During the recent Fox News Republican presidential debate, former Massachusetts Gov. Mitt Romney commented that health care "isn't a Democrat issue. It's a Republican issue."
It was a great sound bite but one that raised eyebrows. After all, while Republicans won the HillaryCare wars of 1993-94, health care isn't something that conservatives have been talking about boldly, or much at all, in the nearly 15 years since.
More to the point, perhaps as a consequence of Republicans tuning out, Americans have come to like the kind of big government health care schemes they used to hate - and it all matters more than ever, because according to a recent Kaiser Health poll, health care has become a Top Two issue where the 2008 campaign is concerned for Democrats, Republicans and independents.
Kaiser's survey shows that 67 percent of Democrats, 35 percent of Republicans and, most critically, 54 percent of independents (the voters most responsible for killing the GOP's "permanent majority" in 2006) now favor a health care plan that will provide near-universal coverage via increased government spending - something that Republicans are loath to endorse and something that Democrats have been leading on for some time now.
Unsurprisingly, they also trust Democrats by large margins on health care and seem to see Republicans as obstructionists.
A September ABC News/Washington Post poll showed that 56 percent of those surveyed trust Democrats over Republicans to handle health care, with just 26 percent taking the opposite view.
Moreover, 72 percent of those surveyed, and even 61 percent of Republicans, say they favor expanding the State Children's Health Insurance Program, putting them at odds with the (still) leader of the Republican Party, President Bush, who vetoed the original SCHIP expansion legislation and has threatened to veto a revised SCHIP bill passed by the House last week.
The SCHIP numbers are particularly telling, because they signal at worst a complete failure of the majority Republican position on health care to resonate with voters, and at best a complete failure of messaging on the issue, combined with obliviousness to that failure.
In the run-up to the SCHIP veto, the main arguments advanced by the White House focused on the expansion of the program being bad because it represented a move toward government-run, or “socialized,” medicine — with no further explanation.
Unsurprisingly, then, since a large swath of voters actually now like the idea of government-run health care, especially when the alternative looks like letting kids suffer, the White House message fell flat — leaving Democrats to reap the spoils of this particular health care battle.
Democrats, of course, also benefited from 45 Republicans in the House (44 on the original veto override vote) and 18 in the Senate siding with them on the original SCHIP expansion plan, and 44 also siding with them where the revised House SCHIP bill was concerned.
That suggests Democrats are the only party with solutions where health care is concerned.
Their preferred prescriptions of more government intervention might also be seen as acceptable as a default, with the plan Romney pioneered in Massachusetts being critiqued as similar to what Hillary Rodham Clinton now proposes on health care, but at the federal, not state, level.
(Conversely, Romney’s ability to hold up a more mainstream record on health care might enable him to campaign on the issue successfully, were he to become the GOP nominee.)
Yet Democrats running straight to the finish line on health care need not be a foregone conclusion — at least not if the front-runners for the Republican nomination start talking credibly about health care as a major issue, and in terms that take more account of shifting views and priorities among the American electorate than Bush’s SCHIP veto rhetoric has.
Both Romney and Rudy Giuliani have detailed health care plans that are generally free-market- and small-government-friendly, look less “small ball” than, say, Bush’s health savings account scheme, and have passed intellectual muster with health care experts.
The question is: Are they prepared to spend significant time explaining how their plans will truly achieve universal coverage and not just bring down health care and insurance costs (which just 39 percent of those polled by Kaiser, overall, treat as the top priority)?
Furthermore, if they blast Democrats for pushing for more government involvement in health care, will they take the time to explain to voters why that is such a bad thing?
Both candidates have shown a willingness to make the case against more government involvement in health care more credibly than Bush has over the course of the SCHIP debate. Romney likes to joke about the perils of the “guys managing Katrina” also running health care.
Giuliani has commented that mandates diminish individual choice. But whether they will continue, and indeed expand upon, these efforts remains unknown.
To be certain, Democrats will be hoping they do not — a one-sided health care debate benefits the party making the most noise. But the GOP front-runners would be foolish not to take the issue head-on, given its importance to the electorate.