Wayne O'Leary

Politics of Health

The Left can't catch a break. For the first time in a half-century (Estes Kefauver's ill-starred campaigns of the 1950s being the last), a genuine progressive populist, John Edwards of North Carolina, has a chance for the Democratic presidential nomination. Naturally, fate has intervened. The candidate's wife, the key person in his organization from multiple standpoints, has developed incurable cancer. What else can happen?

This is a personal tragedy, and Elizabeth Edwards, everyone's favorite first-lady-in-waiting, deserves all possible sympathy and support. Doctors say the situation is far from hopeless; the entire country has recently been educated on the relatively new phenomenon of living successfully with cancer. So the Edwards family may have many good years ahead.

Still, the medical news is fraught with problematic political implications for the Edwards campaign. There will be talk, both inside and outside the political process, that John Edwards should quit the race, that continuing on is personally selfish and self-indulgent. There will be concerns on the part of some squeamish voters about having a less than perfectly healthy first lady in the White House, as well as worries about having a president not fully focused on his job. For those looking for a reason to shift their allegiance to another candidate, excuses will abound.

Historically, however, this situation is not unprecedented. Abraham Lincoln governed while burdened with a mentally ill spouse, and Woodrow Wilson buried his first wife a year into his presidency. Historians would agree that both men did a reasonably good job of serving the nation. Most presidents can function very effectively with personal problems hanging over them, because they usually have the ability to compartmentalize. Better an elected leader periodically concerned about family issues than one prowling the White House late at night, Nixon-style, conversing with portraits on the walls.

The truth is the country needs the Edwards campaign; it's one of a kind, and it could make all the difference for millions of Americans. There are certainly other good people running. Barack Obama, in particular, is an attractive possibility for center-left Democrats. He gives one heck of a good speech, and he appears to have the leadership quality often associated with FDR: a first-class temperament. Nevertheless, Obama's is for now an unformed candidacy, an empty screen onto which voters are projecting their hopes and dreams. That may change, but at present, the Illinois senator is long on charisma and short on specifics.

Edwards can hold his own in the charisma department, but he also has the programmatic substance Obama currently lacks and approximately as much elective experience (one term in the US Senate) as the "experienced" candidate, Hillary Clinton. He's also run for president before, something neither of his main rivals has done. Above all, he has articulated clear, unambiguous positions on the major policy issues facing the country, namely Iraq and health care. For all his eloquence, Obama has yet to do this; beyond saying he wouldn't have gone to war in 2003, he is cautiously vague about the way forward in the Middle East. As for Hillary Clinton, she has given caution a bad name, enunciating an Iraq policy that ebbs and flows according to the latest news headlines, but never quite disavows the infamous 2002 vote authorizing war.

John Edwards has done that and more, not only repudiating his war-authorization vote, but urging an immediate start to troop withdrawals from Iraq. It is on what is shaping up as the key domestic issue of 2008, however, that Edwards has most dramatically set himself apart from the other contenders. He is the first, and so far the only, candidate to produce a detailed plan for universal health-care coverage. He is also the first to attach a price tag to solving the health crisis ($90 to $120 billion) and to honestly say up front that taxes will necessarily be part of the solution.

As this is written, Hillary Clinton and Barack Obama have not yet spelled out their own health plans beyond advocating uncontroversial electronic record keeping. However, the signals they are giving off suggest strongly that those plans will feature some combination of employer mandates, individual mandates, and government subsidies, all operating within the framework of the existing market system. In other words, the private insurance industry will remain the key player in whatever ultimately emerges, and profit-based medicine will continue on in some form.

The Edwards plan, on the other hand, is a hybrid that combines private and public approaches to the problem. Businesses would be required to either provide comprehensive coverage to their employees or contribute to the cost of covering them through so-called health markets, regional nonprofit purchasing pools offering competitive insurance plans for those not covered on the job or under Medicare and Medicaid. Significantly, at least one plan available through the health markets would be a public one modeled on Medicare. "Over time," says the text of the Edwards proposal, "the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan."

No other major candidate for president has been willing to move this far toward endorsing the eventual adoption of a single payer. Edwards is alone in even suggesting the possibility of a government-run program that takes the profit out of medical coverage. Obama has rejected single payer as impractical due to the entrenched private system that already exists. Clinton removed single payer from any consideration when formulating her "Hillary Care" initiative in 1993-94; it appears to remain off the table. Obviously, neither of the two front runners wants to take on the insurance industry directly, which is a sad commentary on them and on our political system in general. John Edwards is at least willing to provide an opening for an alternative to marketplace medicine, even if it has to develop more or less on its own. For that, he is to be commended.

The Edwards plan is far from perfect; it's not the Medicare for All proposal polls indicate Americans, given their druthers, would prefer to see. But that's not likely to happen -- unless the pro-single-payer Kucinich campaign suddenly catches fire, or Al Gore (another single-payer advocate) enters the race. In the meantime, John Edwards seems the best progressive bet among the Democratic Big Three for health care and for other issues as well.

Wayne O'Leary is a writer in Orono, Maine.

From The Progressive Populist, May 15, 2007

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