Access to healthcare for middle-class populations

¶ … uninsured and I vote.' Will this be the new political rallying cry of 2008? Perhaps. According to Catherine Arnst's article "The politics of healthcare reform" in Business Week, 15% of all Americans have no health insurance at all or 47 million people. This represents a 5% increase from 2006 and the largest increase in four years, even though poverty levels have fallen and household incomes have risen. However, these apparently contradictory statistics are not so surprising. Quite possibly, more of the poorest Americans have gotten slightly better-paying jobs. This means they no longer qualify for government assistance even though their current entry-level positions provide no healthcare insurance benefits. This hypothesis is substantiated by the fact that percentage of people covered by insurance through their jobs fell to 59.7% in 2006, down from 60.2% in 2005. And these statistics do not even reveal the whole truth about the nation's healthcare crisis. Even the insured may be underinsured or have to pay high premiums for private insurance (Arnst 2007:1).

These are sobering figures -- for current Presidential hopefuls. There are 6 million more uninsured Americans than there were in 2000. 30% of respondents to a recent poll said that health care is one of the top two issues they want to hear Presidential candidates talk about, second only to Iraq (Arnst 2007:1). The problem is that healthcare reform is very difficult to reduce to a series of sound bites, and as current Democratic frontrunner Hillary Clinton discovered when she was First Lady, addressing the specifics of a healthcare plan can alienate just as many Americans as it satisfies (Arnst 2007:2). Hence, when candidates talk about healthcare in stump speeches, they tend to be short on details or specifics, and long on rhetoric, even those candidates that have released fairly detailed policy statements in writing.

Candidates must strike a delicate balance. They strive to differentiate themselves from their competitors, of course, but they also do not want to polarize or alienate the electorate at this early juncture of the campaign. And any reform process will produce some initial pain: the voting "middle class may be dissatisfied but most of them have employer insurance, so they have something to lose...They are not prepared for a national experiment that will threaten what they have" (Arnst 2007:1).

Currently, none of the Republican candidates have issued detailed plans. Hillary Clinton has put forth a proposal requiring all Americans to have health insurance, through their employers, through an expanded version of the insurance available to federal employees, or through a new government-run Medicare style plan. Tax subsidies and credits will cover the premiums, "and no one could be turned down by an insurer for a pre-existing condition or other health issues" (Arnst 2007:2). Senator Barack Obama also says he will mandate that everyone buys insurance. But no candidate, regardless of how detailed or vague their plan, can iron out all of the specifics before he or she comes in contact with the various bureaucratic institutions and interests represented by Congress, and no matter what their plan, any legislative initiative as complex as health care will create some initial losers as well as winners.