After Connecticut Sen. Joseph Lieberman weighed in last week, five of the nine Democratic presidential hopefuls had given their prescriptions for curing our nation's healthcare woes, which has to be some sort of record this far before the New Hampshire primary.
The plethora of plans reflects three political realities and neglects one large fiscal reality (which I will get back to). One, the war-torn Democrats need issues, and healthcare is one of the few on which the party consistently connects with voters. Second, it underscores the fact that healthcare has risen to the top of the domestic agenda. Third, it is a way for candidates to differentiate themselves from a pack that agrees on most domestic policies.
The plans vary wildly, from Ohio Rep. Dennis Kucinich's go-for-broke, $2.2 trillion-per-year single-payer plan to Lieberman's 10-year, $150 billion plan to speed the system of turning federal research on disease cures into treatments on drugstore shelves.
In between there are some interesting ideas. Former Vermont Gov. Howard Dean, who won kudos for covering almost all of his state's children and 91% of adults, wants to go national with his incremental approach, covering 30 million of the 41 million uninsured Americans through expansions of existing programs, including Medicaid and the State Children's Health Insurance Program, at an annual cost of around $88 billion. Sen. John Kerry of Massachusetts also has gone incremental with a $80 billion-per-year plan but has proposed ways to contain healthcare cost increases. For one, he would require pharmacy benefit managers to disclose rebates and incentives from drugmakers and get generic drugs on the market faster to spur price competition.
The ante was raised by former House Majority Leader Richard Gephardt, whose plan is projected to cost as much as $247 billion per year and would cover some 30 million of the uninsured, many through expanded employer insurance. His employer mandate would replace the current 30% pretax deduction with a 60% tax credit that companies would be forced to accept, just as they would be required to offer insurance. Employees would make up the other 40%. Of course, there is absolutely zero chance of such a mandate passing, nor is there money to pay for it.
Which brings us to that neglected reality. The Democrats want to pay for their plans through a repeal of President Bush's 2001 tax cut and any rollback that occurs this year, plus some other tax changes. The fact is, the Bush tax cut is not likely to be completely repealed. Also, nobody is accounting for a Medicare prescription drug benefit, estimated to cost at least $400 billion over 10 years and likely far more. Then, there is that little issue of the retirement of the baby boom generation, which will hit the Medicare program and any remaining employer-sponsored retirement plans like a tsunami beginning in 2012. Finally, expansion of SCHIP and Medicaid sounds good, but states are set to enact huge cutbacks in those programs this year that will leave hundreds of thousands of new uninsured, including children.
There is no doubt that healthcare will be an issue next year. According to a recent poll by the Kaiser Family Foundation, one-third of Americans are worried about the rising cost of healthcare, many more than are worried about losing their jobs, losing money in the stock market or becoming the victim of a terrorist attack. The Bush administration hasn't ignored healthcare, but its plans to use the drug benefit to push Medicare beneficiaries into private health plans and to turn Medicaid into something resembling a block grant are nonstarters.
If the Democrats want to exploit the issue, however, they will have to avoid beating each other's brains in with it first, and confusing or irritating voters in the process. The Kerry and Dean incremental approach, if neither bold nor groundbreaking, sounds like a plan.