Democrats' early focus: healthcare

The Democratic presidential race is converging around an issue that has long been a mainstay of Democratic primary campaigns, but which is so far proving nearly as divisive as the Iraq war: universal healthcare.

A decade after the collapse of President Clinton's plan to overhaul the nation's healthcare system, Democrats are once again, in varying degrees, taking up the cause.

Nearly every White House hopeful is making broader access to affordable healthcare a campaign centerpiece. But while they may agree on the general goal, their plans are strikingly different in scale and approach, generating sharp clashes over questions of cost and feasibility.

The result is a revealing proxy battle over the fundamental direction of the Democratic Party. At one end of the spectrum are those offering sweeping, costly proposals - which opponents tag as a return to "big government." At the other end are those pushing for incremental, less expensive reform - which critics see as timid and ineffective.

Even strategists are struck by the intensity of disagreements so early in the primary season. "Campaigns tend to be a little less dramatic than this, in terms of ... [policy] issues," says Bill Carrick, an adviser to Representative Gephardt. "This has instantly become a big, serious debate."

The emergence of healthcare as a campaign focus is hardly surprising. With healthcare costs soaring, and the number of uninsured Americans estimated at more than 41 million and rising, a recent Gallup survey showed that 79 percent of Americans are worried about future availability and affordability of healthcare. Polls also show the public is far more inclined to trust Democrats than Republicans on the issue - so it could be a key component of the eventual nominee's campaign.

To some extent, as Mr. Carrick admits, the flurry is attributable to Gephardt, who threw healthcare into the spotlight a few weeks ago by introducing a sweeping plan to cover nearly all of the nation's uninsured, at an annual cost of more than $200 billion. The other candidates, unwilling to cede the terrain, have been scrambling to respond. This week, former Gov. Howard Dean released a plan of his own, as did Rep. Dennis Kucinich last week. Sen John Kerry is expected to release his plan Friday, with other candidates following shortly.

Yet the issue has taken on a larger significance, highlighting sharp philosophical divides within the field and the party. These differences exploded at the Democratic debate in South Carolina, where several candidates attacked Gephardt's healthcare plan as unwieldy and inefficient: Sen. John Edwards charged it took money from working families, while Sen. Joseph Lieberman likened it to "big-spending Democratic ideas of the past."

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