Health care's the key to economic security and opportunity

If you want to understand the debate over economic policy our nation should be having — but mostly isn't — look no further than Barack Obama's and John McCain's health plans.

Democrat Obama wants to insure all Americans and restrain health costs by requiring that employers cover their workers or help fund coverage through a new national framework that gives workers a choice of public or private plans. To make coverage affordable for less-affluent, less-healthy Americans, Obama intends to provide generous subsidies and regulate insurers to prevent exorbitant rates.

The message: We need to tackle rising health and economic insecurity together, even if it means an increased government role.

Republican McCain has a different vision. He wants to take away the exclusive tax benefits for employer-provided health insurance, encouraging employers to drop coverage and workers to seek insurance in the individual market. Instead of regulating this poorly operating market to ensure that it works for less-healthy people, McCain would undermine state regulation by allowing insurers to operate across state lines, so they could set up shop in states with fewest consumer protections.

Perhaps some Americans will get coverage for the first time under McCain's plan. But the proposal is certain to cover many fewer people than Obama's, and many who would be covered would pay more for less under McCain's plan, because they would no longer enjoy the advantages of employer group purchase of insurance.

McCain's message? Health and economic insecurity should be handled by individuals on their own, with relatively limited government help.

These are radically different approaches, and they sum up the two parties' divergent economic philosophies. Yet, media attention to the candidates' health plans has portrayed the struggle as mostly a difference of priorities — covering Americans (Obama) vs. containing costs (McCain) — rather than an epic battle over competing ideals.

The press isn't the only contributor to this confusion. Obama has also failed to fully press his advantage and clearly articulate his vision. He has called for new economic policies, and issued a bevy of well-meaning policy blueprints. But a laundry list of proposals isn't a vision. Obama is still searching for a unifying theme that can organize a 21st-century debate over economic security, just as Ronald Reagan's vision of small government and self-reliance dominated the last quarter of the 20th century.

Obama doesn't need to search far. The theme is already implicit in his health plan, with its message of shared responsibility and risk. It's a vision of common purpose and broad prosperity with a simple goal: "providing security to expand opportunity."

The decline of American health insurance is not, after all, an isolated story. Over the past generation, economic risks once faced mostly by the working poor have crept into the lives of the middle class — and even the upper-middle class. Having a reasonable income doesn't guarantee a good health plan or secure retirement or the ability to gain new skills or send your kids to college. And it doesn't exempt you from the risks of a declining housing market, or the debt that comes with unexpected income drops or expenses.

These are security problems, but they're also opportunity problems. When people feel they cannot leave dead-end jobs because they risk losing health insurance, when they fail to invest in education or skills for fear of falling through America's increasingly tattered safety net, they are giving up opportunities that would be good for them and their families — and for the American economy.

A security and opportunity agenda would tackle the declining financial stability of most Americans. But it would do so not because the United States is a land of hardship and capriciousness, but because we are a nation built on the promise of equal opportunity.

Republicans say entrepreneurs need protections from excessive risk to ensure they'll take chances to fuel our dynamic economy. Obama should insist that workers and their families receive the same guarantees, starting with health care that cannot be taken away.

All Americans need security to achieve opportunity. Obama needs to tell voters how he will provide it, and why McCain's very different economic vision will not.

Health care is the place to begin.