VAN NUYS, Calif.
Looking for holes to poke in Bill Bradley's intriguing proposal to provide universal access to affordable health insurance, I asked the big guy about the biggest hole of all - Medicare.
How come, I wondered, you don't commit one dime to investing in Medicare's trust fund to extend its solvency past the period 20 years down the line when the baby boom generation's retirement will give the vital program its biggest, most dangerous headaches? The Clinton administration, after all, would put more than $350 billion in budget surplus money into Medicare over the next decade.
Bradley's answer showed me up, not him.
After the recent, excessive cuts in provider payments, and given the amazing economic performance of the '90s, the trust fund's black ink is assured through the year 2018, Bradley noted. That's enough for now, he indicated. ''Besides,'' he went on, ''the health care world is changing so rapidly.''
There may be a need for a proposal down the line, but Bradley said he's unlikely to make one in his campaign. What he did do was propose his own version of a new prescription drug benefit for seniors and a way of using Medicare payments to join health plans that combine social services with medical care - an excellent way to help retired people stay in their own homes and communities longer.
According to his fresh batch of policy advisers, Bradley's proposal assumes that even more changes for the better are on the way for the elderly that will restrain Medicare outlays - breakthroughs in research on chronic diseases and breakthroughs in preventive care mechanisms for healthy seniors.
But it's also smart politics for Bradley, who despite his carefully disheveled appearance and engaging awkwardness has played this game in the big leagues as long as he played basketball. Truth be told, a Medicare-centered debate with Al Gore is not the tussle that shows him in his best light. He has some ideas (means-testing of benefits) and votes (raising the retirement age) in his past to explain; and in deference to the drug giants of New Jersey, he was never good on the mandated use of generic drugs.
Until last week, Bradley was a resume and a receptacle for vague wishes for a new, clean, post-Clinton slate. Now he's a presidential candidate who has provided one huge reason for people to consider voting for him. Bradley's health insurance proposal fits neither liberal nor conservative boxes; it's both, it's neither, and above all it's different. Most important, it has shown that there is a way to break free of the stale shouting match over health insurance that has polluted gridlocked Washington for five years and put this topic of huge concern to Americans back on the national agenda.
Gore loses on this topic unless he responds with ideas of similar depth and detail, and he can't afford to lose on this topic. The vice president made a solid start last month, but Bradley was correct to note that the absence of a price tag was a telling omission.
The two rivals match up on children, who make up 11 million of the nearly 45 million people without insurance. Bradley would use subsidized insurance to bring them all into the health care system. Gore would expand an existing partnership with the states and reach those eligible but not enrolled in Medicaid. Each would have every kid covered by the year 2005. Each idea has merits and risks.
The distinction involves working families between poverty and middle-class status. Bradley is proposing fully subsidized, basic health insurance for a working person whose income is at or below poverty, and he proposed a sliding scale of assistance. And for all workers, Bradley proposes that insurance premiums be excluded from income for tax purposes and that people have the choice of what they have now or of joining the highly regarded plan for 9 million federal employees.
Gore, by contrast, would use subsidies to help the parents of eligible children get insurance - that's 7 million people. And he said he will propose a 25 percent, refundable tax credit of his own for people who can't get insurance in the workplace.
However, Bradley's ideas amount to nearly universal (95 percent) access to insurance. There are questions to discuss about the adequacy of the subsidies, the issue of cost containment, and the danger, which Bradley admits, that employers may be tempted even more to drop coverage.
But his credibility shot way up when he put a ballpark price tag - up to $65 billion a year - on his proposal without assuming any additional savings - which could be gigantic - from a new system that finally cover s nearly everyone and from which everyone would benefit.
Bradley has shown how the right lessons can be learned from President Clinton's disastrous experience in 1993-94. His proposal represents a challenge to Gore. If the vice president responds in kind, there is no reason the two of them can't have a discussion from which the rest of us can only benefit.
Thomas Oliphant is a Globe columnist.
