Edwards Becomes the First To Promise a Big Tax Hike

A former North Carolina senator making a second bid for the Democratic presidential nomination, John Edwards, has chosen not to embrace a single-payer health insurance plan, disappointing activists who contend that only a radical overhaul of the health care system can ensure that all Americans are insured.

During an appearance yesterday on NBC's "Meet the Press," Mr. Edwards said he plans to announce details today of a plan that would result in universal coverage by building on the current employer-based system.

The Democratic nominee for vice president in 2004 said his plan would cost between $90 billion and $120 billion a year and would require a tax hike. "Yes, we'll have to raise taxes," he said. Mr. Edwards said he would roll back President Bush's income tax cut for Americans making more than $200,000, but he did not indicate if other taxes would also increase as the new plan was implemented.

"We take the 46 million, 47 million people who don't have health care coverage. We expand Medicaid. We provide subsidies for people who don't have coverage. We ask employers to play a bigger role, which means they either have to have coverage, or they have to buy into what we're calling health markets," Mr. Edwards said. He appeared to be describing what policy experts refer to as "pay or play" or an "employer mandate." In a bid to mollify liberal Democrats who back a single-payer system, Mr. Edwards highlighted the options for individuals to buy into new government-sponsored plans that would be set up in various regions of the country. "One of the choices, by the way, available in these health markets is the government plan. So people who like the idea of a single-payer insurer health plan, that is actually one of the alternatives that people can choose," he said.

"That's not the single payer we're talking about," a former director of Physicians for a National Health Program, Don McCanne, told The New York Sun. "That's way, way short of single payer."

During a speech in California in December, Mr. Edwards indicated that he and his advisers were mulling the idea of a single-payer system, akin to those used in Canada and Britain. "I think there's a legitimate debate that should take place on single payer versus building on the existing system. There are honestly good arguments on both sides of that debate," he said. "Those are the arguments that I'm taking into consideration as I'm trying to make my own decision."

Dr. McCanne said Mr. Edwards's comments on NBC yesterday dashed the hopes of single-payer advocates who were hoping that Mr. Edwards would embrace their goal. "It put us into a funk," he said.

A professor at Cornell's Weill Medical College who also supports single-payer insurance, Oliver Fein, said having a government plan compete with privately-run insurers could lead to significant problems. "The private insurance companies are likely to cherry pick in that setting to try to get healthy people to enroll with them and leave the really sick in the single-payer or government program," he said.

Aides to Mr. Edwards declined to answer questions about his plan until it is formally unveiled today. Mr. Edwards's decision to reject a single-payer plan leaves Rep. Dennis Kucinich of Ohio as the only notable Democratic candidate supporting the concept. In an interview, he described as unworkable Mr. Edwards's notion of single-payer insurance within the existing system. "If you have a single-payer option, unless everybody's participating, you're not going to have resources to do it," the congressman said.

Critics of a single-payer system say it would lead to rationing of care, long waiting periods for certain procedures and surgeries, and could fail to deliver the cost savings promised by proponents of such plans.

However, Mr. Kucinich said he suspects that his colleagues are reluctant to back single-payer insurance out of fear that they will lose campaign donations from the insurance and pharmaceutical industries.

"It's not just Senator Edwards. All these Democratic candidates know full well this is a defining Democratic issue. They want to make it appear they are aligning themselves with the American people, and they want to get help from insurance companies in their campaigns," Mr. Kucinich said. "You can't have it both ways."

Perhaps to inoculate himself against such charges, Mr. Edwards railed against those interests during a speech Friday to the Democratic National Committee. "When it comes to 47 million of our own people who don't have health care, silence is betrayal," he said. "We cannot allow America's health care policy to be set by big insurance companies and big pharmaceutical companies."

Senator Clinton did not embrace the single-payer plan in her proposed 1993 health care overhaul. Senator Obama of Illinois backed a state-government single-payer plan as a state legislator, but more recently, he has expressed skepticism about the idea.

One person often rumored as a presidential candidate for 2008, Vice President Gore, endorsed the single-payer concept in 2002 but never delivered a promised speech laying out his views in detail. Senator Kennedy of Massachusetts supports the idea. Mr. Kucinich and Rep. John Conyers of Michigan have proposed Medicare-for-All legislation that would bring all Americans into the federal program.

A health-policy analyst who has advised President Clinton and Mrs. Clinton, as well as Messrs. Edwards and Obama, Christopher Jennings, said he would not be surprised to see a similar proposal from one of the second-tier Democratic presidential candidates. "Single-payer is very popular in our Democratic base," Mr. Jennings said, naming Senators Biden and Dodd as well as a former Iowa governor, Thomas Vilsack, as possible proponents of such a plan. "I don't necessarily see Obama or Hillary going there."

Mr. Jennings also said Mr. Edwards might quietly sell his plan as a stepping stone to a government-funded system. "What he's going to tell single-payer advocates is that this will become a single-payer plan, [that] everyone will eventually go there."