Health care is a “must” issue among Democrats running for president — popping up at town halls and debates and earning the major candidates’ attendance at a March forum in Nevada dedicated exclusively to the topic.
Among Republicans, it has been almost invisible.
The party’s 2008 presidential front-runner, former New York Mayor Rudolph W. Giuliani, took the first step to change that yesterday, offering broad principles for how he will draw up his own health care proposal in the coming months and blaming government mandates and bureaucracy for ballooning costs.
“We must empower all Americans by increasing health care choices and affordability, while bringing accountability to the system,” he said, accusing Democrats of moving toward socialized medicine by favoring a bigger government role and paying for coverage for those with lower incomes.
Mr. Giuliani proposed a $15,000 tax deduction for a family to buy health insurance, which he said would give individuals more control over their care, help plans become better-tailored and hold down costs.
But his entry into the discussion still leaves Republicans far behind Democrats on an issue that polls show is on the minds of voters of both parties and that analysts say each candidate will have to address before reaching the White House.
“Everybody is going to have to spend a lot of time talking about health care,” said Dr. Mark McClellan, director of the new Engelberg Center for Health Care Reform at the Brookings Institution.
He is calling on candidates to refine a health care message for the elections and said Republicans will need to put more emphasis on it than in the past. Meanwhile, “the Democrats have already started doing that in their campaign — it’s clearly a big issue for their base,” Dr. McClellan said.
It’s so big that “health care” has drawn 99 mentions through the first four Democratic debates, or more than three times the 30 mentions in the first three Republican debates.
That lack of attention didn’t go without notice.
“You know, I’ve been here for two debates. We never had one question on health care,” former Health and Human Services Secretary Tommy G. Thompson said when a health care question finally popped up at the third debate in June.
The U.S. Census Bureau says 44.8 million people in the country lacked health insurance in 2005, up 1.3 million from 2004. That trend, plus escalating costs for those who do have insurance, has driven the issue onto both parties’ agendas.
Democrats said Mr. Giuliani’s plan was a rehash of President Bush’s own health care plan, announced earlier this year, which has not gained any traction in the Democrat-controlled Congress. The Democratic National Committee (DNC) also said Mr. Giuliani’s plan would do nothing to guarantee coverage for millions of Americans.
“The Giuliani-Bush health care plan has already been rejected by the American people as a risky scheme,” said Karen Finney, the DNC’s communications director.
Among Democrats, taking the lead on health care has become a point of pride, and the candidates spend time dissecting each other’s plans on the campaign trail.
Former Sen. John Edwards of North Carolina earned applause and credibility for having been the first to announce a broad, detailed plan requiring individuals to have coverage and making businesses either provide health insurance or pay into a fund for shared coverage plans.
Sen. Barack Obama of Illinois followed in May with his own detailed plan that makes employers who do not offer health insurance pay into a national plan that would cover individuals.
Sen. Hillary Rodham Clinton of New York has released a part of her plan, which calls for controlling the costs of health care, and touts her experience as the author of the ill-fated Clinton administration plan as evidence she’s ready to lead on the topic.
Filmmaker Michael Moore, whose new movie, “Sicko,” looks at health care, wants Democrats to go even further and pledge to refuse their own government-sponsored health care until they enact universal coverage.
On the Republican side, Mitt Romney, who is competing with Mr. Giuliani in the top tier of presidential candidates, signed one of the nation’s only laws as governor of Massachusetts that requires everyone to have coverage.
In the June debate, Mr. Romney said Republicans have to take the issue head on.
“We have to stand up and not just talk about it. I’m the guy who actually tackled this issue,” he said. “We get all of our citizens insured. We get people that were uninsured with private health insurance.”
Dr. McClellan, a former Bush administration health official who was also on a preview press conference call arranged by the Giuliani campaign this week, said Republicans can’t hide from the issue in this election. But he said advances in technology and the personalization of care may mean the issue is starting to dovetail with Republicans’ principles. Dr. McClellan said that gives them the chance to lay out a positive vision for a plan.
“The challenge in the election is going to be how do you reconcile the need for individual involvement in decision-making with making sure even people with low incomes and chronic illnesses can get the coverage they need,” he said.
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