Prescription for a Democratic Win

As Barack Obama moves into the Democratic National Convention, he should speak out more clearly and forcefully on an issue that clearly distinguishes him from his do-nothing opponent — national health insurance.

Nothing illustrates John McCain’s dedication to laissez-faire economics more than his plan to change, although not to improve, a health insurance system that now increasingly fails to meet the needs of Americans.

And nothing illustrates Obama’s failure so far to put some meat on his campaign than his inability to nail McCain on this issue and to speak specifically and powerfully about his own excellent plan, which he announced early in the campaign.

Public opinion polls show the contest to be about even. News media analysts portray this as evidence that Obama has stalled and is even faltering in the face of assaults by that journalistic favorite, McCain.

Actually, as the Los Angeles Times/Bloomberg poll noted, Obama is doing as well or better than the last two Democratic nominees, Al Gore and John Kerry, at this point. Kerry was leading President George W. Bush 46 percent to 44 percent, a statistical tie, and Gore trailed Bush 48 percent to 39 percent in a comparable pre-convention period.

Still, Obama has yet to clearly define himself as the go-to guy we can trust in a crisis. He has to convince undecided voters to say that despite his limited experience, his race and his name, “I like what he says and there’s something about him I trust. I’m going to take a chance on him.”

He’s not there yet. On the campaign trail he remains an inspiring but somewhat remote figure, a weakness evident since the first days of the campaign, when he unexpectedly lost to Hillary Clinton in New Hampshire, hurt by her ability — and his inability — to connect with blue-collar workers in economically troubled areas of the state.

Today, more than in January, the economy is the voters’ top concern. The latest Kaiser Health tracking poll showed that 49 percent of those surveyed felt the economy would be the main factor in deciding their vote, compared to 25 percent who said Iraq.

Digging deeper into the findings, the pollsters said “the survey suggests that this [the economy] is an umbrella issue covering many other concerns, including those relative to health care.”

Obama’s health insurance plan comes close to what would be the best system, Medicare for all, known as “single payer,” the payer being the federal government. Medicare, with overhead substantially less than private plans, has been chugging along for decades, satisfying generations of seniors with its simplicity, accessibility and benefits.

Obama likes this system. The Wall Street Journal reported that he told a town hall meeting in New Mexico, “If I were designing a system from scratch, I would probably go ahead with a single payer system.” But he said it would be a long and complicated process to dismantle what we have now, “given that a lot of people work for insurance companies, a lot of people work for HMOs. You’ve got a whole system of institutions that have been set up.”

Obama’s plan offers a mix of public and private coverage assuring health insurance for all and requiring all children to be covered. Employer-based plans would continue, although companies would have to offer “meaningful” coverage or contribute to a new public plan, which would be open to all. It would offer comprehensive benefits, affordable premiums, co-pays and deductibles. There would be a subsidy for people with low incomes.

Another new feature would be a National Health Insurance Exchange, which would oversee private health insurance plans. Those working for small businesses or without employer-based coverage would buy policies from insurance companies through the exchange. All children would be required to have health insurance.

In other words, whatever your circumstances, you’d have health insurance.

That’s not true of McCain’s plan. He’d rely on the Bush administration’s inadequate health savings accounts, which are more helpful to the high-income group than to the middle class and low-income people and shift medical costs to the consumer. If you have a high deductible insurance policy, you can maintain one of these savings accounts, which have some tax advantages. He also would offer tax credits of $2,500 for individuals and $5,000 for families to offset medical costs. And he envisions some sort of nonprofit organization contracting with insurance companies to provide insurance for those denied access.

This plan is strictly Bush administration, with a few cosmetic additions. It shows McCain for what he is — a dedicated proponent of the free market, which has not provided the country with affordable health insurance.

Obama must explain the differences between himself and McCain on the issue. John F. Kennedy did it with Medicare during the 1960 campaign, and he spoke so effectively that he convinced my dad to cast his first vote ever for a Democratic presidential candidate.

Obama can do it, too. Let’s hear more specifics, expressed in plain, populist language making the issue as personal as a visit to a doctor, a stay in the hospital or a night of worry over how to pay the bills.