Health Care Already a Key Issue in 2008 Race

By Christopher Lee
Washington Post Staff Writer
Tuesday, March 6, 2007

Former senator John Edwards (D-N.C.) says providing health coverage to the 47 million Americans who lack it is so important that he is willing to raise taxes to do it.

Sen. Barack Obama (D-Ill.) says he is determined to enact universal health care by the end of his first presidential term.

Sen. Hillary Rodham Clinton (D-N.Y.), no novice on the subject, calls universal coverage "not only a moral and health imperative, but an economic and jobs imperative as well."

Although health care is usually a bigger factor in Democratic primaries than in Republican contests, at least two GOP contenders -- former governors Mitt Romney of Massachusetts and Tommy G. Thompson of Wisconsin -- are expected to use their extensive track records on the issue as campaign selling points, especially if either emerges as the party's nominee.

All of which illuminates the reality that no White House hopeful can be taken seriously in the rapidly evolving 2008 race without confronting what many Americans have long said is one of their biggest concerns: the availability and affordability of health care.

"Every candidate is going to have to have a health-care plan, because it is the number one domestic policy issue on the minds of voters," said Karen Ignagni, president of America's Health Insurance Plans, an industry group whose "Harry and Louise" television ads in the early 1990s helped torpedo the last big push to overhaul health care.

Although fixing health care is back in vogue, some analysts worry that the prescriptions of the presidential candidates miss the heart of the problem. All the talk about creating universal coverage has obscured the fact that most voters already have insurance, some analysts say, and what they are most concerned about is curbing costs.

"They want some more active government effort to change the way the insurance system works, and to put some more pressure on doctors and pharmaceuticals and hospitals to give a better deal to working people," said Robert Blendon, a professor and public opinion expert at the Harvard School of Public Health. "The cost issue is a very important driving issue, and politicians haven't figured out how to touch that nerve yet."

Taking on costs is more difficult politically because it generally involves challenging powerful interests with a financial stake in the current system, including hospitals, doctors, and drug and insurance companies, said John Rother, policy director for AARP, the seniors lobby.

"The heavy lifting from a candidate's point of view is what they would do to control costs," Rother said. "Getting everybody covered is significant, but it doesn't take you right up against the power of the $2 trillion-a-year medical lobby the way that cost containment does. That's what's missing in the debate."

Since 1999, health insurance premiums have risen faster than wages and inflation. U.S. spending on health care, already the highest per person in the world, is expected by 2016 to nearly double, to $4.1 trillion. One in six Americans has no health insurance, and a shrinking share of those who do can get coverage through their jobs, census figures show.

The burden of rising costs on employers has led to calls for major change, even from some business groups that opposed earlier efforts to revamp the system. Pressure is also bubbling up from states, most notably California, Massachusetts and a few others that have begun, or are considering, statewide experiments to make health insurance affordable for everyone, through state subsidies and new fees on businesses if necessary.

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