Las Vegas

Trying to push universal medical coverage to the top of the ’08 agenda, the country’s largest healthcare union, SEIU, summoned the candidates to a Sin City forum on the issue on March 24. And all of the Democratic contenders except Senator Joseph Biden showed up, not only to present their respective plans but also to court the crucial union vote.

The endorsement of organized labor, a powerful and growing force in Nevada politics, will be central to any Democratic candidate wishing to carry the state. With the January 19 Nevada primary coming second in the country–only five days after the kick-off Iowa caucuses–winning here could fuel momentum going into the mega-Super Tuesday of February 5, when Californians and as much as half the rest of the country will be voting.

The seven Democratic contenders who appeared before the crowd of 1,000 union activists and students at the University of Nevada, Las Vegas, all vowed to provide affordable universal coverage if elected, but only former North Carolina Senator John Edwards presented a plan with any significant details. “One of the reasons that I want to be President of the United States is to make sure that every woman and every person in America gets the same kind of things that we have,” Edwards said, referring to the recent announcement that his wife, Elizabeth, will be in cancer treatment for the rest of her life. Edwards was also the only candidate who unflinchingly supported a tax increase, which he said would be necessary to pay the $90-120 billion per year price tag on his plan. Anybody saying otherwise, he said, is likely trying to sell the voters “a bridge in Brooklyn.” He proposed reaping that revenue by reversing the Bush Administration tax cuts for the wealthy. And in a moment that drew some of the loudest applause, Edwards challenged his rivals to be equally forthright: “I think the [next] President needs to be honest and that starts here.”

Senator Hillary Clinton made an unusually spirited presentation, though one that was less specific than Edwards’s, and she has not accepted the idea of raising taxes. She put her emphasis on legislation she is sponsoring that would prohibit discrimination against policyholders who have previous medical conditions. Senator Barack Obama, whose insurgent campaign has suffered from accusations of dealing too much in platitudes, came surprisingly unarmed with a specific plan. He insisted it was political leadership that counted, not a blueprint. “Every four years, somebody trots out a healthcare plan,” he said. “The question is: Do we have the political will and sense of urgency to actually get it done? I want to be held accountable to get it done.”

Despite differences in the Democrats’ financing approaches, their unified vow to achieve universal coverage was sweet music to the ears of the forum organizers. The 1.8 million-member SEIU is the country’s wealthiest PAC, and it makes no secret of wanting to use its clout to make universal healthcare central to the ’08 campaign. “So far there’s been lots of glitz and glamour and talk of Hollywood fundraisers,” SEIU president Andy Stern said in an interview. “We intend to make this campaign about real issues.”

SEIU was an early endorser of Howard Dean for 2004, and by the end of the general election had poured $65 million into Democratic campaigns. In the current cycle much of its leadership has been working closely, if quietly and unofficially, to build support for Edwards, whose economic-populist campaign resonates in union offices. SEIU has been vigorously promoting a recent poll it commissioned, which showed vast majorities of Democrats and Republicans listing healthcare reform as their top domestic priority, as well as supporting “fundamental” rather than “piecemeal” solutions. Earlier this year Stern recast the healthcare debate when he set up a reform alliance not only with another union but also with the CEOs of Wal-Mart, Intel and AT&T. “Employer-based healthcare is dead,” said Stern. “It’s a relic of the industrial era.” Stern argues that American business can no longer compete globally if it must foot the bill for healthcare, making this a prime time to enlist corporate support for universal coverage.

John Podesta, former Clinton White House chief of staff and now head of the Center for American Progress, a co-sponsor of the Vegas forum, said that achieving healthcare reform is no longer just a “moral issue” but an “economic issue” as well. The big difference between 1994–when the Clinton healthcare initiative failed–and now, he said, “is that now business is on board.”

Edwards’s detailed plan came the closest to overlapping the reform vision coming from the SEIU. First unveiled earlier this year, the proposal calls for an expansion of both public and private health plans, asks employers either to provide healthcare or pay into a fund that does, requires individuals to buy insurance and offers government subsidies for families with incomes of up to $80,000 who can’t afford it. This sort of private/public mix is emerging among some progressives as the most logical, and most politically doable, step short of a government-underwritten single-payer system. “Single-payer is of course our gold standard,” said one SEIU political organizer. “But we can’t just do nothing before we get there.” Representative Dennis Kucinich was the only candidate at the forum to propose a single-payer system, but he provided no details on how it would be achieved or financed.

“If the election were held today, we’d be supporting Edwards,” said one leading West Coast SEIU official on hand for the forum. “When he comes into town, he asks what he can do for us. Hillary asks us what we can do for her.” That sentiment, however, was contradicted by an unscientific sounding of the audience that elicited a pronounced preference for Clinton. A recent statewide poll of Nevada Democrats had Clinton leading with 32 percent, Obama at 20 percent and Edwards and former Vice President Al Gore tied at 11 percent.

In neighboring California, where the Democratic candidates are spending even more time (and mining millions in campaign cash), healthcare also looms as a major issue. Governor Arnold Schwarzenegger put the issue stage center earlier this year when he promised universal coverage before his term is up. California Democrats are also proposing a number of competing plans. The state’s SEIU has praised all of the proposals but has yet to endorse any. The California Nurses Association has put its weight behind a single-payer proposal by State Senator Sheila Kuehl.

After the Las Vegas forum ended, Podesta and SEIU second-in-command Anna Burger said they were pleased that all the candidates offered specifics, but they expressed no preferences. Burger said SEIU isn’t expected to make an endorsement until September and hasn’t yet decided how much to spend on campaign ’08. “But this time around,” said Burger, “I can tell you it’s not going to be anything less than $65 million.”