The Political Interest The Voters' Latest Ailment: Health Care

By Michael Kramer

Harris Wofford is the luckiest of incumbent U.S. Senators. He has the title and the perks that go with it, but he hasn't been around long enough to be tarred as a Washington insider -- a decided plus given the current political environment.

Whether or not Wofford upsets former Attorney General Dick Thornburgh in this week's special election in Pennsylvania, the magnitude and reasons for his comeback from near oblivion offer significant lessons for those unlucky enough to be seeking re-election in 1992, including, especially, George Bush.

From the moment of his appointment last May following the death of Republican John Heinz in a plane crash, Wofford, a Great Society liberal, began transforming himself into a Huey Long-like Democratic populist. In one early move, Wofford rejected the $150,000 he was supposed to receive for mass mailing expenses. In another, he renounced the $23,200 pay raise the Senate had voted itself. "There's a national recession out there," said Wofford. "Now is no time for us to be paying ourselves more of our taxpayers' hard- earned dollars." Wofford gave the extra money to a charity for injured gulf war veterans.

Those actions won Wofford editorial praise, but he still trailed Thornburgh by 44 points when the campaign began in September. His anti-Establishment pledge to "shake Washington up from top to bottom" contrasted with Thornburgh's defense of the status quo, and marginally improved his standing. His call for the Democratic Party to end its preoccupation with programs targeted to the poor in favor of a renewed emphasis on middle-class relief moved the needle a bit more, but Wofford was still considered a certain loser.

What finally made the race competitive was Wofford's constant carping about America's sorry health-care system. "The Constitution says that if you are charged with a crime, you have a right to a lawyer," Wofford intoned endlessly. "But it's even more fundamental that if you're sick, you should have the right to a doctor." Thornburgh claimed that national health insurance is too expensive, and rightly blasted Wofford for a lack of specifics. But the G.O.P. counterattack failed to resonate, and even Thornburgh was forced to admire Wofford's latest stunt, a bill the Senator introduced three weeks ago that would deny to himself and his congressional colleagues the free medical care they now receive unless and until the Congress enacts a national health-coverage program.

While many political analysts have focused on Louisiana (where David Duke, the racist former Klansman, is locked in a tight race for Governor), the White House has been worrying about Pennsylvania. "Win or lose, there are 1 1/2 crucial things to learn from Wofford," says a senior Bush adviser. "The half is about how a sagging economy can be played to advantage by Democrats and about how easily a candidate perceived as an outsider can play the desire-for- change theme against an insider. The more important signal involves the sudden saliency of the health-care issue."

The rise of health care on the political radar screen is relatively recent. "Basically it's because cost increases for health care outpace family incomes by a factor of two or three," says the University of Maryland's William Galston, a leading Democratic strategist. "The anxiety is increased because more and more employers are requiring more and more employees to pay a higher share of health-care costs. What's worse, many people find themselves locked into jobs they don't like simply because they're afraid of losing their existing health plans if they change employment. As the inadequacy of health care is no longer simply an underclass problem, it becomes a more important issue politically."

At last count, 30 health-care proposals described as "comprehensive" were floating around Congress, and three of the Democratic presidential candidates have offered plans of their own. The most intriguing is Nebraska Senator Bob Kerrey's, which would require a 5% increase in payroll taxes. Normally, as Walter Mondale learned in 1984, he who advocates tax increases commits political suicide. But recent polls reveal that two-thirds of Americans view health care as a "right that should be guaranteed by the government" and that 70% would pay higher taxes so that all citizens can be insured.

Bush, meanwhile, is frozen. He announced in his 1990 State of the Union address that Health and Human Services Secretary Louis Sullivan would review the "quality, accessibility and cost of our nation's health-care system," and he talks about the problem at almost every domestic policy strategy session. But Sullivan's report is nowhere in sight, and the President's campaign advisers concede their inability to construct a program pleasing to all. "It's an issue that works better as a statement of general principle and concern," says a Bush aide, "but as Kerrey and the others get down to details, we'll be pushed to come up with our own. Politically, it's hard to see the upside in any particular plan, but it would be worse if we sit on our hands and let the other side define the discussion."

Yet that is exactly what Bush might ultimately do. Right now the campaign debate within the White House is consumed with tactics: Should Bush promulgate his own health-care plan or wait to respond to the Democratic nominee? If Bush stalls, his approval rating may sink in the face of a challenger who appears to know where he wants to go and is courageous enough to say how he intends to get there. Sometimes even incumbents must accommodate the old political rule: in times of high anxiety, the race goes to the risk taker.