More than 100 American deaths ago, President Bush landed on an aircraft carrier and spoke in front of a backdrop that said “Mission Accomplished”. I’ve gotten used to those presidential backdrops with their two-word or three-word slogans. So when Dick Gephardt held a meeting at the Joe King’s Shoes store in Concord, New Hampshire on a Friday afternoon (August 8), I kept trying to find significance in the “Achieve New Balance” banner that stretched over the display of running shoes behind him.
More than any other candidate in the running, I think, Gephardt has been thrown off-stride by the war. Just a year ago he was the House minority leader, seemingly poised to become Speaker of the House when the Democrats picked up a handful of seats in the 2002 elections. It looked like a Democratic year. The opposition party almost always gains seats in the off-year election, and besides, the economy looked terrible. The Afghan War was old news, so the election was shaping up to center on Democratic bread-and-butter issues like jobs and health care.
That’s when President Bush began beating the drum for an invasion of Iraq. One reason the Democrats didn’t challenge Bush on Iraq was that Gephardt and Senate majority leader Tom Daschle didn’t want to. They wanted the issue to go away quickly so that they could get back to talking about jobs and health care in time for the elections. They thought that if the Democrats got in line behind the President’s war authorization resolution without lengthy hearings or debate, it wouldn’t be an issue.
That was a mistake on two counts. First, if there was ever a moment when someone should have said: “Wait a minute. Why exactly are we doing this right now, and how is it all going to end?” that was it. Congress had a duty to ask the hard questions, and it failed in that duty. Second, the political calculation didn’t work. The public never did get back to thinking about jobs and health care, and the Democrats suffered a crushing defeat, losing the Senate rather than gaining the House. On election night in 2002, I promised myself that I would not vote for Gephardt or Daschle in the primary if either of them ran for president.
Nine months later, Dick Gephardt is still trying to regain his balance. He’s still trying to talk about jobs and health care, and he still wishes the war would go away. And, like a lot of other Democratic voters, I still haven’t forgiven him for 2002.
The Gephardt Show
In my report on Dennis Kucinich, I said I liked him better as a talk show host than a presidential candidate. Dick Gephardt looks like he’s auditioning for the talk show host role: He sat in the center of a row of stools under the New Balance banner, surrounded by his panel – local people whose situations point out the problems Gephardt wants to solve. This talk-show technique requires a lot of staff preparation, and his staff assembled a good panel:
a social service worker to talk about the increased number of Concord residents who need help and the decreased resources available to help them;
the owner of the local florist shop to describe the declining local economy and the problem small business owners have finding affordable health care for themselves and their employees;
a retired man worried about the state of medicare and social security;
a worker who had been laid off of a good job and was getting by with a temporary job paying much less
a second small-business owner who is working a second job to make ends meet. “I’ve never seen it like this in the 23 years that I’ve been in business,” he said.
I had brought along my wife Deb and our friends David and Ellen who were visiting from California. We sat on a couple of benches at an angle to the front, and Gephardt started the event by calling on me, apparently thinking that we were part of the panel. I wish I had possessed the presence of mind to go with the flow, because we actually would have made decent panelists too: Deb has survived two bouts with cancer and now takes a drug that costs $2500 a month; our health insurance is taking good care of us, but it makes us wonder what the 40 million people without health insurance do. David and Ellen own a book store in San Francisco; they are also wondering how to provide health care for themselves and their employees, and Ellen may have to find another job to keep their household going.
So maybe assembling a good panel isn’t as hard as I thought – which is probably the point of the whole exercise. The administration does its best to keep us panicked about the threat of terrorism, which is a fairly remote risk for most of us. Meanwhile, we run into people every day whose lives have been adversely affected by the poor performance of the economy and Bush’s let-them-eat-cake approach to health care.
A detour through Democratic health care plans
Gephardt has made his health-care plan the center of his campaign. He was the first major candidate to propose a detailed health-care plan, and his plan raised the bar for everyone. By now, all the candidates have a health-care plan, so this is as good a time as any to review the bidding.
There are basically three ideas in Democratic health care: a single-payer system like the Canadians have, Gephardt’s plan to subsidize employer health-care benefit plans, and plans to stretch existing government programs to cover more people.
Northern exposure. In Canada – and Australia and New Zealand and Germany and just about everywhere else in the civilized world – the government is the health insurance company and everyone is covered. Here in the US, I hear a lot of talk about Canadian waiting lists for operations and so forth, but I’ve never met a Canadian who envied the American system. Per capita, Canada (like every other country) spends less on health care than we do. So one answer to the waiting-list problem might be to spend as much on health care as we already do.
