It's hardly been front-page news given everything else that's going on, but this week John Kerry has been touting his plans to get a handle on escalating health care costs and extend coverage to the uninsured, who at the latest count number more than 43 million.
Kerry's health offensive coincides with a week-long campaign by the Robert Wood Johnson Foundation to drive home the scandalous truth that more than 15 percent of Americans lack a health care safety net. Health care premiums have more than doubled since 2000, according to the Kaiser Family Foundation, squeezing the bottom line of small businesses and forcing states to shell out some $30 billion to treat the uninsured.
Both Kerry and George W. Bush are pushing health care plans that would offer tax credits to low-income people to cover their medical expenses and allow both individuals and businesses to pool together for coverage discounts. The president would spend $90 billion to insure 2.7 million Americans. Kerry would insure ten times as many people at somewhere between $600 and $900 billion.
Former Clinton economist Kenneth Thorpe estimated that Bush's plan would give $3,800 to each recipient, and Kerry's $600 less per person. But Kerry's package aims to provide more perks for more people. It would expand Medicaid and health care for needy families, covering three-quarters of any medical costs over $50,000. It would subsidize insurance for employers and also help the unemployed with health care costs. Thorpe found that Kerry's pitch would in fact save the government nearly $300 billion by streamlining the health care bureaucracy.
Kerry is putting a populist spin on his health pitch. He's telling crowds, for example, "Senators and congressman have given themselves great health care, thanks to you all. So, we need to make certain that's the gold standard for the country." He would thus literally give businesses the chance to buy the same plans as members of Congress. Kerry would fund his health care plan by reversing Bush's tax cuts for Americans making more than $200,000. Up to $900 billion saved by the tax change would help broaden health coverage.
Kerry, though, is tempering his populism by casting his plan as business friendly. Visiting a Kentucky stoneware maker this week revealed an attempt to pitch health care reform as a boon to small businesses, which are finding it harder to provide insurance to their workers and are increasingly cutting corners by withdrawing coverage and laying off full-time staff and hiring temporary workers -- that is, when they don't withdraw coverage entirely. Ballooning health costs are eating into profits and preventing companies from making investments or expanding.
Around the country, Kerry has hewed to the the heart-to-heart formula laid down by Bill Clinton, feeling the audience's pain. In Louisville, Kentucky he "played a political Dr. Phil on Tuesday, with the solution to each person's problems Mr. Kerry's plan to reduce health care costs."
And Kerry is engaging former Clinton advisors to shape his health plan, hoping to go one better than Clinton, whose health care bill a decade ago was a legendary flop . Kerry has to hope they've learned from their experience. The conservative Washington Times doesn't think Kerry can pull it off, and accuses him of trafficking in "essentially worthless budget savings and pseudo budget discipline."
The Economist (subscription) sees it differently:
[L]ook carefully, and differences between Kerrynomics and Clintonomics emerge. In a few areas, this is to Mr Kerry's credit. For instance, his plan to help the millions of Americans without health insurance (by expanding existing government health plans for the poor and subsidising employer-based coverage) may be expensive, but many experts judge it more sensible than the Clintons' arrogant attempt to reorganise the whole health-care industry.
Can Kerry sell himself as an advocate for average Americans? His campaign points out that he wrote bills to widen health insurance for poor children, to address a nursing shortage, and has voted to increase veterans' medical benefits.
Meanwhile, the Bush camp is attacking Kerry for missing the vote over sweeping Medicare reform, the potential benefits of which continue to perplex beneficiaries.
Some pundits argue that this week's health care focus comes at an awkward time, with most of the nation horrified by prisoner abuse in Iraq. Others scold Kerry for not bringing up domestic issues sooner to better define himself against the early onslaught of Bush ads painting the Democrat as a "flip-flopper."
Robert Borosage, writing for the Nation, believes the Kerrry's successwill hinge on his ability to convince working-class Americans that he can fatten their wallets:
It is time to start filling in the blanks, particularly on bread-and-butter issues.
Thus far, Kerry has been intent on proving that he'll fight back, answering Bush's assassins shot for shot.
This is not a recipe for success. It offers little to hard-pressed working families struggling with insecure jobs and wages that aren't keeping up, while college and health care costs soar. If Kerry doesn't champion their concerns, they may see no reason to get rid of a President who seems like a regular guy.
That's why it is vital for Kerry to lay out two or three big things he's prepared to fight for - big ideas about where he wants to take the country. These should demonstrate that Kerry understands what's happening to working families, and that he's prepared to fight for them.
Bush's extremism will rouse the Democratic base no matter what. But this election is likely to turn on whether Kerry can convince working families that he understands and will fight for them, even as Republicans try to paint him as out of touch.