VICE PRESIDENT Al Gore has waded into the subject of health reform. Not surprisingly, given the defeat of the ambitious Clinton-Gore health plan in 1994, he has struck a cautious tone. In a campaign speech last week, he promised "concrete, specific, realistic steps" rather than a grand overhaul. His aim as president would be to extend health coverage to about a third of the 43 million Americans who have none.
Mr. Gore's plan starts, properly, with children. In 1997 Congress passed a bipartisan law to give all children below 200 percent of the poverty line access to public health insurance. Mr. Gore would increase that ceiling to 250 percent and allow those between 250 percent and 300 percent to buy into the program. These two extensions are expected to make Medicaid available to an additional 3 million children. On top of that, Mr. Gore would allow about 7 million parents of poor children to enroll themselves also. The hope is that by offering coverage to all members of poor families this policy would increase the participation rate, which is frustratingly low at the moment.
The second plank of Mr. Gore's plan is aimed at people well above the poverty line but who lack access to company health plans. The candidate goes at this category in two ways: He promises one tax break to individuals who buy their own insurance and another to small firms that set up health plans for employees. These incentives are intended to extend coverage to about 2 million Americans.
Mr. Gore's speech will be criticized. Some will complain that it costs too much or that the proposed tax incentives would further complicate America's Byzantine tax code. The retort is that at least Mr. Gore's plan avoids the excesses of the Republican-favored Medical Savings Accounts, which funnel scarce health subsidies to the very rich; Mr. Gore's tax breaks are targeted at people earning less than $100,000. Other critics will complain that the Gore plan accepts too much of the status quo, in which the world's leading economy leaves millions without coverage. The retort here is that his proposal represents only the first steps along the path that a Gore presidency would take. We would hope so.