Ballot Box


Dr. Dean’s health-care prescription.

Howard Dean, for the health of the country

Tuesday morning, Howard Dean outlined his plan to extend health insurance to 30 million more Americans. Here’s a quick assessment of how Dean’s plan fits into the Democratic presidential race.

1) Dean vs. Gephardt. Dean was planning to release his proposal in March, but he delayed it because of the war in Iraq. As the war subsided, Dick Gephardt beat Dean to the punch, proposing his own plan for expanding health insurance. Then, before Dean could attack Gephardt’s plan, John Edwards attacked it at the May 3 debate in South Carolina. Edwards vs. Gephardt became the Democrats’ chief policy conflict, reducing Dean vs. John Kerry to a clash of personalities.

Dean’s health insurance plan puts him back on the policy map. Edwards hasn’t produced a comparable proposal, and Kerry won’t spell his out until Thursday. For the time being, Dean gets the policy debate with Gephardt all to himself. “Today, the Democrats have two distinct plans on the table for achieving health care for all Americans: Congressman Gephardt’s and mine,” Dean declared. His Web site compares the two plans, purporting to show that Dean covers more people than Gephardt does at less than half the cost.

2) Doctor- vs. lawyer-politicians. Since Dean is the only doctor in the race, health care is his issue. He needed to reclaim it from Gephardt, and today, he did so in an aggressively autobiographical way. He detailed his career as a medical student and physician, “volunteering in the emergency room” and at a “community health center” to help “people who had no insurance.” Dean never mentioned Edwards, but he paved the way for a contrast between the doctor-politician who spent his career healing people and the lawyer-politician who spent his career suing them. Guess which profession voters prefer.

3) The Vermont “miracle.” Dean doesn’t use that term, as Michael Dukakis did. But Dean’s campaign relies on the same idea. On any issue, he’s got figures to show that Vermont, under his governorship, has been a model for the nation. (His opponents can present different figures to undercut his claims, as Kerry did in the South Carolina debate. But then they’re playing on Dean’s turf.) In Tuesday’s speech, Dean bragged about how many Vermonters the state has insured, and at what little cost. In the South Carolina debate, he claimed to have “two advantages” on this issue: “I’m a governor, and … I’m a doctor.” Now he’s capitalizing on both.

4) Taxing the wicked. Why does Dean’s plan cost the government less than Gephardt’s does? One big reason is that Gephardt uses the tax code to reward companies that provide health insurance, while Dean uses it to punish companies that don’t. To big firms that don’t insure their workers, Dean warned, “We’re not going to give you the same generous tax benefits we’re giving to those businesses that are providing health insurance to their workers.” Dean’s Web site says his plan will “send a message” to these companies “by limiting their tax deductions and their government contracts.” But Dean never addresses the hidden costs of removing these tax deductions and reducing competition for these contracts. Would businesses hire fewer people? Would the government pay more for contracted work?

5) Stimulus two-fer. Gephardt proposed to spend all of the government’s disposable money (and then some) on his health insurance plan. He had nothing left over to make a stimulus package, so he claimed that his health insurance plan was a stimulus package. Dean uses the same trick. He says his plan will lower health-care costs for businesses, “freeing up valuable working capital.” Therefore, the plan “is not simply a health care plan. It’s an important part of my economic plan as well.” Or, as Chevy Chase put it: It’s a floor wax and a dessert topping!

6) Redefining strength. Dean’s opposition to the Iraq war could cripple his candidacy. The war ended quickly and favorably, and President Bush plans to milk it in his re-election campaign. Dean needed to change the subject and cover up his perceived indifference to national security. How to look less wimpy? By redefining strength. “America’s strength can’t only be measured by the power of our military,” he argued in Tuesday’s speech. It’s also measured “by the depth of our compassion.” In the post-9/11 world, that may be a stretch. But for political battlefield surgery, it’ll have to do.