The once-taboo subject of universal health care has picked up bipartisan momentum and is likely to play out as a key domestic issue in the 2008 presidential election.
Just yesterday Senator Clinton, speaking at an event convened by the Rev. Jesse Jackson in Manhattan, said, "We must move to a system of universal health care in this country as soon as we reasonably can." Also yesterday, Governor Schwarzenegger outlined a sweeping health care overhaul that will require all residents of California to be insured.
The nod for universal health care from Mrs. Clinton, a probable Democratic presidential candidate, and from Mr. Schwarzenegger, a maverick Republican, comes amid a wave of similar support.
Last week at his State of the State address, Governor Spitzer, a Democrat, vowed to get all children enrolled in health care. And, before leaving office, Governor Romney, a Republican of Massachusetts who is officially exploring a run for president, signed into law the country's first mandatory health coverage act, which requires residents to have health insurance in the same way most states mandate that car owners have auto insurance.
"I think the big shift is probably Massachusetts," the chairwoman of the health policy and management department at Columbia University's Mailman School of Public Health, Sherry Glied, said. "Given the experience of the Clinton health care plan in the 1990s, I don't think she could have been the person who opened this issue up, but Romney did," said Ms. Glied, who served on the president's Council of Economic Advisers during the administrations of presidents George H.W. Bush and Clinton.
After Mrs. Clinton's proposal to create a national universal health care system failed to win congressional backing in 1994, the issue receded from the public conversation, with lawmakers tinkering around the edges and creating Medicaid-run programs such as Child Health Plus and Family Health Plus in New York.
That failed attempt by the Clinton White House — which some believe helped Republicans take control of Congress in 1994 — seems to have faded into the backdrop, with politicians staking out positions again.
Health care analysts say the issue has become a politically attractive one for both Democrats and Republicans because of the number of uninsured Americans — 46.6 million, according to the latest federal census — and the increasing costs associated with American medicine and health care. Perhaps equally important is that it is not only patients being squeezed, but also companies that provide health insurance benefits to their employees. Mrs. Clinton preceded her call for universal health care yesterday with the observation that American businesses were straining under health care costs.
The combination means that health care may be a potent political issue in the next election cycle. "The issue is going to be the subject and the legacy of the '08 election," the president of the Greater New York Hospital Association, Kenneth Raske, said in a telephone interview yesterday.
Mr. Raske, a supporter of universal health care, said that while the Democrats who just won control of Congress may support universal health care, the issue is basically dead at the federal level without support from the president.
Others said the issue may sound good for politicians, but is not a wise move in terms of policy. "It sounds compassionate for politicians to say we need to have universal coverage, but they don't explain what universal coverage really means, what it will cost, and what is it going to do to the tax burden of individuals," the president and CEO Pacific Research Institute, Sally Pipes, said. "It's going to move us down a slippery slope to a single payer system, where the one payer is the government."
Universal health care — the concept of providing all Americans with health coverage —is not being discussed in the same way now as it was in the 1990s. At that time there was a dual emphasis of revamping the entire system, while the focus now seems to be solely on expanding health insurance coverage. The plan Mr. Schwarzenegger unveiled yesterday would charge companies with 10 workers or more who don't buy insurance for their staff a 4% payroll tax. If passed it will also tax doctors 2% of their revenue and hospitals 4%.
Massachusetts had a similar model of mandates and a complex system to allow residents to buy into insurance plans if they don't have coverage provided by their employer. Some say those models are more politically amenable because they don't stick the government with the full bill and don't disrupt those who already have insurance.
But others say the new prototypes will not work and will only get the country closer to a single-payer system, while doing nothing to improve the broken health care system.
"I'm Canadian. I grew up in a system where there were long waiting lists for care, rationed care, and lack of equipment," Ms. Pipes said. "Americans just wouldn't tolerate that."
A senior fellow at the Manhattan Institute, Dr. David Gratzer, said that while universal coverage hits on the "Achilles heel" of the insurance issue, it doesn't address the core problems of rising health expenses, overregulation, and too many subsidies.
Dr. Gratzer said a third of the Americans who are uninsured are already eligible for government-subsidized insurance but have not signed up and another third earn $50,000 or more. "That seems to be a crisis in signing your name to a piece of paper, rather than a crisis in coverage," he said.
A senior health policy analyst at the United Hospital Fund, Danielle Holahan, said bringing business to the table has changed the nature of the discussion. The fund released a study last month showing that requiring New Yorkers to have health insurance would could about $4.1 billion. The cost would be shared by government, business, and individuals.
Ms. Glied said is not surprised that the issue has become a bipartisan one. She noted that the "last person before Clinton to make a serious stab at this was Richard Nixon."
But she said she didn't expect more specific proposals from any of the possible presidential contenders yet. "It's very early in the game and anything you say will be used against you," she said.