Health Care Back in the National Spotlight

The first in a five-part series.

Graph of the number of uninsured Americans.  31 million in 1987 to 46.6 million in 2005. i i

The number of uninsured Americans rose from 31 million in 1987 (13 percent of the population) to 46.6 million in 2005 (16 percent). During that time period, the U.S. population grew from 242 million to 296 million. Lindsay Mangum, NPR hide caption

itoggle caption Lindsay Mangum, NPR
Graph of the number of uninsured Americans.  31 million in 1987 to 46.6 million in 2005.

.

Lindsay Mangum, NPR
Map of the U.S. showing percentage of people without health insurance in each state. i i

Throughout the U.S., uninsured populations range from 8 percent to 25 percent of state residents. Lindsay Mangum, NPR hide caption

itoggle caption Lindsay Mangum, NPR
Map of the U.S. showing percentage of people without health insurance in each state.

Throughout the U.S., uninsured populations range from 8 percent to 25 percent of state residents.

Lindsay Mangum, NPR

It has been nearly a decade and a half since the last effort to overhaul the nation's health care system.

But the issue is back, driven by recent state initiatives seeking ways to provide universal health care and by the 2008 presidential campaign.

And President Bush — whose administration has so far taken a limited approach to health-care issues, for the most part — is also joining in.

During his State of the Union Address in January, he unveiled a plan that would change how health insurance premiums are taxed in order to help more Americans afford insurance.

In a recent Saturday radio address to the nation Bush described his plan as a "common sense solution [that] will level the playing field for all Americans, whether you get your health insurance through your job, or on your own."

The Democrats Weigh In

Also chiming in on the health-care debate are the Democratic presidential candidates, including Sen. Hillary Rodham Clinton (D-NY), who as first lady led the last effort to address the issue in a comprehensive fashion — an effort that did not succeed. She poked fun at Bush's newfound interest in health in a February speech to the nation's mayors.

"I welcome his participation in the health-care debate," Clinton said, "I'm going to send him a suit of armor, because I know that anybody who puts a foot into the health care debate's going to need that."

But Sen. Clinton quickly made clear that she is ready for another run at the issue.

"I believe we still need to make a commitment to universal health care," she said.

The phrase "universal health care" has been widely used among the Democratic presidential candidates.

Sen. Barack Obama, the Democrat from Illinois, recently told the International Association of Fire Fighters that he will make sure that everybody in the country has universal health care by the end of his first term as president.

Not to be outdone, Democrat John Edwards, the former North Carolina senator and presidential candidate, has already laid out a fully detailed plan for universal health coverage. On NPR's Talk of the Nation, Edwards pledged that he would implement his plan even faster than Clinton and Obama would: before the end of his first presidential term.

Back in the Spotlight

The talk about universal health care may be cyclical, but there were a lot of people who did not see this particular cycle coming. For decades, Drew Altman, president of the non-partisan Kaiser Family Foundation, has tracked the ups and downs of attempts to reform the nation's health-care system.

Altman says health care was still a political afterthought as recently as last November — when political pollsters didn't even include a question about it in the national exit polls for the mid-term congressional elections.

"Now, just a few months later, it's front and center again," Altman says. "That's an awful lot of change in just a few months."

Why is health care coming on so fast as a national political issue? Altman says it is not because the public cares about health care more than it did last fall.

"Their level of concern about health care and about health care costs in particular has been pretty constant," he says. "It's about the same now as it was in the early '90s. What's really changed is that leaders and leadership groups driving the national agenda from the top are back in the game."

An 'Urgent Priority'

The last time Altman saw national leadership on health care was in the early 1990s, when political unknown Harris Wofford won a surprise election to the Senate from Pennsylvania, largely on the strength of his stance on the health-care issue.

"If criminals have a right to a lawyer," Wofford said in his best-known TV ad, "I think working Americans should have a right to a doctor."

Wofford defeated heavily-favored Richard Thornburgh, who had stepped down as President George H.W. Bush's Attorney General to run for the seat. Altman says the upset sent shockwaves through the political world.

"It was the first time that politicians came to see that you could win an election and get votes by talking about health care as an issue," Altman says.

The message was not lost on then-Arkansas Gov. Bill Clinton, who rode it to a presidential victory, and then tried to follow through as president.

"We must make [health care] our most urgent priority," Clinton said when he unveiled his plan before the Congress and the nation in September, 1993.

Clinton pledged to give every American health security: "Health care that can never be taken away, health care that is always there."

In the end, however, the opposition proved stronger than the president.

"Unfortunately, that was an opportunity [to reform health care] that was blown," Altman says.

The business and insurance communities played a key role in defeating attempts to reform health care in the 1990s. Their opposition was epitomized by "Harry and Louise," a fictional couple in a series of television ads who questioned whether their existing coverage would be made worse by the Clinton plan:

"Things are changing, and not all for the better," the ads said. "The government may force us to pick from a few health care plans designed by government bureaucrats."

"Having choices we don't like is no choice at all," lamented Harry and Louise, the fictional couple. "If they choose, we lose."

Health Care Today

Now, business and insurance groups are pushing to reform health care on their own. Their plans have a major role for the government.

Even further along than business or federal officials are the nation's governors. Altman says a key reason they've been able to make headway is that states are more practically oriented than the federal government.

"[States are] not as frantically ideological as Washington is," he says.

Illinois is on its way to providing insurance to every child in the state. Massachusetts is implementing a plan to cover virtually all residents. At least a dozen other states are in various stages of planning overhauls.

California Gov. Arnold Schwarzenegger's plan, like several others, includes an "individual mandate," which would require all individuals to have health insurance.

"I believe that part of the health care answer is mandatory medical insurance, just like we have mandatory care insurance," Schwarzenegger, the recently re-elected Republican, said in a February speech to the National Press Club.

Altman says what is really new about these plans is the willingness of governors to take ideas from both ends of the ideological spectrum.

"[The governors' plans] cut through the ideological paralysis that has prevented any progress on health reform," Altman says. "[They have] sent a message to the country and to Washington that the paralysis that has gripped us is not necessarily an inevitable or insurmountable condition."

Yet the biggest challenge remains for those attempting to reform health care — how to find the money to provide health insurance for everyone.

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