Can you say DISGRACE?
September 30, 2003
Boiling Brew: Politics and Health Insurance Gap
By ROBIN TONER
ASHINGTON, Sept. 29 — The jump in the number of Americans without health insurance is not just another bad economic statistic.
Health care costs are soaring again, after several years of stability; average premiums rose nearly 14 percent this year, the third year of double-digit increases, according to the Kaiser Family Foundation. Employers are pushing more of the costs onto their workers, raising co-payments and deductibles. At the same time, many Americans saw their health benefits jeopardized by layoffs, which have continued despite the official end of the recession in November 2001.
In such times, the plight of the uninsured becomes more of a middle-class issue, more of a symbol of real close-to-home insecurity and thus more politically potent, advocates and experts say. Until now, "it's mainly been an issue of altruism for a discrete and disadvantaged population," said Ron Pollack, executive director of Families USA, a liberal consumer group.
"Now that the losses in health coverage are impacting more middle-class and working families," Mr. Pollack said, "this issue becomes one of self-interest for a very substantial part of the population."
Even before the Census Bureau announced the numbers, showing that the number of uninsured Americans had risen by 2.4 million last year, to 43.6 million, most of the major Democratic presidential candidates were campaigning hard on the problems in health care. Not since the 1992 election has the issue drawn so much attention, and the reasons are not hard to find.
For Democrats, it is a powerful symbol of a sluggish economy, of a lack of federal money to deal with domestic problems because of the deficit and the war in Iraq and of what they say is the Bush administration's insensitivity to the needs of the home front. It could, in short, be a significant vulnerability for President Bush — if the Democrats succeed in framing this election as a referendum on domestic policy.
Republicans argue that the administration has several major initiatives on the table to deal with the problems of cost and access to health care, from its Medicare prescription drug plan to legislation that would cap jury awards in medical malpractice lawsuits.
"If Democrats are seen as obstructing that process, that could be a significant problem for them politically," said Christine Iverson, a spokeswoman for the Republican National Committee.
The Bush administration has also proposed in the past to expand coverage to the uninsured through the use of tax credits to help them buy insurance. Still, some experts say the administration will eventually have to offer a broader vision on health care as an alternative to the Democrats.
In fact, Americans place the health care issue high on the political agenda, based on recent polls. A CNN/USA Today/Gallup Poll last week found that a candidate's position on health care was cited as "extremely important" by 43 percent of Americans, just below terrorism (cited by 49 percent) and the economy (49 percent), and well above the environment (30 percent) and taxes (36 percent.)
An NBC News/Wall Street Journal poll in July found that health care costs ranked at the top of Americans' economic concerns, cited by 24 percent, compared with 16 percent who cited high taxes.
Most of the major Democratic candidates have produced a major plan to expand health coverage, generally financing it by rolling back all or part of Mr. Bush's tax cuts. But Republican strategists are quick to point out that the politics of health care are complicated and that the candidate with the biggest plan is not always rewarded.
The classic example, of course, is President Bill Clinton, who ran on the promise of universal health care only to see his actual plan for national health insurance turn into a political and legislative debacle. Critics said that plan would cost more, create a huge new government bureaucracy and give many Americans poorer health coverage than they already had.
Given the Democrats' reliance on using the tax cut to finance a health care plan, Republicans are very likely to make a version of that argument again. Bill McInturff, a Republican pollster and expert on public opinion and health, said, "A lot of 2004 will be a fight about who is perceived to pay versus who is perceived to get the benefit." In the past, Mr. McInturff said, when middle-income voters sensed they were being asked to pay more so that others received health care, "political paralysis has happened."
Still, he added: "People still don't get how big an issue this will be. The numbers and the state of the economy and the relationship between the cost of care and what's happened to the uninsured will be addressed in the 2004 campaign cycle, because it's what people care about."
The problems in the health care system are related to nearly every issue bubbling domestically, from unemployment to the fiscal crisis in the states. Moreover, even if employment begins to pick up — and new estimates will be released on Friday — nobody is expecting a speedy turnaround in the problems of health care costs and coverage.