Bill and Al's Excellent Adventure

BRADLEY'S INITIATIVE AGAINST CHILD POVERTY IS IN REALity an initiative against poverty per se. Like most Democrats, he calls for fully funding Headstart and for increasing the Earned Income Tax credits. Like most Democrats, and certainly like Al Gore, he supports strengthening labor laws to protect workers' right to organize. Like virtually every Democrat, he wants to raise the minimum wage, though like only the most liberal, he also wants to index the minimum wage to the median wage -- so that as average wages rise, the minimum wage will automatically follow along, subject no longer to congressional whim.

His signature initiative, of course, is his proposal for near-universal health care. His plan calls for creating federal subsidies to allow low-income Americans to buy into the existing array of health plans currently available ã to federal employees. All children in households with incomes up to twice the poverty level would be eligible for full subsidies, and those in households with incomes up to three times the poverty level could get partial subsidies. All adults in households with incomes below the poverty level could get full subsidies; in households up to twice that level, partial subsidies. Medicare recipients could get 75 percent of their prescription-drug purchases paid for by the government, after the first $500 each year. And for good measure, an additional $2 billion a year would go to community public-health programs.

In crafting his program, Bradley notes, he incorporated three lessons from the failure of the Clinton plan in 1994. First, by working within the existing system of private health insurance, he means to avoid the kind of fierce industry opposition that helped kill the Clinton effort. Second, by imposing no mandate on employers, he avoids the kind of fierce small-business opposition that was the other factor in killing the Clinton plan. Third, by proposing his specific plan during the campaign, as Clinton did not, he can claim more of a mandate than Clinton could in '94.

The price of specifics, though, is that it gives your opposition an opening to attack. The Gore campaign, and some independent observers, have complained that the plan is at once too costly and still insufficient. Critics argue that the $1,800 allotted for a full adult subsidy won't buy a year's coverage on the federal plans. (Bradley pro- jects a drop in the plans' cost as their membership swells.) The plan's total price, they say, will exceed the $65 billion a year Bradley projects. Gore argues that even if the plan sticks to Bradley's figures, it's still too costly.

To Bradley, this is crackpot realism. The Clinton plan -- which, needless to say, Gore supported -- was a good deal more costly than his, and proposed when the federal government was running a $290 billion annual deficit. Gore's new plan, by contrast, reads like something crafted during a time of high budget deficits rather than at a time when they have been eliminated altogether. It costs a comparatively negligible $14 billion a year, and really amounts to nothing more than an incremental expansion of the current Children's Health Insurance Program (CHIP). Under CHIP, states are now able to claim federal funds to pay for the health insurance of children in households making up to twice the poverty level -- provided the state wishes to match those funds with its own. States can set their own lower thresholds of eligibility, and many do. The problem with CHIP -- and with Gore's program, which raises the federal threshold to two and a half times the poverty rate -- is that it hasn't reduced the number of uninsured Americans. "If states are not under strong political pressure to cover their working poor, they're not going to do very much," says UCLA public-health professor E. Richard Brown, a health-insurance authority and advocate not associated with any campaign. "There will be no dramatic change in that situation under Gore's plan."

As to Bradley's plan, says Brown, "I'm very impressed. He's certainly gone a long stride past Gore, who is basically repackaging what the states are already doing. Bradley federalizes the coverage levels, which is good. His plan has its problems: I'd prefer that it let the states set up their own purchasing groups, and turning long-term care over to the states could be a fiscal time bomb. The long-term potential for federal costs rising raises fiscal questions, too, but as a question of health policy, if employers drop their own coverage of low-wage workers, I'm not unhappy. People will trade up for better coverage under the federal employee plans."

Trading up, in fact, is one of the most attractive aspects of the Bradley plan. Medicaid, like welfare, is a means-tested plan open to and crafted for poor people only, and as any rider of the L.A. bus system can attest, a system designed for poor people only is generally a pretty poor system. Bradley proposes "mainstreaming" the poor into programs open to the middle class -- reducing the inequities not just in coverage but in treatment as well.

Questions as to the total costs of Bradley's programs are very much in order, but Gore has gone well beyond those. He has railed that Bradley calls for an end to Medicaid while providing no effective alternative (and, speaking to African-Americans in Pasadena, claimed that Bradley's war on Medicaid was going to hit nonwhites especially hard). Gore's argument is doubly duplicitous -- first, because in supporting an end to welfare while providing no alternative safety net (a position Bradley opposed), Gore did exactly what he now falsely accuses Bradley of doing; second, because the Clinton plan also called for an end to Medicaid, as recipients would be mainstreamed into existing plans -- just as the Bradley plan now proposes.