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."