Remedy and Reaction by Paul Starr

Author:Paul Starr
Language: eng
Format: epub
Publisher: Yale University Press
Published: 2013-03-19T16:00:00+00:00

Making 2008 a Health-Care Election

It was not Obama who put health-care reform into the center of the 2008 presidential race. His two major rivals in the Democratic primaries, John Edwards and Hillary Clinton, each had a better claim to that role. But the focus on health care was not the doing of any of the candidates; they were all responding to the activist constituencies and ultimately the voters in the Democratic primaries. According to the Kaiser health tracking polls, health care was the top domestic issue for voters during 2007, and even when the economy jumped ahead as a concern in February 2008, the proportion that month identifying health care as one of the top two issues was 40 percent among Democrats, compared with only 18 percent among Republicans.51 Health care mattered to Democratic constituencies and primary voters, and they made it a focus of the campaign.

How that process worked was evident on March 24, 2007, when Obama and the other candidates spoke to a Las Vegas meeting co-sponsored by the Service Employees International Union. According to SEIU’s Andy Stern, the union had informed all the candidates invited to speak that they were expected to have a detailed health plan by that time.52 Obama began by warmly recalling his long ties with SEIU going back to his days as a community organizer in Chicago and pledged that health-care reform would be crucial if he was elected. “I want to be held accountable for getting it done,” he said, though he was vague about specifics. Immediately after Obama finished his speech, the moderator turned to what was surely a prearranged question from a woman named Morgan Miller, who pointed out that Obama hadn’t yet provided a definite health-care plan. Pressed on the issue and unable to give crisp answers, Obama alluded to a plan that he was “in the process of unveiling.”53 Angry with himself afterward, he told his staff that he had “whiffed” the event for lack of a worked-out proposal, and as a result, according to his campaign manager David Plouffe, health care “shot to the front of the line” in the campaign’s decision-making about issues.54

By that point, Edwards had already released his plan, staking out a position on the left, though perhaps not as far to the left as his wife Elizabeth—a persistent advocate for single-payer inside his campaign—wanted him to go.55 The Edwards plan called for state insurance exchanges, an individual mandate, and the expansion of Medicaid, and in these respects his proposal followed the standard Massachusetts pattern. Edwards, however, also included a government-run insurance plan as an option within the exchange, as well as a play-or-pay requirement that employers provide coverage or pay 6 percent of payroll. Not shying away from the cost, Edwards estimated that the program would require an additional $90 billion to $120 billion in federal spending, which he said he would raise by eliminating the Bush tax cuts for people with over $200,000 a year in income and by enforcing capital-gains taxes more effectively.

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