The Politics of Health-Care Reform

With health-care costs rising and 47 million uninsured in the U.S., Presidential candidates talk about reforming the system. Few have detailed proposals

by Catherine Arnst

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Editor's note: This story is from the first of two series examining how top Presidential candidates are grappling with the major science and technology topics of the day.

Could 2008 be the year health-care reform becomes a decisive election issue? It's possible. Reforming the nation's system for delivering and paying for health care has never been front and center in an election year, and political pollsters often say it won't take center stage until the number of uninsured reaches 25% of the population. The actual number is probably about 15% right now, judging from 2006 Census Bureau data. Still, there are some signs 2008 may defy conventional wisdom.

For one thing, the 15% slice represents about 47 million people. That's a 5% increase over the prior year and the largest increase in four years, even though poverty levels fell and household income rose in that period. It also suggests there are 8.6 million more uninsured than in 2000, another Presidential election year. On top of that, the percentage of people covered by insurance through their jobs fell to 59.7% in 2006, from 60.2% a year earlier, making even those with insurance feel insecure. And health insurance premiums have risen 78% since 2001, four times the rate of wage increases.

Consequently, in the most recent poll by the nonprofit Kaiser Family Foundation, 30% of respondents said health care is one of the top two issues they want to hear Presidential candidates talk about. Only Iraq ranked higher. And talking they are—virtually every Presidential candidate has made some mention of how he or she would cover the uninsured. The Democratic and Republican candidates do tend to take very different approaches, with the GOP contenders embracing free-market solutions while the Democrats want a stronger role for government. But none has managed to duck the issue entirely.

Candidates' Dilemma

What some of them are trying to duck are the details. Health care "could well be the critical issue in this election," says Robert Blendon, professor of health policy and political analysis at Harvard University's School of Public Health. "The dilemma for the candidates is how they can talk about it in a way that will differentiate themselves from one another without getting into specifics that will turn voters off."

There's the sticking point. Although poll after poll shows a majority of Americans would like to reform the inefficient U.S. health-care system (BusinessWeek 9/17/07), there is no broad consensus on a fix. And because the issue is so complex, it is difficult for candidates to convey a detailed position in a way voters will understand—and, more important, not reject.

Their problem: Any effort to effect large-scale change to the current system will be both disruptive and costly for at least some people. "The thing that is critical to understand is that the middle class may be dissatisfied but most of them have employer insurance, so they have something to lose," says Blendon, who talks regularly with candidates about health-care reform. "They are not prepared for a national experiment that will threaten what they have."