Before the energy-price crisis, before the mortgage crisis, before the credit crisis and the banking crisis, there was the crisis in health insurance that is in reality a crisis in care.

This crisis has deepened in recent years as the number of uninsured has climbed and out-of-pocket costs for those still with insurance have soared. It has become common knowledge that a serious illness — even among those with insurance — can plunge families into bankruptcy. Though “problems paying for gas” topped the financial challenges people listed in the most recent Kaiser Family Foundation health tracking poll, “problems paying for health care and health insurance” ranked third — just behind job concerns but well ahead of paying for food, dealing with credit card debt and paying the mortgage.

So it is downright shocking that there was a tussle over what the 2008 Democratic platform would say about the party’s generations-long, bedrock commitment to health care for all Americans. In short, presumptive nominee Barack Obama did not draft a statement keeping that pledge. He presented instead his plan as one that would provide “access to” affordable and comprehensive health care. A coalition of liberal activists and Hillary Clinton supporters managed to negotiate a change so that the platform says the party is “united behind a commitment that every American man, woman and child be guaranteed to have affordable, comprehensive health care.” Inclusion of the word guaranteed was the crucial point.

On the surface, this may look like a victory for Clinton supporters or even for the far larger group — that is, millions of Democrats — who have long believed that the promise of guaranteed, universal health care is a fundamental principle of their party. I am less certain, and it’s not because I know that politicians can discard party platforms faster than they rid themselves of scandal-tainted donors.

It is because Obama did not campaign during the primaries on a plan that would achieve universal coverage, and, indeed, excoriated Clinton for her proposal to mandate that everyone have it. In fact, even some of those involved in achieving the small health-care victory take little solace from it. “I’m not sure that Obama will actually pursue the same kind of idea that we had inserted in the platform,” says Donna Smith, who lobbied the platform panel as a member of Progressive Democrats of America. “I think we will have to pursue our congressional representatives to bring legislation forward.”

Smith is not a Clinton delegate, or even a convention delegate. She and her husband, Larry, were featured in the Michael Moore film “Sicko” because they were forced into bankruptcy and lost their home trying to pay the out-of-pocket costs stemming from her treatment for uterine cancer and his for heart disease. “Our purpose was not to attack the party,” says Smith, who adds that she wants Obama to be elected and describes herself and her husband as “good and loyal Democrats.” But certain lines have to be drawn.

“To say you’re going to provide affordable coverage to people is not the same as giving them health care,” she says. “Just because you have insurance coverage does not guarantee you access to the care that you and your doctor decide you need. And people with insurance understand that.”

Most Democrats do, too.

In 1992, the party’s platform said everyone should have “universal” access to health care “not as a privilege, but as a right.” In 1996, a party chastened after the collapse of President Bill Clinton’s health care initiative nonetheless committed itself to “ensuring that Americans have access to affordable, high-quality health care.” In 2000, the platform noted that “for 50 years, the Democratic Party has been engaged in a battle to provide the kind of health care a great nation owes its people.” In 2004, the platform said this: “We believe that health care is a right and not a privilege.”

Securing that right is as important now as it was four, or even 50, years ago. When gas prices recede, when the housing market stabilizes and fears of imminent job losses ebb, there will still be an unconscionable gap between the glory of American medical science and the ability of millions of people to get the most basic care.

Obama avoided an intra-party brawl over the health platform. The unanswerable question is whether he will be as determined, as president, to take on the much larger — and excruciatingly harder — health-care fight.

Marie Cocco’s e-mail address is mariecocco(at)

© 2008, Washington Post Writers Group


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