The Democrats' healthcare agenda.

One of the most famous quotes of Oklahoma humorist Will Rogers was his description of his political preferences: "I belong to no organized political party," he said, "I'm a Democrat."

No matter what happened in the election recently concluded (press time preceded the November 7 date), chances are it seemed to validate Will Rogers's quip. Many analysts assured us that the election overwhelmingly centered on whether voters agreed or disagreed with George W. Bush on Iraq. The Democrats were depicted as hopelessly divided on everything else, including policies related to health, housing, and long-term care. Some columnists predicted that the Democrats would not take control of Congress because they lacked the kind of consistent agenda that carried the Republican Party into power in 1994. Others, however, argued that dissatisfaction with President Bush was so widespread that the Democrats didn't need another issue.

One reason for this perceived disunity was that the Democratic Congressional Campaign Committee chose to recruit relatively conservative candidates to run in congressional districts with entrenched Republican incumbents. For example, in Indiana's 2nd congressional district, Democrats recruited Joe Donnelly to challenge incumbent Republican Chris Chocola. Donnelly told the voters of South Bend and Kokomo that "I am not going to Washington to represent any special interests, extreme political agendas, or be a 'yes man' for anyone," and promised to continue to be steadfast against gun controls, abortion rights, and any effort to allow illegal immigrants to remain in the United States. Donnelly's right-of-center positions were not an isolated case: In Iowa, several of the Democratic candidates had been Republican officeholders in 2004.

In contrast, a few Democratic nominees for Congress offered policy agendas that can only be described as radical leftward departures from the mainstream. Bob Bowman, a retired Vietnam-era Air Force pilot and former Reform Party presidential candidate, won the Democratic nomination in Florida's tightly contested 15th congressional district with a platform that included a sharp attack on all privately financed healthcare:

We must kick the insurance companies out of the healthcare business
completely, and break the stranglehold of the HMOs and for-profit
hospital conglomerates. We must finally join the rest of the civilized
world with a doctor-run single-payer national health system. This can be
achieved through a gradual improvement and expansion of Medicare until
all Americans are covered for all healthcare expenses.

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The gulf between the perspectives of congressional candidates like Donnelly and Bowman gave critics lots of ammunition to charge that the only unifying theme of Democrats in 2006 was "anybody but Bush."

Looking at these extreme cases, however, can be misleading. A review of congressional campaign speeches and literature this fall finds that most Democratic candidates for the House and Senate used very consistent language to describe what they intended to do about healthcare if elected.

Harry Mitchell, former schoolteacher-mayor of Tempe, Arizona, was this year's Democratic challenger to entrenched Republican congressman J.D. Hayworth. His positions on healthcare focused on only a handful of points: Congress needs to work to ensure the solvency of Medicare by eliminating special interest giveaways and by offering a real prescription drug benefit, managed directly through Medicare and allowing for the purchasing power of more than 40 million beneficiaries to be used to lower drug prices. The same points, with the addition of a pledge to legislate a "Patients' Bill of Rights," were echoed by Joe Donnelly in Indiana, and by dozens of other Democratic candidates throughout the country.

A thorough background in healthcare issues made little difference to the positions adopted by most Democratic nominees. In Connecticut, for example, two of the Democratic challengers of incumbent Republican congressmen had served as chairs of the state legislature's health committee, and this provided an opportunity for them to describe what they previously had done for healthcare. Chris Murphy, running in Connecticut's 5th district, reminded voters about his recent achievements in health policy:

I want to bring many of the successes I've helped achieve here in
Connecticut to Congress. This year, thanks to a bill I authored and
passed, Connecticut became the third state in the nation to authorize
and fund stem cell research, in the hope of one day finding cures for
horrible diseases such as juvenile diabetes, Parkinson's disease, and
cancer. I've also made expanding health care for the poor and indigent
a priority of the Public Health Committee. I've written legislation that
expands the reach of mental health treatment for the poor and
legislation that better protects uninsured patients from over-aggressive
bill collection practices.

He added that, "In part, my decision to run for Congress stems from my realization that the important fights for the future of our health care system will be won or lost not in Connecticut, but in Washington, D.C." When it came to specifics, however, Murphy offered the same agenda as Democratic candidates who lacked his experience: allowing the Medicare program to use its bulk purchasing power to negotiate lower drug prices and passing a national Patients' Bill of Rights.

The reality is that the Democratic National Committee, headed by former physician Howard Dean of Vermont, adopted a "Democratic agenda" earlier this year that includes several of Dr. Dean's priorities on healthcare. These include eliminating the prohibition against federal agencies using their bulk buying power to obtain price reductions on prescription drugs, removing barriers to federal funding of embryonic stem cell research, and enactment of a "Bill of Rights" regulating interaction between patients, clinicians, and managed care. The Democratic Party deliberately downplayed the agenda, allowing congressional candidates to emphasize that they will be "independent voices" in Washington. We saw how effective this was in the recent election. In any event, the repetition of identical healthcare ideas in the campaigns of the majority of the Democratic congressional candidates strongly suggests that these policies will be high-priority items for the party in the next Congress.

Where does this leave long-term care? Skilled nursing facilities might benefit from the bulk purchasing measures and may gain some advantages from the protection for clinician autonomy in the proposed healthcare "Bill of Rights." In general, though, long-term care was not addressed by the Democratic agenda. This could be an opportunity for providers to educate new congressmen about the realities of their field, including the fact that campaign promises to "help keep the elderly out of nursing homes" are no more practical than pledges to keep them out of hospitals and hospices. In the last analysis, demographics are likely to force the hand of both parties on this issue.

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