Election 2008 will feature a fundamental debate about healthcare. That debate will offer a stark contrast in goals and strategies: for or against coverage for all; a common government guarantee versus individualized, “market based” insurance.
Voters rank healthcare just below Iraq as a top concern. A March New York Times/CBS News poll found that nearly two-thirds of Americans believe government should guarantee healthcare to all, and a majority say they’re willing to pay higher taxes to get it. Healthcare looms very large for Democratic and independent voters. For Republican voters, however, other issues–immigration, tax cuts–rank higher. Not surprisingly, healthcare has moved quickly to the center of the Democratic debate, while Republican candidates have said comparatively little about it.
Among the GOP candidates, Representative Duncan Hunter bluntly states a common theme: “I’m against universal coverage.” Republicans generally oppose mandates to provide healthcare, instead advocating “market mechanisms” that, they say, would make healthcare less expensive. As governor of Massachusetts, Mitt Romney led the effort to implement a universal state program that required companies and individuals to get healthcare. But he says very little about his plan now. “I don’t like calling it universal coverage. That smacks of Hillarycare,” Romney says. He adds, “The Democrats’ path is always government-mandated, government-run, government insurance…[which is] almost by definition going to be inefficient, ineffective and expensive.”
Former New York Mayor Rudy Giuliani has taken the lead in the Republican field. Scorning Democratic plans as “socialized medicine,” Giuliani says the “problem with our health insurance is it’s government and employer dominated. People don’t make individual choices.” He would accelerate the move away from employer-based insurance, giving individuals a tax credit of as much as $15,000 to help pay for their own. But he wouldn’t require people to self-insure, so with the young and healthy forgoing insurance and insurance companies imposing a higher premium for those purchasing outside a broad pool, this kind of individualized insurance is likely to drive costs up and coverage down.
Among Democrats, the debate was initially focused on incremental reforms, but activists demanded more, and the broken system requires it: Nearly half of people in the Times/CBS poll have had their coverage cut or had to pay more. A fourth of those with insurance reported that they had done without tests or treatment because it wasn’t covered by their plan. Forty-seven million–15 percent of Americans–do not have health insurance, up some 6.8 million over the past seven years. Only comprehensive reform can address these problems.