The Alan Katz Health Care Reform Blog

With Iowans going to caucus today it’s tempting to write about how this marks the beginning of journey toward national health care reform. Unfortunately, that’s not the case. The impact of Iowa on the health care reform debate will be minimal. To be sure, there will be exit polls parsing the issues that matter to voters (health care will be high on the list). In reality, however, the positions of the candidates within each party are too similar to be sway many voters one way or the other.

On the Democratic side, the health care reform plans outlined by Senators Barack Obama and Hillary Clinton, former-Senator John Edwards, and Governor Bill Richardson are fairly similar. They all seek to reduce the uninsured through expansion of public programs. They all have cost containment provisions. The only differences are that Senator Clinton and Senator Edwards would require all consumers to obtain coverage. Senator Obama focuses more on affordability issues and Governor Richardson’s proposal avoids the creation of new bureaucracies.

On the Republican side Senator John McCain, former-Governors Mitt Romney and Mike Huckabee, and former-Mayor Rudolph Giuliani all seek to increase the number of Americans with medical coverage through tax incentives and fewer restraints on the private sector. Even Governor Romney has backed away from the heavy government role he championed in Massachusetts.

Once the general election is engaged the differences between Democrats and Republicans on health care will move front and center. That’s then. For now, even though voters are concerned about the issue, it won’t greatly impact the results coming out of Iowa.

There will be one interesting dynamic to watch, however. In Iowa, independents can choose to attend the caucus of either party. If exit polls show unaffiliated voters made their choice of caucus because of a candidate’s stand on health care reform it would provide important insight on which party’s approach is resonating with swing voters. 

That today’s caucuses in Iowa are unlikely to provide much insight into voters thinking about health care reform doesn’t make them any less interesting. They kick off the most unusual presidential election in generations. For the first time since 1928 no sitting president or vice president is on the ballot. Then there’s the sheer number of possible “firsts” we may witness. Senator Clinton could be the first woman president? Senator Obama could be the first African American to hold the office? Governor Romney is seeking to be the first Morman elected president and Mayor Giuliani wants to be the first Italian chief executive. The list goes on, but you get the idea.

And think of the possible match-ups in November. The nominees could both be New Yorkers (Senator Clinton and Mayor Giuliani). Far more interesting would be having the Republican most willing to work with Democrats (Senator McCain) facing off against the Democratic most willing to work with Republicans (Senator Obama). Then there would be the most ironic match-up: Governor Romney versus Senator Edwards — two wealthy, out-of-office white guys with perfect haircuts.

Iowa matters — just not so much concerning health care reform. Regardless of the match-up the next 11 months will be exciting. OK, not if we get stuck with Romney versus Edwards, but let’s hope it doesn’t come to that.