Beneath the stylish Clinton-"Obomba" storyline, Edwards injects substance into health care forum
By Hugh Jackson
03/25/07

It is a long, long presidential campaign, so odd and counter-intuitive things are bound to happen now and again. A case in point: At a forum on health care in Las Vegas over the weekend, Sen. Hillary Clinton energized and connected with the audience; Sen. Barack Obama didn't.

Such a violation of the hitherto established natural order generally qualifies as "news" and so Clinton's shinier performance, and Obama's lackluster one, have been more-or-less the prevailing media narrative coming from the forum sponsored by the SEIU and the Center for American Progress at UNLV.

Meantime, poor John Edwards. The Clinton-"Obomba" angle, along with the compelling storyline about Edwards and his wife Elizabeth, combined to bury the fact that of the so-called top-tier candidates, the former senator and 2004 Democratic vice-presidential nominee is the one with a detailed, comprehensive and posted-for-scrutiny plan to reform the nation's dysfunctional and over-priced health care system.

To be sure, Rep. Dennis Kucinich has a plan too. Or, rather, Kucinich has a bill, one that essentially extends Medicare to the entire population in a true single-payer universal heath care system. From a pure policy standpoint, there is an argument to be made — and developed nations the world over make it every day — that Kucinich's plan is intellectually, morally and economically sensible and reasonable. However, there is nothing reasonable about the likelihood of a Kucinich presidency, so ... of the candidates who stand at least some chance of actually becoming president someday, Edwards is the only one with a plan.

But the most intriguing part of the Edwards plan is that it includes a mechanism that, eventually, very well might take the country to — though Edwards might wince at the characterization — the Kucinich plan.

Edwards proposes that everyone would obtain coverage in regional non-profit health markets, where people could choose between private coverage and at least one option that would be a government-provided plan based on Medicare — "Medicare plus," as Edwards called it in Las Vegas. And given the opportunity to choose between private insurers and the Medicare-type plan, "We'll find out over time ... whether people want" a single payer system.

The Edwards proposal subsidizes premiums for low and middle income families — Edwards said income eligibility for subsidies would cap out at about $80,000. Insurance companies would not be able to deny coverage for pre-existing conditions or otherwise cherry-pick the most desirable customers, i.e., those least likely to ever want the insurer to ever actually pay for some health care (as it happens, ending insurance discrimination was, more than any other, the specific issue that Clinton fleshed out during her presentation at the Las Vegas forum). And it will cost between $90 billion and $120 billion per year, which Edwards said he would pay for by rolling back the Bush tax cuts for the wealthy.

Forum moderator Karen Tumulty of Time magazine asked Edwards about the political palatability of advocating more taxes. "I think it it's important, especially given what has happened in the last six, seven years, that the president of the United States be honest with the people," Edwards said.

That approach, of course, is a magnificently wild gamble on Edwards' part, in that there is little in recent American electoral history to suggest voters view a frank and honest assessment of policy as a desirable characteristic in a candidate.

Which brings us, momentarily, back to the Kucinich campaign. During his address in Las Vegas, Kucinich railed against the absurd amount of money -- more than 30 percent of the private sector total, by most estimates -- spent on health care in the U.S. that goes not toward providing any care but toward corporate profits, CEO salaries, advertising and pushing paper around.

Though they tended to describe it more innocuously as "administrative costs," all the other candidates at the Las Vegas forum, including Edwards, also derided the profoundly expensive impact overhead has on the cost of the nation's private sector-based health care system.

So why is Edwards even bothering with the choice of private insurers; why not just go straight to the single payer model?

Single payer systems around the world have dramatically lower costs per person than the U.S., Edwards acknowledged. "But lots of people like what they have now and want to keep it." As a result of consumer choice, the nation may ultimately "gravitate" to a single payer system, but public consensus will decide, Edwards said.

Other candidates at the Las Vegas forum, Gov. Bill Richardson and Sen. Christopher Dodd, offered mildly sound if modest proposals for reform. Richardson said he wanted to extend the same plan enjoyed by federal employees to the entire population, long an attractive idea among some health care advocates. Dodd, echoing a theme that Clinton had made before leaving the stage immediately before Dodd's turn at the forum and taking most of the audience with her, emphasized the realities of how difficult it will be to get any reforms through Congress, and touted his ability to build consensus and get things done (though Dodd's explanation that it took seven years and two presidential vetoes before he could get the Family and Medical Leave Act passed, for which he rightly should be lauded, may not be the best example of leadership to offer a nation that increasingly seems to want large-scale health care reform implemented yesterday).

As the campaign for the nomination continues, perhaps Richardson or Dodd, or Sen. Joe Biden, who missed the Las Vegas forum, will break into the top tier -- especially if Edwards eventually decides to get out of the race after all because of the diagnosis showing that his wife's cancer has reappeared.

In Las Vegas, Edwards vowed that he will stay in the race for the duration. And hopefully he will. Because there may come a point in the campaign when attention turns away from how many style points should be awarded to, or detracted from, Clinton and Obama, and voters instead focus, even for a moment, on what candidates actually propose to, well, do if they are elected. If such a point arrives, whether voters decide they like Edwards' health care plan or not, the discussion of what many Americans feel is the most pressing domestic issue, health care reform, will be a lot richer if Edwards is in the thick of it pitching his case.

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