Democrats and their presidential nominee, John Kerry, didn't get the post-convention "bounce" they had hoped for. With so few undecided voters, neither Kerry nor President Bush is likely to benefit from the renewed campaign energy a convention usually generates, pollsters and others are saying.
That leaves the candidates in a neck-and-neck race where some voters might be swayed by a single issue important to them personally-which is where healthcare comes in. Seeking to capitalize on that, the Democrats have been relentless in pushing their plan for affordable, high-quality care for the vast majority of Americans.
As always, the devil is in the details. None of the Democratic convention speeches, including Kerry's, elaborated on how the senator's 10-year, $895 billion reform plan would actually work, and whether it would accomplish what the campaign says it will-namely, providing health coverage to all children and 95% of the population broadly.
The Kerry team was careful to orchestrate a convention where healthcare coverage was a centerpiece of the agenda but where politically charged phrases like "universal coverage" and "single-payer system" were not mentioned in official proceedings.
Away from the convention podium, however, not everyone was so cautious. At a healthcare forum in Boston's historic Faneuil Hall, sponsored by the Service Employees International Union and the consumer group Families USA, a string of high-profile Democrats-from former Vermont Gov. Howard Dean to House Minority Leader Rep. Nancy Pelosi of California-railed against Bush and Congress for not addressing the uninsured or the growing disparities in how people of different races are given care.
Party officials and lobbyists say Republicans will use their convention to focus on the economy, homeland security and Iraq. Healthcare, therefore, won't get the same play it did in Boston. For critics of the Bush administration, the reason for that is simple: Kerry's plan, whatever observers may think of it, is much more far-reaching than the White House's.
"If I were advising the Bush campaign, which I am decidedly not, I would say retool to announce a much more ambitious health reform plan with a price tag that adds a zero to what (Bush) has," says Ed Howard, executive vice president of the bipartisan Alliance for Health Reform, Washington.
Under the broad strokes of his healthcare plan, Bush proposes spending $90 billion over 10 years on healthcare tax credits and other steps to make coverage more available and affordable. Analysts have said the plan will expand access to care to just 2.5 million uninsured, but the administration says it would cover four times that number.
Analysts say Bush, too, is unlikely to provide much more detail, especially at a convention where energy, charisma and fiery language always beat out finite policy plans. But Republicans argue fervently that the Bush healthcare record is strong and that Democrats are the ones who have put the brakes on measures to relieve soaring costs, such as medical liability reform.
"President Bush and the Republicans have a lot of positive things in the healthcare arena to talk about," says Pete Jeffries, director of communications for House Speaker Rep. Dennis Hastert (R-Ill.). He cites health savings accounts, Medicare prescription-drug discount cards and Republican-led efforts to put caps on the awards allowed in medical liability cases.
The Senate has rejected measures to limit the noneconomic damages plaintiffs can collect, allowing Republicans to blame Democrats for kowtowing to trial lawyers and to chide Kerry's running mate, North Carolina Sen. John Edwards-a former plaintiffs' lawyer-"whose whole platform when it comes to healthcare is to sue people," Jeffries says.
How much of an effect comprehensive or partial medical liability reform would have on escalating costs is anyone's guess. For voters who don't spend their time studying health policy, the bigger picture is more important.
In a recent poll conducted by Democratic polling firm Lake Snell Perry & Associates, 12% of voters said healthcare is the "single most important issue" in their vote for president. Fifty-four percent said rising healthcare costs are a "very serious problem."
Not wanting to get themselves in trouble, some hospital lobbyists quietly echo Howard's view that it's surprising Bush hasn't come out with a more comprehensive plan to address the uninsured. At a public event last week in Washington, a Bush-Cheney campaign spokeswoman declined to say what Bush's second-term healthcare agenda would entail but argued that the president would cover as many as 10 million uninsured while controlling costs with a series of initiatives.
There are some areas of agreement among the campaigns. Most significantly, everyone seems to think that information technology can be used to improve healthcare delivery and administration, and that the federal government should help. Again, however, IT represents a tiny piece of the puzzle for voters struggling to insure and care for their families.
"A lot of concerns around the economy have to do with healthcare," Howard says. "It's a larger factor on people's minds than shows up in the polls."
To be sure, the Republican convention will not avoid healthcare. Instead, they will paint a different portrait of how the system should change and downplay Kerry's plan as too expensive and expansive to make it off the canvas.
Political platforms and policy proposals are no more than visions of what might-or should-be. As the election approaches, what really matters are voters' perceptions. Do they prefer Kerry's 10-year plan to improve coverage, or do they want a president who favors more incremental and market-driven solutions?
We'll find out who won Nov. 2, but given that voters are rarely clear on policy details, the winner is unlikely to have much of a healthcare mandate.