Health Care Already a Key Issue in 2008 Race

"We're at the beginning of the next great debate about health reform," said Drew Altman, president of the Henry J. Kaiser Family Foundation, a nonpartisan source of health-care information. "This is an issue which was very much on the minds of the American people as an economic worry for quite some time, but was just nowhere as a national political priority even six months ago. Now it's front and center again, and the words 'universal coverage' are back at the center of the debate."

Indeed, analysts say national politicians are approaching the subject with a zeal not seen since the Clinton administration's health plan collapsed in 1994, amid concerns that it would give big government too much control over the health-care system.

Edwards has so far staked out the most detailed position. His plan would require employers to provide health coverage for workers or pay a portion of their payroll into a fund that would help individuals buy private insurance through new regional health-care purchasing pools. He would also expand Medicaid and the state-federal Children's Health Insurance Program, and would provide tax credits to help make insurance more affordable for lower-income families.

Most of the $90 billion to $120 billion annual cost could be paid for by eliminating President Bush's tax cuts for households earning more than $200,000 and by increasing Internal Revenue Service efforts to collect unpaid capital gains taxes, Edwards has said.

"I want to start putting universal health care in place as soon as I am sworn into office in January of 2009, which is what America needs," he said at a Feb. 22 candidate forum in Carson City, Nev. "We can't wait."

His campaign sent a mailing yesterday touting the plan to more than 70,000 Iowa households, the first such large-scale voter contact effort by a Democratic presidential candidate.

The 12-page booklet notes that 265,000 Iowans have no health coverage and argues that only Edwards has a plan "that will cover all of them and lower healthcare costs for everyone." It does not mention the program's cost.

Obama has not released a detailed plan, but in announcing his candidacy last month he said he would deliver universal health care by 2012. "Let's be the generation that finally tackles our health-care crisis," he said. "We can control costs by focusing on prevention, by providing better treatment to the chronically ill, and using technology to cut the bureaucracy."

Clinton said last month that she wants universal health-care coverage by the end of her second term, but she has not offered a plan to achieve it. She has said that she "learned from experience" that no comprehensive proposal will work unless employers, government and labor organizations support it, and that simply throwing money at the problem will not solve it.

"I am looking for answers that will not have us spend more money," Clinton said while campaigning in New Hampshire last month. "I am convinced we can do that."

Rep. Dennis J. Kucinich (D-Ohio) has proposed expanding Medicare to cover everyone, a plan he says would eliminate any role for for-profit insurance companies. Their certain opposition would be a major political obstacle.

Polls by Gallup and other organizations routinely show that Democrats are more likely than Republicans to rate health care as an extremely important issue for Congress and the president. Still, some Republican presidential hopefuls have considerable bona fides on the issue. In 2006, Romney signed legislation requiring that all Massachusetts residents have health insurance by July of this year. Thompson served as President Bush's health and human services secretary at a time when the administration successfully sought to create a drug benefit under Medicare.

Whoever wins the presidency will have trouble converting voters' desire for change into politically viable legislation, analysts say. There is broad agreement on health-care problems, but a consensus on how to fix them remains elusive -- a reality Bush encountered when his recent proposal to overhaul the tax treatment of health insurance fell flat in the Democratic Congress.

"One thing that history really shows us is that the enthusiasm at the beginning of these debates often wanes when you get to the details at the end," said Altman, the Kaiser president.

Washingtonpost.com staff writer Chris Cillizza contributed to this report.