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Vouching Toward Gore

By William Saletan
Posted Tuesday, Dec. 21, 1999, at 3:30 AM ET

Toward the end of Friday's Nightline debate, after Al Gore had called Bill Bradley's health-care proposal a "voucher" plan for the third time, Bradley finally woke up and smelled the danger. "They're not vouchers, Al," Bradley protested. "It is not vouchers. The health-care program doesn't have vouchers." Two days later, in their debate on Meet the Press, Gore elaborated: "There are 75 million Americans today who get Medicare and Medicaid. They are all left out under Sen. Bradley's plan because he eliminates Medicaid and replaces it with little $150-a-month vouchers." Bradley fired back immediately. "That's wrong," he insisted. "It's not a voucher."

The "voucher" debate represents the third and decisive stage of the Democratic presidential contest. In the first stage, each candidate tried to put his best issues on the agenda. Gore pushed suburban sprawl, health care, and education. Bradley pushed gun control, health care, and campaign reform. Each man got one of his issues on the agenda--campaign reform for Bradley, education for Gore--plus the issue on whose importance they agreed: health care. In the second stage, the candidates fought for the high ground on those three issues. Gore won the high ground on education by proposing a $115 billion school aid package while portraying Bradley as a voucher sympathizer. Bradley won the high ground on campaign reform by offering a comprehensive reform plan while teaming up with John McCain against a fund-raising system whose corruption McCain helpfully traced to the Clinton-Gore White House.

The third stage is the battle over the remaining issue: health care. Each candidate is trying to marshal his assets on this battleground by building a thematic bridge to it from the issue he is already winning. Bradley is trying to carry his message of comprehensive reform from campaign finance to health care. He proposes to replace Medicaid with subsidies that would make health insurance affordable to more people but would require those with sufficient incomes to pay part of their premiums out of their own pockets.

Gore, meanwhile, is trying to carry his message of public responsibility from education to health care. He wants to convince Democrats that Bradley, by substituting partial subsidies for guaranteed benefits, would gut the public health-care system as well as the public education system. If Gore succeeds in linking the two issues this way, Bradley will lose the health-care debate, and with it the nomination. That's why Gore has distilled this linkage to a single word--"vouchers"--and why Bradley is fighting to extinguish that word with such fury.

In the context of education, Gore has defined the word "voucher" in two negative ways. First, vouchers are a zero-sum game. As Gore sees it, every penny spent on them comes out of funds previously allocated to a fully subsidized program. "Experience shows there's a set amount of money that communities have been willing to spend on education," Gore argued on Meet the Press. "If you drain the money away from the public schools for private vouchers, then that hurts the public schools." Second, vouchers don't cover the cost of the program they replace. "The flaw with the voucher theory," said Gore, "is that the vast majority of those who receive a tiny little down payment on the tuition cannot afford the rest of it."

Having packed these two poisonous assumptions into the word "voucher," Gore is now injecting that poison into Bradley's health-care proposal by applying the same word to both contexts. "Every single time vouchers came up in the Senate, Bill, for 18 years, you voted for them. Now you're proposing vouchers in place of Medicaid capped at $150 a month," Gore charged on Nightline. "You canceled Medicaid and give people $150 vouchers to try to replace it. … If we cancel Medicaid and substitute little vouchers capped at $150 dollars a month, there's not a single plan available here in New Hampshire that you can get for anything approximating the cap in this plan." On Meet the Press, Gore said Bradley expects recipients of health insurance subsidies to "buy into the federal employee benefit plan. Ninety-five percent of all the health insurance plans that are part of [that] plan have premiums that are far in excess of $150 a month."

The "voucher" attack has at least made Gore's ideological position coherent. For months, Gore vacillated between calling Bradley a liberal budget-buster and calling him a crypto-Reaganite menace to federal entitlements. Now that question is settled: Gore will attack Bradley from the left. Gore will defend Medicaid, the public schools, and other government-guaranteed programs. He will accuse Bradley of threatening to replace these programs with risky and inadequate "voucher" schemes. And he will direct this argument to specific Democratic constituencies such as senior citizens, blacks, gays, and labor unions.

