f the four leading candidates for president, three have thus far run basically positive campaigns. Republicans John McCain and George W. Bush are content to talk mostly about their own views and vision, as is Democrat Bill Bradley.
Not so Al Gore.
Since Bradley pulled abreast of Vice President Gore in New England, Gore has transformed his campaign into a gattling gun aimed at the former New Jersey senator.
A tough campaign isn't necessarily a bad campaign, of course, provided a candidate's charges are accurate and reasonable. But after two recent nationally televised Democratic debates, a viewer has to wonder if
Gore is more intent on gamesmanship than on discussing the issues.
It's Bradley's ambitious health care plan that Gore has targeted most tenaciously. It's one thing to argue that the billions Bradley would devote to health care are better spent on other priorities such as education. But Gore has hardly contented himself with that argument. Instead, he has cast his rival's plan as arrant folly, saying, by turns, that it would endanger Medicare, desert Medicaid recipients, ''shred the social safety net,'' spend the country into deficit, and send us into recession.
That's less an explanation of difference than a prediction of disaster. So what do health care specialists think of those charges? The answers do not bode well for the Gore campaign.
Cost
One key point of contention between the two camps is whether Bradley's plan is affordable. He estimates the price tag at $55 billion to $65 billion a year, or as much as $650 billion over 10 years. The Gore campaign, relying on the estimate of former Clinton administration member Kenneth Thorpe, now a professor of public health at Emory University, says the plan will cost $1.05 trillion over a decade. (Gore's plan, Thorpe says, would cost $312 billion over 10 years.)
Specialists aligned with neither camp say the actual cost will probably be significantly higher than Bradley's estimate, but considerably lower than what Gore charges. Professor William Hsiao, director of the Center for Health Care Financing at the Harvard School of Public Health, says his own examination of Bradley's plan leads him to think it will probably cost about $85 billion a year, or $850 billion over 10 years.
''I think it is a workable plan and a realistic plan,'' says Hsiao, who served as an actuarial specialist on Medicare in the Nixon administration and has advised the House Ways and Means Committee and the Senate Finance Committee on Medicaid and Medicare. And as for Gore's criticisms?
''I think it is all a political game,'' said Hsiao. ''The vice president does not think there is sufficient political will for a major initiative in health, but a significant portion of Democratic voters are in favor of something like this, so he has to undermine it.''
Economic disaster
Of all Gore's claims, perhaps none is as troubling as his charge that Bradley's plan would spend the nation back into deficit, occasion an increase in interest rates, and thus drive us into recession. Is Bradley's plan a Trojan Horse that will end the economic boom?
Exceedingly unlikely, economists and specialists say.
One well-known federal budget authority, who would speak only on condition of anonymity to avert being caught in partisan cross-fire, says the program cost has to be measured against the total budget and gross domestic product.
''Let's say it costs $900 billion over 10 years,'' he says. ''That's $90 billion a year in a budget of $1.8 [trillion] to $2 trillion in a total economy of about $10 trillion. The budget and the economy could absorb that very easily.''
But make no mistake, Bradley's program is expensive. Certainly it would take up most, if not all, of the currently projected surplus for the next 10 years. That's why it is a legitimate political issue to question whether the country should devote that much money to health care or to point out that Bradley will have less for other priorities, be they education or Medicare or tax cuts, says Roger Porter, a senior economic policy adviser under Presidents Reagan and Bush and now director of the Kennedy School's Center for Business and Government.
Still, Bradley's program ''would not, however, be likely to have a major effect on short-term interest rates or to plunge the economy into recession,'' Porter says.
Robert Reischauer, former director of the Congressional Budget Office and now a senior fellow at the Brookings Institution, concurs. ''I think it is going to cost more than Bradley has set aside, but it won't spend us into recession,'' he says. ''Recessions are very rarely caused by excess government spending.''
Indeed, should revenues keep showing the healthy growth of the last few years, ''there will be more than enough money to go around for competing priorities,'' Reischauer says.
But even if all the new spending came as deficit spending - which is highly unlikely - there is no logical link to a recession.
Any increase in interest rates would simply counterbalance the economic stimulus the new spending added to the economy, says Roger Brinner, managing director and chief economist at the Parthenon Group, a Boston-based management consultant and investment firm.
''It is really a short-circuited piece of logic to say the economy would go into recession because interest rates went up, because they would just be bringing the economy back to the glide path the Federal Reserve wants for ... growth in the first place,'' said Brinner. ''They would be an offset to the stimulus effect.''
Quality
A new Gore tactic that emerged in the debates is an attempt to blur the largest issue difference with Bradley by asserting that he, Gore, also wants universal health care.
''I'm in favor of universal health care,'' the vice president saidduring the rivals' ''Nightline'' encounter. Or, as he put it during their ''Meet the Press'' exchange: ''Both Bill and I have the same goal, to get to universal health insurance.'' That's a claim that puts the vice president in the odd position of supporting in principle what he opposes in fact.
Whatever Gore might say, the differences between the two men are real. The Consumers Union, the nonprofit group that publishes Consumer Reports magazine, has done a detailed analysis of both Bradley's plan, which centers on sliding-scale federal subsidies to individuals for health plans, and Gore's smaller proposal, which calls for expanding the federal Children's Health Insurance Program, or CHIP, to cover all children and more parents, and to offer partial tax credits to both small businesses and uninsured workers to encourage the purchase of health coverage.
The nonpartisan consumer group looked at eight aspects: commitment to universality of care, progress toward insuring all children, plans for Medicare prescription drugs, other changes to improve Medicare, the promotion of consumer-friendly market measures, equitable tax policy to finance health care, incremental improvement to the health care system, and realistic cost estimates and financing plans.
The results? Consumers Union judged Bradley's plan superior in seven of the eight categories. Gore's health care proposal was viewed as better only in strengthening Medicare beyond the prescription drug benefit both candidates have proposed.
Gail Shearer, director of health policy analysis for CU's Washington office, says Bradley's plan needs some tuning to ensure that the subsidies it provides can replace Medicaid - and help families moving off Medicaid keep coverage - but says Gore's charges that Medicaid recipients ''will be left out in the cold'' is unfair. Actually, his plan would probably insure more minorities than Gore's plan, her analysis found.
''There are some concerns, but Gore overstates those concerns,'' Shearer says. ''When Bradley is talking about giving low-income people a benefit like what federal employees and members of Congress have, I don't think it is fair to call that being left out in the cold.'' Further, Shearer says the very fact that the Clinton administration put together a plan for universal health care in 1993, in a time of large deficits, undermines Gore's argument that such a plan is impossible now, in a time of large surpluses.
As for progress toward insuring the uncovered, even the Thorpe analysis Gore cites to his advantage says Bradley's plan would cover 3 million more people than Gore's. Meanwhile, a new analysis by two Harvard and Stanford specialists who advised Bradley on his plan concludes that it will cover 30 million previously uninsured people, while Gore's will reach 7 million.
''To me, that sounds about right,'' says Shearer. ''Bradley's plan includes deep subsidies, so it will have a major impact.''
And as for Gore's proposal? ''I am glad he is talking about universality,'' says Shearer, ''but his plan really doesn't go far toward that goal.''
It's that same sort of continuing gap between rhetoric and reality that has led to questions about Gore's commitment to an honest discussion of the issues.
For all the candidates' talk about offering a positive vision, a ''say anything'' campaign which assumes that truth is expendable - and that people are more easily swayed by exaggeration and distortion - reflects a politics-as-usual approach, not a commitment to enlightened debate.
