In the money primary, Barack Obama and Hillary Clinton may be way out in front, but in the health-care primary, John Edwards is the candidate to beat. New York Times columnist Paul Krugman—whose March 2006 essay in the New York Review of Books, "The Health Care Crisis and What To Do About It," provides the most cogent explanation I know of how the current health-care debate falls short (if you haven't read it, please do so immediately)—gave Edwards' health-care plan his blessing in a February 2007 column, "Edwards Gets It Right." When the Democratic presidential candidates gathered in Las Vegas in March to debate health care, Marc Cooper of The Nation identified Edwards as the standout, at least among top-tier candidates. (The only candidate who truly steps up to the plate on nationalizing health care is Dennis Kucinich, who—in case you're wondering—is not going to get the nomination.) William F. Buckley has singled out Edwards' plan for attack, which further burnishes its pedigree. Edwards has positioned himself to the left of the other major contenders for the Democratic nomination, which is a liability in many ways. But when it comes to health care, it is only an asset. As I've noted before, this is one debate that needs to shift leftward, and a Michael Moore documentary won't be enough to do the job.
How does the Edwards plan measure up by the Health Care Primary yardsticks? Read on.
Candidate: John Edwards.
Elegance: His coiffure's a bit overdone (would somebody please muzzle his stylist?), but let's remember this category refers to the plan, not the man. Edwards' health-care proposal (to read it, click here) is superficially complex, because it includes many components. This is widely and incorrectly regarded as an advantage. In March, the Washington Post's Christopher Lee wrote that Edwards had "the most detailed position." That laurel subsequently passed to Obama's plan, at least if you measured by page length (15 pages to Edwards' seven). Edwards, not to be bested, then produced a revised description of his plan, with details on cost savings, which ran 27 pages. It was the wrong fight. What mattered wasn't whether Edwards' plan was multifaceted, but rather whether its parts worked in harmony. They do. To learn why, proceed to "market gimmicks."
Market gimmicks: The main one is creation of regional "health markets" in which insurers, if they wish to compete, must provide certain "comprehensive" benefits. Consumers, to be eligible, must be able to demonstrate either that they receive no health insurance through their employer, Medicare, or Medicaid, or that the coverage they receive from their employer is inferior to the coverage offered in the health markets. Why many regional health markets rather than one big national one like Obama's National Health Insurance Exchange? Edwards doesn't say, but I presume it's to provide multiple laboratories of democracy.
Why laboratories? Because in each of these health markets, an experiment would be conducted. The experiment would be whether the private health-insurance plans could compete effectively with "a public insurance plan modeled after Medicare, but separate and apart from it." What could be more market-minded than a competition between private and public health insurance? We wouldn't need to argue about which was better. We could watch and find out! The reason this is a gimmick is that the outcome would be a foregone conclusion. Everything we know about how Medicare and Medicaid stack up against private insurers tells us that the public plan would win. Edwards is aware of this. "Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan," reads the plan overview. Strike may and substitute will, strike if and substitute when. In the current political environment, nobody is willing to believe that the government can deliver health care with greater efficiency than the market. Edwards has therefore undertaken to prove it over and over in one regional health market after another. It's what parenting handbooks call a "teachable moment."
Susceptibility to the insurance lobby: Edwards' health-care markets are less susceptible to being gummed up by the insurance lobby than Obama's National Health Insurance Exchange. That's because if health insurers persuaded Congress to loosen the rules about what they had to cover, they'd only be making their plans even less able to compete with the new public insurance plan. They'd have to persuade Congress to forbid the public plan to be more generous than the private ones, which would not be a terribly popular thing to do. Other parts of Edwards' plan would be easier to undo. For example, "Edwards will require insurers to keep plans open to everyone and charge fair premiums, regardless of preexisting conditions, medical history, age, job, and other characteristics." Well, maybe he will and maybe he won't. Insurers would do their best to water down any such regulations. But it probably wouldn't matter, because businesses would see the creation of health-care markets as an occasion to dump all health-care obligations to employees, and pretty soon just about everyone would be eligible to participate in the health-care markets, where, again, it would be suicide for private insurance companies to be stingy with benefits.