The All-Revealing Health Primary

In recent years, the Democratic Presidential primaries have assumed a Russian-nesting-doll quality: Before the caucuses and votes come the money primary, the Shrum primary (testing who can attract the political consultant with a zero-and-nine record in national elections), the netroots primary and the “invisible primary”—the catch-all term for the indicators that convince political elites of a candidate’s seriousness.

This year, however, there’s a surprising addition: the health-policy primary.

Given the subject’s legendary political toxicity (many give it a starring role in the devastating losses Democrats suffered in 1994) and eye-glazing density, it’s rather surprising to watch the speed and eagerness with which the candidates are unveiling ambitious, substantive and heavily progressive plans. John Edwards, Barack Obama and Bill Richardson have all brought out their full proposals. Hillary Clinton has outlined the cost-control measures in her proposal, with the actual details of the coverage portion presumably on the way.

But like so many of the primaries, this one is not about its putative subject. The Shrum primary, for instance, wasn’t about the utility of Bob Shrum’s legendarily ineffective advice, but about the imprimatur of establishment support he offered. The money primary isn’t fully about the money—primaries, particularly those in Iowa and New Hampshire, really don’t cost that much, and only occasionally reward the flushest competitors—but about the depths of elite support the fund-raising signals.

Similarly, the health-policy primary, and its attendant attention to policy minutiae, is about more than subsidy levels and mandate schemes: It’s a demonstration of how each of the candidates would govern, and how each would deal with the resuscitated progressive movement, which has settled on universal health-care reform as its chief domestic priority.

The health-policy primary has been particularly revealing about Mr. Obama and Mr. Edwards, both of whom have used detailed policy proposals to demonstrate courage and commitment to progressive ideals that aren’t apparent from their histories.

Mr. Edwards was the first out of the gate, with an expansive, detailed and astonishingly ambitious health-care-reform proposal. Portions of it—notably the creation of a publicly run insurance option—would have been considered unthinkably far left even four years ago. The contrast was particularly stark in the context of Mr. Edwards’ campaign in 2004, when he ran as a sunny Clintonian centrist.

His proposal this year was meant to explode any lingering hunches that he might be running the same campaign. Without a fundamentally progressive record to fall back on, he needed progressive policies to prove his transformation: By running on public commitments to transformative change, he’s ensuring the left that they—and not his elite backers from four years ago—are his core support, and the constituents he’ll seek to serve. He’s also signaling a belief that reform will not be achieved by soliciting the insurance industry’s cooperation, but by bringing about its defeat.

The All-Revealing Health Primary