In my heart, this is the system I want. But it runs so counter to the prevailing political philosophy here in the United States that I see no hope of getting it any time soon. Not only is the American public suspicious of big government programs, but the health insurance and pharmaceutical industries would spend any amount of money on scare ads to fan those fears. (Remember the Harry-and-Louise ads that undid the Clinton plan?)
Al Sharpton, Carol Mosley-Braun, and Dennis Kucinich (as well as Ralph Nader and the Green Party) back this plan. “Medicare for everyone” is the way Kucinich puts it. If your poll numbers are sitting at 3% anyway, why not go for it?
The Gephardt plan. In Dick Gephardt’s plan, coverage comes through an insurance company as an employment benefit – as it does now for people who have good jobs with good companies. The difference would be that the government would subsidize the employers’ cost to such an extent that they’d be foolish not to offer such a benefit. Gephardt does this by reimbursing companies for the first 60% of the cost of their employees’ coverage and 60% of whatever else they pick up. (For example, it would cost a company nothing to pay 60% of the premiums and leave 40% to the workers. If the company picked up the whole premium, they’d be reimbursed for 84%.)
At the first debate after Gephardt announced his program, John Edwards had an immediate objection: What about all the companies that already pay 60% of their employees’ health premiums? The government subsidy lowers their costs and goes straight to the bottom line. So a sizeable chunk of the cost of the program is immediately diverted into corporate profits, not health care.
As someone who occasionally works as a free-lance writer, I have another objection: Tying health benefits to your job was a fine idea in my father’s generation, when many people worked for one company until they retired, but today a lot of people are independent contractors of one sort or another. And many other people change companies every few years, either by choice or because their employer was bought by someone else. Individuals want to have long-term relationships with their doctors, clinics, and hospitals – but not necessarily with their employers.
The spandex solution. Just about everyone else in the race has converged on the same idea: Stretch existing government programs to cover more people, making health insurance free for the poor, subsidized for low-wage workers, and available (but more-or-less reasonably priced) for everyone else. John Kerry, Howard Dean, John Edwards, Bob Graham, and Joe Lieberman all support some version of this plan. The details differ, but I believe the differences have more to do with candidate branding than with actual philosophical differences. If any of these guys gets an opportunity to put his plan before Congress, I’m sure the others will support it.
Right now, the old are covered by Medicare, the very poor by Medicaid, and poor children by the State Children’s Health Program (S-CHIP). The costs of these programs are split between the federal government and the states in some complicated way that only the technocrats understand. The Bush administration wants to give states more control over Medicaid, which means (given the budget crisis that exists in every state) that spending would be cut and fewer people covered. (In New Hampshire right now we’re having an argument about whether poor people can get by without glasses.)
The convergent Democratic plan would stretch these programs as follows: S-CHIP expands to cover all children who aren’t covered some other way. Medicaid gets a sliding-scale subsidy to cover adults who make less than two or three times the poverty level. (Dean proposes 185% of the poverty level, Kerry 200%, Edwards 250%, and so on.) Let individuals over 55 buy into either Medicare or the federal employees health system if they can’t get coverage elsewhere. Encourage businesses to cover more of their employees, but not with an across-the-board subsidy like Gephardt’s.
Not all the candidates supports every piece of this. Lieberman has the most timid plan, which stops with covering children. Kerry and Dean would let everyone (not just the over-55 folks) buy into a federal program. Kerry uses a carrot to encourage businesses to cover their employees (the federal government would take the most expensive patients out of the risk pool), while Dean uses a stick (only businesses that covered their employees would be eligible to bid on government contracts). But these are the kind of details that would get re-negotiated as the plan went through Congress anyway, so it’s silly to obsess over them now.
Can any of them get passed? Cost estimates for these programs are all over the map, and are probably inaccurate anyway. The single-payer system is by far the most expensive, but its advocates all ask the question: Compared to what? Compared to what the government spends on health care now, the plan is very expensive. Compared to what the United States as a society spends on health care now, maybe not. And only the single-payer system achieves the goal of universal coverage. The other plans all have cracks that a few people would fall into, but they all cover millions of people who don’t have coverage now and aren’t likely to get coverage during a second Bush term. So the second relevent question is: Can any of these plans get passed?
