Here's the good news: Health care has emerged as the leading domestic issue in the presidential election. Finally, candidates are talking about something that matters to every American family every day. Occasionally, Iraq even gets pushed off the front page.
Here's the bad news: Precisely because health care is such a hot topic, many candidates in both parties deal with the issue in purely political terms, criticizing their rivals instead of seeking common ground.
Take the reaction to Hillary Clinton's latest plan, a thoughtful proposal to extend health coverage to the 47 million people who now lack insurance. Mitt Romney immediately reached back for the oldest bromide in the Republican playbook, branding her approach "European-style socialized medicine."
That's plain silly, there's nothing European or socialized about her proposal. But Democrats could be silly as well, with John Edwards blasting Clinton for consulting with "lobbyists" from drug and insurance companies. Those industries are major players in the healthcare debate, and any serious attempt at making progress — as opposed to making speeches — compels any good leader to understand their interests.
But behind all this political posturing, a national consensus is starting to emerge on two key points. The current system is broken. But it has to be fixed, not replaced. Americans want a middle ground between a free market that leaves too many citizens vulnerable, and a government-run bureaucracy that leaves too many without individual choice.
The urgency behind the debate is demonstrated by a few statistics. Business Week reports that the number of uninsured Americans is climbing rapidly: 8.6 million added to the rolls since 2000, a five percent increase in the last year alone. For those who have insurance, premiums have risen 78 percent since 2001, four times the rate of wage increases.
No wonder that in the latest CBS News poll, 76 percent called the lack of health insurance a very serious problem, and 2 out of 3 people expressed dissatisfaction with quality of care. The ABC/Washington Post survey reports that health care is the No. 2 issue concerning voters, right behind Iraq.
Of course, the debate over details will be huge and complicated, but a few principles are already clear. There is no interest in a single-payer, government-run system modeled after Canada or Great Britain. Her plan, Clinton emphasized, would "not create a single new government department, agency or bureaucracy." She used the words "choice" or "choose" more than a dozen times, reflecting the fact that Americans want to purchase their own insurance on the open market.
But the market doesn't always work, as the statistics painfully demonstrate. Many families need help. The poor now get it through Medicaid, the elderly through Medicare. The challenge is to extend that concept of government subsidies to working families who don't qualify for either of those programs, but don't get coverage through their jobs and can't afford a private policy.
As Clinton pointed out, "there is a much broader consensus on the need for reform now" than 15 years ago, when "Hillarycare" crashed and burned. Business and labor, threatened by global competition, are on the same page; Republican and Democratic governors, who have to deal with real-world problems, agree as well. And a preview of this search for a workable compromise is happening right now on Capitol Hill, where House and Senate negotiators have agreed to an expansion of State Children's Health Insurance Program (SCHIP), a program providing insurance for 6.6 million children.
The House voted to add $50 billion, the Senate $35 billion and Democratic negotiators — eager to attract Republican votes — have smartly settled on the lower figure. That's still not good enough for President Bush, who's threatened to veto any expansion, denouncing it as a step "down the path to government-run health care for every American."
Pragmatic Republicans know that's nonsense. Sens. Orrin Hatch (Utah) and Chuck Grassley (Iowa) point out that SCHIP actually saves money by keeping kids out of costly emergency rooms. In a joint a statement they called Bush's veto threat "disappointing, even a little unbelievable."
Republican governors are even more supportive. Sonny Perdue of Georgia co-authored a letter to Congress saying, "This program has enabled millions of children the opportunity to see a doctor, to receive preventive care and to live healthier lives."
That's what voters want: practical solutions that allow them and their children to "live healthier lives." Candidates in both parties who don't understand that, who play to their ideological base instead of the sensible center, will pay a heavy price. And they should.
Steve Roberts' latest book is "My Fathers' Houses: Memoir of a Family" (William Morrow, 2005). Steve and Cokie Roberts can be contacted by e-mail at email@example.com.