Diner Exchange Underlines Voters' Health-Care Concerns

By Perry Bacon Jr. and Michael D. Shear
Washington Post Staff Writers
Saturday, August 4, 2007

MANCHESTER, N.H. -- Michele Griffin didn't want to hear Mitt Romney talk about how to fight the spread of AIDS around the world.

"What about our nation? How 'bout the USA? C'mon!" yelled Griffin, who has worked for more than 12 years behind the counter of the Red Arrow Diner, a popular stop for presidential candidates.

For the next 10 minutes Romney tried to respond, describing his approach to health care when he was the Republican governor of Massachusetts, while Griffin kept interrupting him with comments such as "After we pay our huge deductibles for our insurance and our cost for our prescriptions, there's nothing left."

Eventually, Romney's message -- criticizing European-style "socialized medicine," attacking Sen. Hillary Rodham Clinton's health-care efforts in the 1990s and praising the virtues of private insurance -- got through.

It was a relatively brief exchange but an emotional one, and a snapshot of an issue that could play an important role in the presidential primaries in both parties.

Rising costs, the growing number of people without insurance and general frustration with the system are all reasons that health care keeps surfacing at candidate forums and campaign appearances. Large businesses such as Safeway and Wal-Mart, once wary of government intervention in health care, are pushing for universal coverage, as are many Republican officials, particularly California Gov. Arnold Schwarzenegger.

"Health care is going to be a top domestic issue, if not the top domestic issue," in the general election, said Dean Rosen, a health-care policy expert who was a top adviser to former Senate majority leader Bill Frist (R-Tenn.).

Surveys show that Democratic voters rank health care behind only the economy and the war in Iraq in their priorities; Republicans rank it lower. But "polls that require voters to itemize their priorities don't tell the whole story," said Kevin Madden, Romney's spokesman. "It's a quality-of-life concern as well as an economic concern that affects the bottom-line budget of so many American households."

Griffin, who has a daughter with Crohn's disease and another who is diabetic, also confronted another 2008 hopeful, Democratic Senator Joseph R. Biden Jr. (Del.), when he came to the Red Arrow. But she is not the only voter with a personal story on health care.

"We have all kinds of settings where people tell us their personal stories," said Jennifer Hanley, a Clinton aide who often travels with the Democratic senator from New York to the early primary states.

The responses vary widely, befitting an issue that evokes both strong passion and sharp disagreement. Romney, as he did at the diner, often notes his work in Massachusetts to pass a law that requires everyone in the state to purchase health insurance and provides subsidies for those who cannot afford it on their own.

Clinton speaks of her failed effort in 1993 but also reminds voters of her work on a bill in the Senate that would ban insurance companies from denying coverage to people because of pre-existing conditions.

Generally, the debate on the campaign trail resembles that in Washington, where congressional Democrats are trying to push through a major expansion of the State Children's Health Insurance Program, which provides coverage for low-income children, but President Bush is threatening a veto in part because he opposes increasing the number of people who receive health care through the federal government.

Democrats, particularly Sen. Barack Obama (Ill.) and former senator John Edwards (N.C.), are calling for higher taxes for people who make more than $250,000 a year, to pay for tax subsidies and increase the number of people on public programs.

Former New York mayor Rudolph W. Giuliani and other Republicans are touting approaches that would be less costly and would cover fewer people. This week Giuliani released a plan, similar to an initiative that Bush has adopted, that would exclude up to $15,000 of a family's income from taxes if it was spent to purchase health insurance.

Both parties have been wary of calling for radical changes in health care, something that polls show makes voters nervous. None of the leading Democrats have offered plans that would create government-run health care as in many countries in Europe, nor have any Republicans sought to break down a system in which most individuals purchase insurance through their employers. Recognizing GOP nervousness about massive health-care plans, Romney has not advocated turning his Massachusetts model into a national system.

And neither party is afraid of demagoguing the issue. When voters tell the Democratic candidates about chronic illnesses, the candidates are eager to respond by attacking Bush's restrictions on stem cell research. Giuliani spent much of his health-care speech this week denouncing filmmaker Michael Moore, who in his movie "Sicko" castigates the U.S. health-care system and praises Cuba's.

Giuliani's aides, unlike those in other campaigns, say that while people ask the former mayor about health care, the topic comes up less frequently than terrorism or illegal immigration. And evidence from past campaigns does not suggest that talking about health care is the key to the White House.

In 2004, former congressman Richard A. Gephardt (Mo.) talked the most about health care and had the most expansive plans of the Democratic candidates, but lost his party's nomination to Sen. John F. Kerry (Mass.). Kerry was defeated by Bush, who rarely spoke about the issue. And although Bill Clinton campaigned in 1992 on creating universal health care, he and his wife were not able to accomplish that goal after he was elected.

Griffin remembered, as she complained to Romney at the Red Arrow Diner, that Hillary Clinton "had a plan and she never followed through. Now, she wants to be president."

"They all talk about health care till they get in there," Griffin said. "But they all have health care, don't they? Do they have to pay outrageous co-pays? No."

Bacon reported from Washington.