Democratic presidential candidates will face the first directtest of how well they handle the issue of a national plan to financehealth care when they tackle the subject at a special forum in NewHampshire today.
What the forum -- being staged by the New Hampshire DemocraticParty -- amounts to is the first run by the candidates at a topicthat now ranks near the top of the 1992 campaign agenda. Voters havemade it clear in polls -- and in recent state elections -- that by anearly 3-to-1 margin they favor some form of universal health care onaffordable terms. Three articles on the op-ed page today suggest theparameters of the discussions occurring across the land.
With Sen. Jay Rockefeller of West Virginia in charge of today'sforum, it is unlikely that the candidates can get away with softanswers on this tough issue. Rockefeller, an almost-ran himself, ischairman of the Senate Finance Subcommittee on Medicare and Long-termCare, and he headed the Pepper Commission, which outlined a nationalhealth insurance plan earlier this year.
The force of the issue was driven home in Pennsylvania last monthwhen Harris Wofford overcame a 40-point lead by former AttorneyGeneral Richard Thornburgh in an election for the Senate. Wofford'swin was based on his emphasis on guaranteed health care for allAmericans.
Wofford managed to exploit the issue, however, without spellingout details of how such benefits would be provided. He definedneither the extent of coverage nor how it would be paid for.
Rockefeller knows that controversy over a national healthinsurance plan lies in what form it will take. The fistful of plansthat have been proposed are of two basic types.
One is known as the play-or-pay approach. Employers would offerworkers health-care coverage as a benefit -- they would 'play' in thehealth insurance game -- or they would 'pay' additional taxes tocover employees who would obtain government-subsidized healthinsurance.
The other is the sole-payer method, which is in effect in Canadaand, more familiarly, in the United States as Medicare, the medicalprogram for the elderly. In these programs, the government collectsand dispenses all funds to pay for health care under a single systemthat covers everyone.
But as the debate intensifies, voters are going to demand clearinformation on the two aspects of health care that now bedevil them:How much will it cost them -- person by person and family by family?And how much coverage can they get?
Candidates need to answer specific questions, say experts who areadvising Congress on how the public will respond to an overhaul ofhealth-care coverage and financing.
Each voter wants to know under any national health program:
- Will I pay more -- or less -- than I do now for health insurancepremiums?
- Who pays? Me, my employer or a tax-based government system?
- Will my medical care be rationed?
- Will I have to wait for medical care?
- Will I have free choice of doctors, hospitals or healthmaintenance organizations?
Among the topics not yet fully aired is the disproportionate (toearnings) share of health costs now paid by subscribers to healthinsurance. Each member pays (individually or with an employer) a setpremium, regardless of how much he earns.
Were the cost of health coverage to be paid as a tax on wages, asis Social Security and Medicare, workers who earn more would pay moreand vice versa. For example, under a tax-based health-paymentsystem, a person earning $100,000 a year could pay 10 times more --as a tax on his or her wages -- than a person earning $10,000.
As the first round of political debate on health care gets underway, the stakes are high. Only candidates who can demonstrate truecommand of the issue will have an edge with voters.