What's not yet clear is whether Bradley will accept this arrangement. On Meet the Press, he challenged Gore's leftist dogma against school vouchers: "If [voucher] experiments demonstrated that the quality of public education was improved, does that mean that you would not even consider vouchers?" Then he scoffed that "Al proposes an education program" that "comes from Washington." Yet Bradley refused to cede the left to Gore. Rather than defend the idea of substituting vouchers for government control of schools, Bradley insisted that the two options are compatible. "Every time I voted for vouchers, I voted for it as an experimental basis," said Bradley. "And I also said that I would not take any public money that was set aside for schools. This would be new money."

Similarly, Bradley refuses to defend the mildly libertarian position Gore has assigned him on health care. Bradley could affirm that his subsidies for health insurance don't cover the entire cost of premiums. He could argue that individuals ought to bear responsibility for paying a portion of their premiums. Or he could simply argue that the amount of money the government takes from taxpayers to subsidize health care should be limited. He could, in short, embrace and defend the idea of vouchers.

Instead, Bradley repudiates the word. On Meet the Press, he insisted that the $150 he allots to each person's monthly insurance premium is "not a cap. It's a weighted average." In a "Memo to National Reporters" after the debate, Bradley's campaign drove home the point: "THE BRADLEY PLAN IS SUPPORT FOR HEALTH INSURANCE, NOT 'VOUCHERS.' " Calling the $150 a "cost estimate," the memo provided dictionary definitions of "subsidy" and "voucher," indicating that vouchers are explicitly finite whereas subsidies are not. The implication of these caveats is that if universal health insurance turns out to cost even more than the $65 billion a year Bradley has allotted to it, the government will tax and spend more to cover the difference.

Listening to Bradley's equivocal remarks on school vouchers, and looking at the sliding scale of subsidies and tax breaks he proposes for health insurance, you get the feeling he's rather sympathetic toward solutions that take account of market dynamics. You get the feeling that this sympathy is what he's hiding behind noncomittal words such as "cost estimates" and "weighted averages." You wonder whether he could win a general election coming out of the right lane of the Democratic Party. But first he has to get the Democratic nomination, a race he has clearly decided he can't win in that lane.

In a way, it's Bradley's fault. On firearms and campaign finance, he defined reform as government control. He thought he could pass Gore on the left. Instead, Gore cut him off--and now Bradley can't connect his campaign-finance crusade, under the rubric of reform, to his challenges to existing welfare-state policies on health and education. Every time Gore utters the word "vouchers," he's bumping Bradley closer to the right edge of the road. It's going to be a short race if Bradley won't bump back.

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William Saletan is Slate's national correspondent and author of Bearing Right: How Conservatives Won the Abortion War.
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Highlights from the Fray:


If the education vouchers controversy between Gore and Bradley didn't clinch the nomination for the former, the Medicaid-for-"vouchers" debate sure has. If Social Security is the Third Rail of American politics, Medicare and Medicaid have become the Fourth and Fifth since LBJ signed them into law in 1965. And it's not just because middle-class elderly and their middle-class relatives easily confuse the means-based Medicaid with the universal, non-means-tested Medicare. (Although this they certainly do--and, as a result, millions of voters elide this key difference in the programs, vaguely seeing Medicaid as a sort of indistinct twin to the beloved Medicare.)

The fact is that virtually all nursing home patients--even middle-class ones--rely on Medicaid. And rising Medicaid income levels in many states mean that more and more above-poverty elderly and disabled have become covered by Medicaid too. (Congress just passed legislation letting states give Medicaid to working disabled persons with ANY income level---further strengthening Medicaid's hold on middle class disabled people and their many relatives.)

Bradley committed major heresy--all the more unforgivable with a Democratic primary electorate--by even thinking of tampering with one of the crown jewels of the Great Society. He effectively lost the nomination during this debate. And while pundits and political activists and policy wonks may see Gore's rhetorical and substantive victory with Medicaid as "running to the left," this won't entail any "price" with the moderate center come general election time.

To be sure, Democrats' reverence for LBJ's Great Society agenda is absent outside their base. But the general public's confabulation of Medicare and Medicaid--which is which, and what's the difference anyway?--ensures that it will be merged seamlessly into the untouchable Medicare in the average voter's mind. This result will be hardened given the fact that Medicaid is in fact becoming--more and more for both nursing home patients and other aged and disabled persons--a program they rely on for a family member's care.

--{{TomMccormack

#2:mailto:tomxix@ix.netcom.com}}(To reply, click here.)

(12/21)

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