speak only if not identified by name.
In contrast, Bush generally avoided becoming enmeshed in the specifics of implementing policy during the 2000 campaign. Instead, he would declare his principles on a key subject -- the value of providing more federally funded social services through religious organizations, for instance, or the need to extend prescription-drug coverage to all seniors.
The implication: Working out the messy details is for legislators, not presidents.
'The credibility primary'
But the debate over health care this year has become the keystone of what some strategists call ''the credibility primary,'' one of a series of hurdles the candidates are jumping to look serious in a big Democratic field and against a popular Republican incumbent. The early hurdles also include ''the money primary,'' a test of fundraising prowess, and ''the endorsements primary,'' the effort to get backing from other officeholders.
When he was running the Democrats' Senate campaign committee last year, Jim Jordan says he urged Senate candidates to avoid ''offering up inviting targets'' with overly detailed policy proposals.
But now, as Kerry's top aide, Jordan says the dynamic in a presidential campaign is different. ''Our interest groups are simply too wonkish, too demanding to allow any campaign to get away with offering up warmed-over slogans and aspirations,'' he says.
''There's a credibility test you have to pass,'' agrees Steve Elmendorf, Gephardt's top strategist. Being specific in the campaign is also a way to build public support that will help get an ambitious plan through Congress once a candidate is elected, Elmendorf says. He argues that Gephardt's plan repeals Bush's tax cuts in favor of ''cutting taxes in a different way'' -- by subsidizing health coverage.
Gephardt launched the current health care sprint when he unveiled his proposal last month. With it, he jump-started a campaign that had lagged on fundraising and electricity. His approach has been particularly well-received among the liberal-leaning voters in Iowa, which holds the critical opening caucuses, and among labor leaders. The powerful Service Employees International Union has demanded that candidates who want its endorsement outline proposals and the funding to cover everyone.
Dean, a medical doctor, already had laid out the framework of his plan. Once Gephardt moved, other candidates felt compelled to unveil proposals of their own.
''Without a serious health care discussion, they don't get out of the starting gate,'' says Democratic strategist Donna Brazile, who ran Gore's 2000 campaign.
Robert Blendon, a Harvard University expert on health care policy, says the issue is as fundamental and potent among Democratic voters as tax cuts are among Republicans.
The Democratic approaches fall into three broad categories:
* Cover everybody now. Gephardt and Kucinich are embracing proposals that provide health care coverage for nearly everyone. But their plans cost more than the other Democratic proposals. Critics say they don't address rising health care costs; proponents counter that covering everyone will result in savings and make it easier to address costs later.
* Add big building blocks. Dean and Kerry propose expanding state and federal programs to cover almost all children and low-income adults. They would provide tax breaks to encourage small businesses to offer insurance for their workers. Kerry's plan makes the greatest effort to control costs, including a provision to shield businesses from the huge health bills of the sickest people. He calculates that could reduce workers' share of premiums by 10%.
* Take it step by step. Aides to Lieberman, Edwards and Graham say they will outline plans soon that cost less but cover fewer of the uninsured. In the toughest exchanges of the campaign so far, the candidates have blasted Gephardt's plan for its cost.
At a candidates' debate in South Carolina last month, Lieberman likened it to ''big-spending Democratic ideas of the past.'' Edwards said that by repealing all of Bush's tax cuts, Gephardt's proposal would take money ''out of the pocket of working families'' and give it to big corporations in tax breaks to finance health coverage. ''It feels like saying, 'You're in good hands with Enron,' '' Edwards said.
Gephardt responds that his rivals are being too timid.
''If we're going to win, we have to stand for something,'' he says. ''If we're just going to be Bush Lite and try to keep half or more of the Bush tax cut and not really solve this health care problem, I don't think we're going to win the election.''
Meanwhile, Republicans are taking notes. When the Democratic nominee is chosen, rivals' critiques of his or her plan will be remembered and probably replayed by the GOP, Republican National Committee spokesman Jim Dyke says. He mentions the Democrats' fierce debate in South Carolina and notes, ''We have a tape of it.''
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