March 22 (Bloomberg) -- John Edwards was the first presidential candidate to get one. Mitt Romney signed a Massachusetts law creating one that he now distances himself from. Barack Obama promises one. Hillary Clinton had one in 1993 and won't talk about it now.I think that the US's broken system of health insurance is the single biggest policy issue facing the US for at least the next ten years, and that any serious presidential candidate has to make it clear that it will be a priority for them.
"It" is a plan to revamp U.S. health care, the world's most expensive system and, compared with those of other industrialized countries, not necessarily the best. While candidates for president are reluctant to take on a $2.1 trillion industry that makes up 16 percent of the U.S. economy, surveys show that a majority of Americans want the government to overhaul the system.
The political environment may be right for the first time since former President Bill Clinton took on health care 14 years ago. The puzzle of how to hold down costs while providing health care to 47 million Americans who don't have it has only grown more intractable. The leading Democratic candidates will discuss solutions at a forum this weekend in Las Vegas.
..."Candidates know they have to engage on this issue, and they will," said Chris Jennings, a former senior health-care counsel to President Clinton who is working informally with Senator Clinton of New York.
The candidates must find ways to provide more coverage without making people afraid that they will lose the benefits they already have, he and other advisers say. Another issue is whether to focus on America's uninsured or take on the entire health-care system, from rising costs to the role of insurance companies.
The down side to addressing the health care issue, of course, is that fixing the US's health insurance system is almost certainly going to be fiercely resisted by currently entrenched interests, as well as by those Americans who are simply nervous about dramatic changes in general. It is the right thing to do for the country, and will make most Americans far better off in future years, but passing any major health insurance reform is going to be messy, ugly, difficult, and very likely politically costly.
It's kind of like fixing the deficit. Democrats have a choice (about which there's been substantial debate). Do they do the responsible thing, and fix a problem that has just been growing and growing in size during the years of Republican control of the White House, while possibly paying a substantial political price for making the difficult but necessary trade-offs? Or do they just do the minimum necessary to keep the problem from getting out of hand, so that their responsible actions don't hand the keys back over to Republicans in the next election?
My hope is that doing the right thing (in this case, substantially reforming the way health insurance is provided in the US) would yield the positive results that I know it would have quickly enough that those who behaved responsibly would be rewarded at the ballot box. But Democrats do face a very real danger that, as with raising taxes in 1993 to fundamentally improve the federal government's finances, the benefits to Americans may not be felt for a few years, giving Republicans a chance to return to power, possibly undoing some or all of the good done by the responsible party.
Either way, it's something that political candidates need to talk about, and address. I haven't decided whom I will support for President in 2008, but I can guarantee you this: I will definitely not support any candidate - Democrat or Republican - who thinks that the US's health insurance system can continue without major, major reforms.