A Prescription For Details

Sen. Barack Obama, left, speaks as Sen. Hillary Rodham Clinton listens during the Democratic Party Presidential Primary Debate, April 26, 2007, at South Carolina State University in Orangeburg, S.C.
Stan Honda/AFP/Getty
This column was written by Jonathan Cohn.

Last month the Service Employees International Union (SEIU) issued an ultimatum to the Democrats running for president: Issue detailed plans for universal health care by August 1. Or else.

OK, it wasn't quite that dramatic. There was no threat of specific reprisals against candidates who fail to meet the deadline. Nor was there a precise definition as to what would qualify as "detailed." Given that the SEIU's president, Andy Stern, has been willing to embrace companies like Wal-Mart for making the vaguest of commitments to universal health care, it's safe to assume Democratic candidates could satisfy the union's demands without getting too specific.

But that doesn't mean vague is good. Indeed, with health care atop the domestic political agenda, the Democratic candidates need to flesh out their visions for how they will make health care affordable for everybody — even though it means facing some potential political hazards.

Getting specific isn't such a problem for Senator John Edwards, who earlier this year unveiled an ambitious framework for universal coverage. But it does present a quandary for the two frontrunners, Senators Hillary Clinton and Barack Obama. While both have promised that they would pursue universal health care as president, neither has said much about how they would achieve this.

This reticence doesn't reflect lack of interest. Both candidates have histories of working on the issue — Clinton, most famously, when she ran the task force that developed her husband's ill-fated universal coverage proposal in 1993. And both candidates seem sincere in their desire to overhaul American health care so that citizens here finally share the kind of financial and health security that citizens in the rest of the developed world have long enjoyed.

No, the reason Clinton and Obama are acting so cautiously is that they fear getting specific on health care will expose them to political attacks — the kind that could doom their candidacies and the prospects for universal coverage simultaneously. It's a powerful argument that goes something like this: As soon as a candidate explains exactly what he wants to do about health care, he becomes a piñata for his rivals and — eventually — special interests, who can be counted on to seize on the provisions that are most unappealing politically, even if it means twisting what they mean.

The case study in this was the campaign for the Democratic presidential nomination in 2000, when then-Senator Bill Bradley put forth an ambitious proposal that would have brought coverage to about half the uninsured population. Then-Vice President Al Gore tore it apart — claiming, among other things, that Bradley's plan would leave the poor worse off than now. Nobody following the debate seriously, or familiar with Bradley's record in office, believed that would actually happen. But Gore's attacks were instrumental in blunting Bradley's initial momentum — and, eventually, depriving him of victory in the New Hampshire primary.

Howard Dean had a similar experience in 2004. He put forth what was arguably the most fiscally realistic plan for expanding insurance coverage to nearly all Americans, offering to pay for the proposal by rolling back Bush's tax breaks. But he rarely got credit for it. Most pundits, unfamiliar with the details, ended up parroting the talking points of rival camps. A few actually called Dean's plan fiscally irresponsible.

And all of that was just in the primaries. Any plan to give all Americans health insurance is going to involve more government (since only government can subsidize the poor and provide coverage to people whose medical conditions make them uninsurable in the private market). And it's also going to involve higher taxes (since the government can't do these things without more money). Democratic primary voters tend to be tolerant of such things. But swing voters? Not so much. A candidate committing himself to these propositions would seem to be inviting a lot of hostility from the voters who determine election outcomes.

Today, virtually any Democratic candidate proposing universal coverage can expect such treatment. But Clinton and Obama come into the contest with additional liabilities. As Clinton herself says, she has the scars from the fight to create universal coverage in 1994. (Whether she deserves those scars is another story.)