Edwards: If Members of Congress Won't Give Americans a Healthcare Plan, I'll Take Away Theirs

Last week, John Edwards launched a series of ads across Iowa promising that if he were elected and Congress didn't pass his healthcare plan, he would strip lawmakers of their own coverage (you can view the ad in the window to your right).

Arguing that ordinary Americans deserve access to healthcare that's just as good as what members of Congress get is a devastatingly effective message and has long been a crowd-pleaser among progressives. Edwards told radio talker Ed Schultz, "There's no excuse for politicians in Washington to have heathcare, but America doesn't have healthcare, and I think we have to shake this place up a little bit. What we would do is we would submit legislation saying if universal healthcare is not passed by this summer, that the Congress and members of the administration would lose their healthcare coverage."

It's a beautiful piece of populism -- a message that appeals to an American Main Street that polls show to be as disdainful of Congress as it is hurting from spiraling healthcare costs in the face of stagnant wages. It's a campaign that can showcase how much lawmakers appreciate the kind of coverage they receive and just how hard they'd fight to keep it, and, importantly, will make it that much harder for opponents to mouth the inevitable blather about the perfidy of "government-run," "socialized healthcare" with a straight face.

But while the ads represent a very nice piece of political rhetoric by Edwards, make no mistake: It's also the public presentation of a serious and thoughtful healthcare proposal (PDF) -- one that would cover every American -- that is both pragmatic in its approach and also the most progressive in the field after Dennis Kucinich's.

Edwards's plan, like that available to members of Congress, is built around a lot of choice. Employers would have the option of either covering employees privately or sharing the costs of purchasing coverage from among a menu of state-run plans -- called "health markets" -- with different amounts of coverage and at different prices. These would all have the advantages of economies of scale and of spreading risk out over large insurance pools. All of the plans would be "open to everyone," regardless of "pre-existing conditions, medical history, age, job and other characteristics."

Some single-payer advocates have criticized the plan because, unlike Dennis Kucinich's call to establish a not-for-profit health system, Edwards' plan would leave the insurance industry in place to suck patients dry and add enormously to the nation's healthcare tab.

But while it's well-intentioned, most of the criticism misses a crucial aspect of the plan.

The key to Edwards' approach is that it mandates the creation of at least one health market that's fully public, based on the Medicare model and available to all. That means that the public sector would be allowed to compete with private insurers -- a concept that's anathema among conservatives -- and consumers would be able to choose the option, public or private, that gives them the best bang for the buck.

The idea is that once the benefits of a single-payer system become clear -- especially the lower costs advocates predict -- eventually most people would move, voluntarily, from the private health markets to the fully public one, and the politics of the transition to single-payer would be infinitely more manageable.

That Edwards' healthcare plan anticipates that transition is no secret; it's spelled out explicitly:

Health Markets will offer a choice between private insurers and a public insurance plan modeled after Medicare, but separate and apart from it. Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price. Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan.

Some observers have argued that Edwards' threat is a nice piece of political theater -- a means of making a point -- but not much more. When blogger Ben Smith asked University of Chicago law professor Cass Sunstein about some legal questions surrounding Edwards' proposal, he said that the question was irrelevant. "It's a stunt," he replied, "Congress isn't going to enact legislation taking away its own healthcare."

But the campaign is adamant that this is a very real proposal -- one that Edwards feels strongly about -- and not a mere stunt. "He's deadly serious about passing this," a senior staffer with the campaign told me. "And, contrary to what many are saying, I don't see how Congress could not pass it."

That may just be true. As blogger Ezra Klein noted: "The idea behind this bill is that it will ratchet up political pressure for change, creating a situation in which congressmen come to the table because they fear losing their seats if they don't. It's a strategy based on the application of political pressure, not legislative finesse." Edwards promised Ed Schultz that if he's elected and Congress doesn't pass his bill, "I'm going to go as president into their congressional district, into their Senate states and say your senator or your congressmen is supporting healthcare for himself and against healthcare for you."

One thing is clear about Edwards' proposal: Audiences in Iowa eat it up. What remains to be seen is whether it's enough to give him some traction in a race that's seen Hillary Clinton build a commanding lead nationwide. Edwards trails Clinton by 15 points in New Hampshire, but is statistically tied with Clinton and Obama in Iowa, where the first primary (caucus) will take place in about seven weeks. According to a recent New York Times poll, primary voters in Iowa and New Hampshire prefer both Edwards and Obama on the issues -- and say they're more likely to speak honestly to voters -- but favor Clinton in terms of electability. While that's probably a dubious means of evaluating a candidate's strength, it does indicate that some portion of Clinton's support is purely tactical and not deeply held.

That's an opportunity. Momentum can shift quickly in those early primaries and, with a bit more smart politics like Edwards' latest campaign on healthcare, we could be looking at a very different race in early 2008.