The conventional wisdom says that the more modest a plan is, the more likely it is to become law. That’s unfortunate, because the current system is very screwed up, and the closer you stay to it the more screwed up your health plan will be. Just to take one example: When an uninsured, unable-to-pay person gets into a car accident and is delivered to an emergency room, he gets treated. A lot of the cost of that treatment is eaten by the hospitals, who make up for it by overcharging everyone else. (That’s why your hospital bill may show that you paid $50 to have a nurse bring you an aspirin, or something equally ridiculous. And your hospital may go broke anyway.) In any other country this would be a scandal, but here it’s just how the system works; we take it for granted.
One lesson most of the candidates have learned from the failure of the Clinton plan ten years ago is that the government can’t fall into the role of deciding which treatments get covered. Politically, that turns out to be a quagmire even deeper than Iraq. Every divisive social issue gets pulled into the discussion like light into a black hole. Does the plan cover abortions? Viagra? Birth control? Breast implants? Sex change operations? Acupuncture? What about talking therapies? What about a fundamentalist Christian program to “cure” homosexuals? If we have to answer all those questions to everyone’s satisfaction before we can proceed, we’re doomed. The non-Canadian plans all take the health-insurance playing field as they find it. They don’t try to put the health-insurance companies out of business, and they don’t try to define exactly what health insurance has to cover.
So which plan is best? I hope I live long enough to see a Canadian-style system in the United States, but I think we’re going to have to do something less ambitious first. So I reluctantly support the spandex plan. I’d love to make President Bush explain to the electorate why some children should do without health care so that we can give millionaires a bigger tax cut.
Meanwhile, back at Joe King’s Shoes
A shoe store isn’t the ideal place to address a large crowd, so I suppose it’s fortunate that Gephardt didn’t draw one. Various pillars and display racks prevented me from seeing everyone in the room, but my best guess was that there were about 50 people. (Dean and Kerry events in the same week drew over 300 each.) Some of those people were from Gephardt’s staff, some were journalists, and at least three were camera operators. Five were on the panel, and I picked out two as being the husband and daughter of a panelist. So at best there were a handful of voters who had come to hear Dick Gephardt.
In person, Gephardt looks more fit and handsome than he does on TV. He is quite thin and must work out regularly. He impressed me as being very earnest and well-intentioned. Like John Edwards, he makes much of his working-class roots. His father drove a milk truck and was a Teamster, a fact that goes over well when Gephardt seeks support from organized labor. (He has received far-and-away more labor union endorsements than any other candidate). Unlike our current president, Gephardt does not have to have Karl Rove convene a focus group to find out what ordinary Americans care about.
He also struck me as being dull. Maybe I was having a bad day, but a few minutes after the panel finished its testimony and Gephardt began to talk, I realized I wasn’t retaining any of this. I resorted to taking notes, something I hadn’t done for any of the other candidates.
“This administration has declared war on the middle class,” Gephardt said. He talked about the three million jobs that the US economy has lost since Bush took office, describing this as “the worst performance since Herbert Hoover”. And he decried the destruction of the budget surplus Bush inherited from Bill Clinton. “It took 200 years for this nation to create its first one trillion dollars of debt. This president is going to create another trillion in 24 months.”
The heart of his program is his health care plan, which he would fund by repealing the Bush tax cuts. He sees the tax cuts as a net loss for the working class, because the states and local governments are having to raise their taxes. “The president’s tax plan does nothing for state and local governments. You’re losing at the local level while you’re not gaining enough at the federal level.”
His health plan serves many purposes beyond health care. It would, for example, be an aid-to-the-states plan, because the states would get reimbursed 60% of their workers’ health benefits, just as businesses would. He also thinks it would do a better job of stimulating the economy than the tax cuts it would replace. This is an interesting point, one that most people don’t appreciate yet. In the old days, economists took it for granted that private sector spending would stimulate the economy better than government spending. But things may be different in this age of globalization, because money put into the private sector by tax cuts is more likely to leak out of our economy. If a worker spends his tax cut to buy a new Sony or Toyota, or if an investor puts his tax cut into yen or euros or yuan, the US economy doesn’t get stimulated. But health care is a service we can’t import from China, and government spending on roads and bridges (which Gephardt also favors) builds assets in this country rather than in Taiwan or India. “You have to have workers with money in their pockets to make the economy go.”
Gephardt also sees health care as a moral issue. “To me it’s immoral for anybody not to have health insurance.”
In addition to public works, Gephardt would like to see federal investment in alternative energy. He made the connection between energy policy and our continued involvement in the Middle East. (Here, both my memory and my notes fail me; I can’t give you the quote. After he said it, I listened to the silence for a couple of seconds and then decided to start a round of applause. So my hands were too busy to write down what he said.)
