Fineman: Americans Warm Up to Universal Health Care

Michael Moore is a uniquely American hybrid: the profit-making, anti-establishment agitator. In that line of work, your instincts have to be sharp. His are. In films that mix brave journalism and brazen agitprop, he has been ahead of the curve on the demise of heavy industry; the deadly blend of teenage rage and the gun culture, and the shaky reasoning behind, and execution of, the Iraq War. In person, he is a friendly bear of a guy—until the tape is rolling. Then the populist piranha pops out. I watched him working the lobby of one of his Washington premieres. He had a film crew in tow. Beltway types (including me) were glad to say hello. Few (including me) lingered on camera.

Now Moore is back with "Sicko," his docu-tribe about our health-care "system." Once again, Moore's timing is perfect. Aside from Iraq, there is no bigger issue on the minds of voters. Two presidential candidates, John Edwards and Sen. Barack Obama, have come forth with ambitious plans that call for vastly extending coverage. The world awaits the proposal of Sen. Hillary Clinton, who touts herself as a leading expert on the topic.

It would be nice to think that the urgency is the result of outrage at our mediocre infant-mortality and life-expectancy numbers, which are among the worst in the developed world. With a sure sense of how to be annoying, Moore praises Cuba's record (which in some respects is better than ours), and heaps kudos on France, the health-care paragon.

But the real reason the topic is atop the agenda is that the middle class is scared—again. In 1991, in the midst of a recession, Democrat Harris Wofford scored an upset victory in a U.S. Senate race in Pennsylvania with an ad, written by James Carville and Paul Begala. It asked: if every criminal is entitled to a lawyer, why isn't every family entitled to a doctor? Carville and Begala migrated to Bill Clinton's presidential campaign; a promise to push for universal health care went with them. "Back then, the concern was that people were losing jobs, and, with them, their health care," says Len Nichols, an economist at the New America Foundation. "Now it's not that you will lose your job, but that you simply can't afford the coverage." Twenty years ago, Nichols's figures show, health spending comprised 7 percent of the average family's income and compensation. Today that number is 20 percent.

Americans may be inching toward the idea that a truly universal system may be the only way to guarantee that we can all afford some coverage. Edwards's plan, which requires that all Americans get coverage (and pay for it, if they can), is the most ambitious in that regard. It calls for those making more than $200,000 a year to give up their Bush-era tax cuts to help pay for it all. Obama's plan, which relies on incentives rather than on mandates, and which does not claim to cover everyone, caps the tax cuts at $250,000. So far, Hillary has come forward with cost-saving proposals.

Her next step is the crucial one. She has been through this movie. In 1993 she engineered a plan to guarantee health care for all, using market mechanisms overseen by government. It was booed off the stage. Americans weren't ready for the idea of turning health care into what amounted to a regulated utility. To make that case now means arguing for the efficacy of government itself—and for raising taxes.

That is what is known in the trade as "a heavy lift." I asked her spokesman when she will unveil her full proposal. "In the coming months," he said. In a pre-emptive strike, Moore already has called Clinton a "sellout." I don't know if he's rolling tape again, but she should expect him to be.