When the Clinton-Gore administration attempted to reform the nation’s approach to financing health care in 1993 and 1994, the one proposal that administration aides always rejected was a single-payer health care system. Even when more Democratic members of the House endorsed a single-payer plan sponsored by US Rep. Jim McDermott, D-Washington, than any other proposal, the administration rejected attempts to cut costs and guarantee quality service for all with a fully government-funded system.

When Al Gore ran for president in 2000, he maintained his opposition to single-payer proposals. Such was Gore’s opposition to investing in fundamental health care reforms that he went so far as to criticize costs associated with a plan, advanced by his Democratic primary challenger, Bill Bradley, to take modest steps toward universal coverage.

Now, however, as Gore edges toward another presidential campaign, he is singing a different tune. Wednesday night in New York, as he began a national book tour that many see as an attempt to raise his profile in advance of the 2004 contest, Gore announced that he had “reluctantly come to the conclusion” that the only way to respond to what he described as an “impending crisis” in health care is a “single-payer national health insurance plan” for all Americans.

Gore didn’t explain whether that plan would mirror the Canadian system, various European models, or the proposals currently being advanced by members of the Congressional Progressive Caucus, led by McDermott and Representative Tammy Baldwin, D-Wisconsin. Indeed, all Gore aides would say is that his newfound commitment to fundamental health care reform is part of the former vice president’s new “speak from the heart and let the chips fall where they may” approach.

Despite his stated reluctance to enthusiastically embrace the single-payer model, Gore’s move does position him closer to the mainstream of the Democratic Party primary and caucus voters who will decide the 2004 nomination. As Baldwin has noted, it was her outspoken support for single-payer that distinguished her from two more cautious Democratic opponents in the hard-fought 1998 Democratic primary that ultimately sent her to Congress. A commitment to support the single-payer model, says Baldwin, “is a sign for a lot of voters who are serious about these issues that you are really are committed to work for the health care reforms that are needed.”