Politics & Government

Health care is voters' top domestic concern

Health care workers in Des Moines, Iowa, listen to Sen. Hillary Rodham Clinton speak about her health care proposal.
Health care workers in Des Moines, Iowa, listen to Sen. Hillary Rodham Clinton speak about her health care proposal. Charlie Neibergall / AP

WASHINGTON — In 1994, doctors and other medical professionals were up in arms over "Hillarycare," the universal health-care plan that was drafted under the former first lady's leadership.

Health industry representatives were excluded from the task force that devised the plan, prompting groups such as the American Medical Association to withdraw support for the proposal and label it too heavy-handed, costly and complex.

Today, Hillary Clinton is the Democratic presidential front-runner, and she tops all candidates with nearly $1 million in contributions from doctors and other health professionals, according to The Center for Responsive Politics, a nonprofit group that monitors political contributions.

Her transformation from health-industry punch line to candidate emeritus on health care is a byproduct of the changing political climate that's pushed health care to the forefront of voter concerns.

The combination of spiraling costs, declining employer coverage and growing numbers of Americans without health insurance has prompted consumers, employers, lawmakers and the medical industry to call for change.

Unlike previous years when concern for the underserved was the guiding force, self-interest now rules the debate.

"For decades, health-care reformers were acting on altruism for others who were disadvantaged. But I think this issue has been transformed," said Ron Pollack, the executive director of Families USA, a liberal patient-advocacy group. "This issue is now an issue of self-interest. ... I don't know if we've reached that tipping point, but we're getting closer and closer to where this is an issue that must be addressed because the American public demands it."

Michael Cannon, the director of health policy studies at the libertarian Cato Institute, said he thought that self-interest had always dominated the discussion.

"From my vantage point, all of the special interests, they're all out for themselves," Cannon said. "The pharmaceutical companies want their enormous Medicare prescription-drug program without any controls on it. Insurance companies, pharmaceutical companies and physicians want government programs for the elderly and the poor to shower them with subsidies. Physicians and the insurance industry want more tax benefits for private insurance, because that works to their benefit."

Indeed, doctors want Medicare and Medicaid to cover the full cost of their services. Hospitals want to be fully reimbursed for treating uninsured patients. But businesses also want relief from costly employee health and retirement benefits. Workers want insurance premiums to stop increasing faster than their wages do. The collective push of these forces has helped health care escape its legacy as a second-tier, election-year concern. An August survey by the Kaiser Family Foundation found that health care was the top domestic issue that voters want presidential candidates to address. It found that Republicans and independents put health care second only to Iraq in terms of importance, while Democrats put health care on par with Iraq for the first time. The fanfare and furor that greeted Clinton's health-care proposal last week are testament to the issue's renewed urgency.

Nowhere is that more evident than in the nation's capital, where subway trains are plastered with ads from the American Medical Association urging legislation to cover all Americans by 2009. The American Cancer Society just launched a $15 million television ad campaign focused on uninsured and under-insured cancer patients.

A number of longtime special-interest adversaries have joined forces to call for change. On Monday, groups that represent health insurers, drug makers, doctors and hospitals will join some of their sharpest critics in the patient advocacy arena to urge President Bush to sign a reauthorization bill for a popular children’s health insurance program.

Cannon said he'd been most surprised by the position of Republican candidates on health care. "I think the biggest change has been on the right and how the right has moved left on health care," Cannon said. "You have Republicans who were railing against government-run health care in 1993 and 1994 who are presenting the same ideas that Hillary Clinton was presenting then and now."

Chip Kahn, the president of the Federation of American Hospitals, likened today's political climate to 1992, when there was broad interest in change before "Hillarycare" was hatched. At the time, Kahn, a Republican, was an executive vice president with the Health Insurance Association of America, now known as America's Health Insurance Plans.

The association had supported employer mandates for coverage, a key component of the first Clinton health plan. But it ended up opposing the Clinton proposal once the details became public in 1994. Kahn helped craft the group's infamous "Harry and Louise" ad campaign, which helped push "Hillarycare" off a cliff.

"What the (association) members really wanted was a discussion with the (Clinton) administration, and they felt like they weren't being heard," Kahn said. "That was the original purpose of 'Harry and Louise,' to sort of say, 'Geez, we think there are some issues that need to be discussed, and that’s why we're doing this.’ "

After alienating the medical industry and pushing for too much change too fast, Clinton said recently that she'd learned from her mistakes. There's little chance that any major health restructuring will occur without input from health industry stakeholders, which have legions of congressional lobbyists to push their cause. It takes about five years to pass meaningful health legislation in Congress, so voters have plenty of time to educate themselves on the issue.

Because roughly 6 in 10 people don't know or can't name presidential candidates whose health-care views best represent their own, Kaiser will sponsor a series of forums that give the candidates an hour by themselves to discuss health-care costs, coverage and quality with a panel of journalists.

The forums begin at 11 a.m. EDT Monday with John Edwards, and will be available for viewing live online at http://presidentialforums.health08.org.