In a presidential primary season dominated by the Iraq war,
the No. 1 domestic issue roars onto center stage Monday as
Sen. Hillary Rodham Clinton (D) of New York unveils her
proposal for healthcare reform.
For Senator Clinton, the front-runner for the Democratic
nomination, the issue is fraught with risks. In 1993 and
1994, she oversaw the failed effort by her husband, former
President Clinton, to remake healthcare in America. The old
Clinton plan, which would have mandated coverage for all
employees through health maintenance organizations, was
lampooned by opponents as a government takeover. Mrs.
Clinton was also criticized for operating in secrecy.
Now, the former first lady is seeking to turn that failure
into a positive - and, so far, is succeeding. A recent
poll by the nonpartisan Kaiser Family Foundation shows that,
among all the presidential candidates, voters see Clinton as
placing the biggest emphasis on healthcare. She tops the
list with a plurality of 27 percent, followed by Sen. Barack
Obama (D) of Illinois with 6 percent. Among Democrats,
Clinton is also by far the candidate seen as best
representing their views on healthcare, with 35 percent.
Among Republican voters, former New York Mayor Rudolph
Giuliani was the top choice, with 8 percent.
"Senator Clinton starts off with an edge on health," says
Dean Altman, president of the Kaiser Family Foundation.
That's "not because the voters have scrutinized the details
of anyone's plan, and obviously she's only released pieces
of hers so far, but just because they so closely associate
her with the issue."
On the stump, Clinton herself often refers to her abortive
healthcare reform in the '90s, a failure that played a
significant role in the voters' rebuke of her husband during
the 1994 midterms, when the Republican Party seized control
of both houses of Congress. But she tries to spin that
failure into a positive, telling voters that her efforts
show how deeply she cares about the issue and that she has
"the scars to show for it."
The last piece of Clinton's health plan, to be announced in
a speech Monday in Des Moines, Iowa, will focus on insuring
the uninsured, a segment of the population that has swelled
to 47 million people in the US, out of a population of 300
million. According to published reports, citing Clinton
aides speaking on background, the senator's proposal would
require insurance companies to accept all applicants for
coverage and would limit insurers' ability to charge higher
premiums because of preexisting conditions.
The plan, these aides and advisers say, would also aim to
make health insurance more affordable for those who already
have it. She aims to have universal healthcare in the United
States by the end of her second term, a goal analysts call
Clinton has already unveiled portions of her healthcare
plan. They include: a "prevention initiative" to help people
avoid contracting preventable conditions, focus on improving
care for the chronically ill, establishment of a
public-private "best practices institute," easing
restrictions drug imports, requiring Medicare to negotiate
for lower drug prices, and computerization of healthcare
Achieving such reform would require bringing on board an
array of stakeholders, including government, insurance
companies, the pharmaceutical industry, physicians and
hospitals, employers, labor, and citizens. Clinton hinted at
the magnitude of the task last week in a forum sponsored by
the liberal website Huffingtonpost.com: "We've got to have a
political consensus in order to withstand the enormous
opposition from those interests that will have something to
lose in a really reformed healthcare system."
Clinton is the last of the major Democratic candidates to
announce a healthcare plan. Senator Obama's plan aims to
cover most of the uninsured by creating a new public plan.
Of the top-tier Democratic candidates, former Sen. John
Edwards of North Carolina aims to cover all of the uninsured
by 2012. Both Obama and Mr. Edwards would pay for their
plans by eliminating tax cuts on high-income Americans.
The Republican candidates approach the issue differently,
aiming to boost coverage by providing tax incentives that
make it easier for consumers to buy coverage from private
insurers. Mr. Giuliani would provide a tax deduction of up
to $15,000. Former Gov. Mitt Romney of Massachusetts is not
proposing a nationalized version of the statewide healthcare
reform he instituted, which requires residents to purchase
health coverage. Instead, he believes solutions should be
reached state by state, with the federal government playing
a supporting role through tax incentives and flexibility in
the use of federal healthcare funds.
Whether healthcare emerges as a major factor in how voters
select the nominees remains to be seen. But Mr. Altman of
Kaiser foresees a major debate on healthcare during the
general election, in which different visions between the two
parties are already clear.
"There's no question there will be a lot of mud-slinging and
demagoguery," Altman says. "Already, we've heard the
Republicans calling the Democratic approach socialized
medicine, and for all we know, the Democrats will call the
Republican approach Dickensian capitalism. Beneath all that,
there are actually very different, sincerely held ideology
and policy beliefs about which way healthcare should go."
© 2007 The Christian Science Monitor. All rights reserved. Reprinted Via Rightslink.