At that particular moment, he came very close to implying that we were fighting a war for oil, but Gephardt has been one of the strongest Democratic supporters of the war. He defends his vote and his leadership on that issue, but his plan for moving forward in Iraq is virtually identical to every other Democrat’s – including Dean, who was against the war. He would internationalize Iraq at this point, by getting another UN resolution and cooperation from allies who opposed the invasion, like France and Germany. He quoted someone as saying that the Bush administration would find it too “humiliating” to ask for help from these countries, and lashed at the administration for its pride. (Here again, his exact words did not stick in my head.) The time to be humiliated, he said, was when you had to tell an American family that their son or daughter was dead, not when when you had to ask for help from other countries.
On trade, Gephardt has a long record of skepticism about trade agreements like NAFTA and trade organizations like the WTO. He is struggling to avoid the label “protectionist”, but he wants “fair trade” as opposed to the merely “free trade” that the Bush administration favors. (His position in this seems similar to most of the other Democratic candidates; their differences are in the details of execution, not in the general principles.) He would not repeal NAFTA or get the US out of the WTO (only Kucinich would), but he would try to use these agreements to raise environmental and workers-rights standards in other countries. The point would be “to move standards up in other countries rather than moving ours down to theirs”.
At some point an aide stepped in and announced that the candidate needed to be on his way. This was the cue for the TV news people to converge on Gephardt and ask questions. Their questions were all about the horse-race, not policy. In particular, they did their best to try to get Gephardt to say something nasty about Howard Dean, who had just been on the covers of both Time and Newsweek and was starting to look like the front-runner. (A few days before, Lieberman had warned that a Dean candidacy might lead the Democrats “into the wilderness”. The best answer to this charge came from Jon Stewart, the host of Comedy Central’s The Daily Show. “The Democrats,” he warned, “could wind up without the White House, without control of either house of Congress, without the Supreme Court ... oh, wait. Never mind.”) Gephardt was having none of it. He refused to say anything negative about any other Democratic candidate.
After the TV people had gotten their sound bytes, I maneuvered to shake his hand. I hadn’t gotten to ask my usual Patriot-Act question, so I did it now. Gephardt – like all the other Democratic candidates who were in Congress (other than Dennis Kucinich) – voted for the Patriot Act. I asked him how he felt about that vote now. He responded that the law was being abused by Attorney General Ashcroft. He acknowledged that there might be a few parts of the law that would need to be rewritten, but mainly he thought we needed a new attorney general. My wife went on to ask if that didn’t make us a government of men, not of laws – but that point was too abstract for him to field on the fly.
So far, Gephardt and Edwards tie for giving the least satisfying answer to my Patriot-Act question. I’m no fan of John Ashcroft either, but in my civics class we were taught that this is a government of laws, not of men. In other words, if I really had rights, it wouldn’t matter who the attorney general was, because the courts would defend me. But the Patriot Act took my rights away, and so now it does matter who the attorney general is. Sure, it would be a big improvement to have a nice guy in charge of the police state. But I would rather dismantle the police state.
How Gephardt compares
If Dick Gephardt wins the Democratic nomination, I’ll have no trouble voting for him against Bush. The positions of the Democratic candidates are converging more and more as the campaign goes on. (They’re stealing each other’s lines as well as programs. I’m not sure how many times I’ve heards someone say that Bush has “the worst jobs record since Herbert Hoover” – and each time I’ve wondered how many of the young voters in the room know who Herbert Hoover was.) So the better question is: Who can do the best job of representing those positions?
I don’t think Gephardt is the best candidate we can put out there. It’s not obvious how significant it is that he draws small crowds at this point in the campaign. But there is a Chinese-food quality to his rhetoric; an hour later you ask your friends “Didn’t he say something about ... ?” He can’t give a passionate speech like Dean. He doesn’t have the dazzle of Edwards. He doesn’t radiate niceness like Lieberman. He doesn’t have John Kerry’s medals. He doesn’t seem as smart as Dean or Kerry, for what that’s worth. He seems like a good, decent, well-intentioned guy. But is that enough?
Like it or not, I think Gephardt’s chances (like Lieberman’s) are tied to the situation in Iraq. He was front-and-center when Congress passed the war authorization resolution. The more that war looks like a bad decision – and it already does to a majority of Democrats – the harder it is going to be for Gephardt to make the campaign revolve around his health-care plan. If, on the other hand, the situation stabilizes – if we stop losing a soldier or two every day, if we capture Saddam, if the Iraqis start moving towards democracy – then Gephardt’s candidacy looks a lot better.
But so does George Bush’s.
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