used to rooting for teams that start strong but never make it into
the playoffs. Still, when the game is elections and my team is health
care, I have a hard time adjusting to another fading finish.
Americans’ concerns about health care costs and coverage make
health care reform a perennial favorite in politics. Health care tied
for third in the early season Gallup poll last January, just behind
Iraq and terrorism and even with corruption. By last week, however,
health care failed to make the cut, as corruption moved to the top
of the list.
So don’t expect to see 30-second spots about health care reform
when the political ads appear between innings of the World Series.
This is not our year, health care fans. But then, it’s never
our year — at least not at election time.
The problem with health care as an electoral issue is that most voters
don’t see a clear role for government in solving our health
care crisis. If the issue were health care for seniors, i.e. changes
to Medicare, those voters and their middle-aged children would be
paying attention — and so would the candidates whose elections
depend on their votes.
But Medicare and Medicaid cover only 25 percent of Americans. Most
Americans (53 percent) earn their health care from their jobs, and
a good number of those without health insurance (16 percent) look
to the jobs they have or hope to have as their most likely source
of health insurance in the future. They don’t think of government
as a provider of health coverage and, only rarely, as a provider of
So it’s hard for candidates to reach voters with proposals to
lower health care costs or to expand health care coverage. Many Americans
don’t think government can or should do that for them.
If soccer or hockey were our national pastime, we’d have a different
view, because we’d be used to government as a guarantor and/or
provider of health care. And we’d be having very different debates
during our elections about controlling the costs and protecting the
benefits of our health care system.
But we’re stuck in a different game here, a game whose biggest
players swing their big bats against government to discourage voters
from supporting reforms that can give us what most of those soccer-playing
countries already have — a health care system that delivers
better health at lower costs to all citizens.
We need a new playbook.
You may believe, as I do, that a system by which we earn our health
coverage with our paychecks is eminently defensible in a country that
prides itself on its free-market work ethic. But that system is being
destroyed by employers who are abandoning it. If that abandonment
continues, our paychecks will become conduits by which we pay for
our own health care, which will eliminate the whole reason for employer-sponsored
Given these trends, we will never get the reforms we need to achieve
affordable health care for all Americans without a major intervention
So what’s our next play? Do we take the path of government as
regulator (with employer mandates), government as insurer (with Medicare-style
programs) or government as provider (with public health clinics)?
All of these approaches make sense — for different populations.
States are making headway with proposals to provide affordable health
insurance for all children. The downside is that these taxpayer-financed
insurance systems invariably shift more of the costs for health care
from employers to working families. But that shift could be beneficial
for many of those families if employers are required to support health
coverage for all working adults.
Governor Ted Kulongoski has put forward a smart program to provide
affordable health care coverage for all children in Oregon, combined
with more school-based health centers to provide direct care. State
Senators Ben Westlund and Alan Bates will soon unveil a more ambitious
plan to provide health care for all Oregonians with a state-financed
voucher system. And, former Governor John Kitzhaber will be right
behind them with plans for reorganizing our publicly-financed health
care system at the state level, including federal waivers to restructure
We have four big hitters of our own, but each has a different strategy.
Health care has faded as an election issue again, because we haven’t
coalesced around a compelling reform agenda, and we haven’t
been able to overcome the skepticism that government can do anything
to solve this problem.
But, unlike many other issues, health care won’t disappear after
Election Day. Just wait ‘til next year. It will be right back
in the top three, gnawing at the physical health and the financial
well-being of a growing number Americans.
More and more commentators are talking of the need for a new political
alignment in this country. That realignment could well be organized
around health care. Whoever solves this problem in a way that makes
government work for working people will lead a winning team in future