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Health Care, Not Social Security, the Third Rail of 2008

By Peter Brown

Campaign lore has it that Social Security is the "third rail" of American politics - meaning any candidate who touches the issue dies. Yet, health care reform could very well wind up assuming that dubious distinction in 2008.

The politicians have yet to fix the nation's retirement program without killing their political careers. In fact, precisely because President Bush's effort to do just that went down in flames, no 2008 contender is likely to take on the thorny issue.

Yet, most of those who have looked at the two problems find health care, not Social Security, to be the more difficult, both in finding a workable policy solution and selling it to the American people.

Most everyone thinks that all Americans should have health insurance. But, no one has come up with a workable plan to do it that would not make a large group of people unhappy.

Bush's proposal to help those without employer-provided health insurance was dead on arrival in Congress because it would make some pay a bit more in taxes, and might push some companies to drop their health care coverage. But most Americans would probably get a financial boost from his plan, and it would likely expand coverage to several million Americans, although nowhere near the estimated 47 million currently without health insurance.

Keep your eye on the campaign for the Democratic presidential nomination. The candidates will almost certainly be forced by party activists to detail how they would make sure every American has health insurance.

That's less likely in the Republican race, even with the candidacy of former Massachusetts Gov. Mitt Romney, whose state was the first to legislate a universal access plan. Unlike their Democratic counterparts, GOP primary voters don't take as gospel that it is immoral for 21st century America not to provide health care for everyone.

Since presidential campaigns are historically the venue for testing new political ideas, how the issue plays, and how the candidates line up, will determine what, if anything, is done.

The problem with providing universal health care, as Hillary Clinton found out more than a decade ago, is not morality but practicality.

The goals-- universal coverage, consumer choice and cost control - are to an uncomfortable degree mutually exclusive. In other words, to cover everyone, costs have to rise and/or patients' medical options must be limited, agree most who have studied the issue.

That's why Sen. Clinton's recent remarks were more than just a laugh line. "We're going to get to universal health care coverage ... I do have a little experience in this area, I know what not to do."

The political disaster that followed her husband's very complicated plan to overhaul U.S. health care is a warning to all. Since then, the only federal proposals have been incremental ones, such as the idea Bush advanced on tax credits. It might help some, but not nearly all the uninsured.

The lesson from the quick Democratic rejection of Bush's proposal to offer tax credits, which would begin to detach health care from employment, may well be that any real solution to the problem is going to come at the state level.

Perhaps the presidential candidates will let governors do the heavy lifting. How Romney's plan in Massachusetts fares will be a campaign issue. So too what happens in California and Pennsylvania, where Republican Gov. Arnold Schwarzenegger and Democratic Gov. Ed Rendell respectively are proposing universal coverage for all residents.

Bush clearly understands that too; overlooked in his State of the Union speech headlined by his tax credit idea was a proposal to help states that decide they want to tackle the problem themselves.

And, it might work. Partisan politics are less vicious in the states than in Washington, D.C. Moreover, the interest groups who would fight any national solution are often less entrenched in state capitols than in Congress.

It seems inevitable than many presidential candidates will make health care reform a major part of their campaign. Worth watching will be whether they are elected because of it, or electrocuted by it.

Peter A. Brown is assistant director of the Quinnipiac University Polling Institute. He can be reached at

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