As Democrats gather this week in Boston to nominate John Kerry for president, healthcare will be at center stage. The candidate's biggest domestic policy initiative is a $653 billion, 10-year plan to cover 27 million of the nation's 43 million uninsured and provide relief to employer-sponsored care through a form of government re-insurance for high-cost medical cases, to be paid for by repealing tax cuts for the wealthy.
Although healthcare may be a more muted topic at the Republican convention that begins next month in New York, President Bush will tout his Medicare reform and electronic medical-records initiatives, as well as his plan to cover about 2.5 million uninsured through about $90 billion in tax credits.
The real question is whether such proposals will translate into enough votes to affect the election. The early line is that they won't. Surveys show that the uninsured and sky-rocketing costs of care are part of a broader insecurity about the economy that may well determine the next president, but specific healthcare promises aren't getting much traction this year.
This isn't 1992, when another President Bush was facing a recovery that wasn't providing enough jobs, and Bill Clinton scored big with a call to take care of the uninsured (insert your own joke here). Nor is it 2000, when the need for a Medicare prescription-drug benefit had both major candidates making bold proposals.
This year the economy, the Iraq war and domestic terrorism are cited more often in polls. In a recent Kaiser Family Foundation survey, healthcare was fourth on the list of voters' priorities.
This is not to say that people are happy with what is happening in this industry. Republican pollster William McInturff says his most recent surveys show that Americans are less satisfied with their healthcare today than they were when he first started asking 12 years ago.
Kerry's task this week is to make his rather complex healthcare plan understandable to voters and to bring passion to the topic, inspiring people to believe he can make a difference without busting the budget.
His problem isn't that people don't want more coverage; most people favor universal access. It's that when a candidate gets specific, support drops off dramatically. As Harvard University healthcare opinion expert Robert Blendon puts it, "Americans think everybody should have insurance, but there's no single plan for universal coverage that more than one-quarter of the nation thinks is a good idea."
One of Kerry's ideas is to expand access to government programs such as Medicaid. A 2003 Harvard poll found that 82% of the public generally backed expanded Medicaid but support dropped off to 55% when respondents were told their taxes might rise to pay for it. These surveys show why it is so much easier to attack a healthcare plan than to successfully sell it.
The president, despite having delivered on Medicare reform, is hardly reaping any benefit. The Kaiser poll, only the most recent to come to this conclusion, found that only 28% of respondents said they had a favorable impression of the Medicare reform law. Democrats in general and Kerry in particular are seen as better suited to handle most healthcare issues. Only 4% of Americans were "enthusiastic" about Bush's healthcare policies, while at the other end of the spectrum, 15% were "angry" about them.
There are very real problems with the healthcare system, problems of quality and cost of care, access to care, and waste and inefficiency in the healthcare delivery system. Unless Kerry delivers something unexpected this week, however, we won't get very far toward solutions during this campaign.
What do you think? Write us with your comments. Via e-mail, it's [email protected]; by fax, dial 312-280-3183.