Democrats and healthcare reform

Barak Obama's proposal marks a crucial turn in the healthcare debate.

from the June 5, 2007 edition

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This year, though, John Edwards, another 2008 Democratic hopeful, has already proposed a mandated employer contribution as part of his universal coverage plan. Democratic Gov. Ed Rendell in Pennsylvania and Republican Gov. Arnold Schwarzenegger in California have incorporated the idea into state-level universal coverage initiatives. The universal healthcare plan Massachusetts adopted last year also included a mandatory, though token, employer payment. Obama, who has stressed national reconciliation, underscored the idea's resurgent mainstream appeal by joining that list.

Democrats are trying to attract business to comprehensive reform by emphasizing ideas that would cut their costs. Senator Clinton last month proposed that health insurance companies, as a condition of participating in federal programs, be required to cover both preventive and disease-management services that could help reduce premiums. Obama echoed her last Tuesday. Obama also revived the best policy idea of Sen. John Kerry's 2004 campaign: a proposal for Washington to fund most of the bill for high-cost patients once their annual healthcare bills exceed a fixed level. Shifting those catastrophic expenses to government would lower employer premiums. So might Obama's surprisingly sharp-edged proposals to limit insurance company profits.

The best chance for reaching (or even nearing) universal healthcare coverage is a system of shared responsibility that requires government, individuals, and business to all contribute. The ideas percolating in the states and among the leading Democratic presidential contenders move in that direction. But unless big employers finally act on their stake in reform, healthcare for all is likely to remain out of reach – at great cost not only to the national interest but to corporate America's own bottom line.

• Ronald Brownstein is the national affairs columnist for the Los Angeles Times. ©2007 Los Angeles Times Syndicate.

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