By Brian P. Janiskee Posted December 16, 2002

Consider the following scenario. It is a year before the next presidential election. George Bush's popularity is at a record level. Victorious American troops come home from Iraq to dozens of parades, ceremonies, and made-for-television patriotic galas. The top-flight potential Democratic nominees, one-by-one, drop out of the race, not wanting to charge the political machine gun nest that is the Bush presidency. Media pundits have declared the Democrats' hopes for the White House moribund.

Then a strange thing happens. A special election for an open Senate seat changes the picture. The heavily favored Republican is defeated by a virtually unknown placeholder Democrat that had been appointed by the governor. The cannon fodder candidate becomes a conqueror. The key issue in the campaign is the struggle of many middle class people to find affordable health insurance.

A long shot Democratic presidential hopeful seizes upon the issue, and upon the possibility of a chink in the Republican armor. Although he hails from a small state with little numerical clout in the Electoral College, his campaign gains momentum. After a bruising primary struggle against the old-guard elements of his party, the maverick candidate wins the Democratic nomination and then shocks the world by defeating the seemingly invincible incumbent Republican president in a landslide.

Is this a Democratic strategist's daydream or a Republican's nightmare?

It is neither. It is a summary of the 1992 presidential campaign. The senatorial candidate was Harris Wofford, who had been appointed to fill the Pennsylvania U.S. Senate seat vacated by Republican John Heinz, who was killed in a mid-air plane collision. The underdog small-state governor was Bill Clinton. The brains behind both campaigns was the now-famous Democratic campaign strategist James Carville.

A recent high profile newspaper article by New York Times reporter John Broder indicates that the health issue may be back on the political radar screen. This is good news for the Democrats. While Americans tend to trust the GOP with issues like national security, crime, and social morality, the U.S. public places more faith in the Democrats when it comes to kitchen table issues like health care and education.

Out of pocket costs are soaring in health care. Monthly premiums are on the rise as are co-payments for prescriptions and office visits. Many middle class families cannot afford health insurance. The HMO strategy of squeezing costs by rationing access to specialists appears to have run its course, its financial utility all but drained.

Furthermore, the policy "action" is on the political left. The battle lines seem to have formed around a socialist single-payer system as opposed to a Clintonian center-left managed care plan. Other than some half-hearted attempts to promote a medical savings account plan, the Republicans appear bereft of ideas on this front. The Democrats would have the initiative if this issue ever becomes salient in a presidential race. Can the Democrats repeat the 1992 Wofford-Clinton-Carville campaign?

The "Clinton" of 2004 could be Howard Dean. Dean is the Governor of Vermont and also happens to be a physician. He has made universal health care the cornerstone of his presidential campaign, having initiated a version of this program in his home state. He is charismatic, charming, and likeable. And most importantly he will have a home court advantage of sorts in the New Hampshire primary.

While many in the GOP establishment will scoff at a potential threat from such a wild card, it should be remembered that the previous two Democratic candidates that have defeated incumbent Republican presidents were dark-horse, long-shot governors from small states: Carter and Clinton.

The other two elements for the Democratic upset in 2004 are still missing. The Democrats need a "Wofford," a state-level underdog who defeats a high-profile Republican. And despite claims to the contrary, Mary Landrieu is not Harris Wofford.

In addition, they must find their "Carville," a grand strategist who is able to see through the fog of battle in order to plot the perfect strategy to take on a very powerful and popular president. Needless to say, the task will not be as easy for the Democrats this time around.

Unlike his father, the younger Bush is coming off a historic midterm election victory and has shown his mettle in fighting the Democrats tooth and nail in key races. The Bush of 2004 will not be the Bush of 1992. Even if the Democrats find their Wofford-Clinton-Carville triumvirate, it may not be enough to defeat the "W" juggernaut if Bush can deflect the rhetorical power of the health issue, while at the same time providing a few direct solutions to the more acute problems.

Bush would be wise to "hug the issue" as soon as possible, to borrow a term from political consultants. The president should close the distance between himself and the Democrats, not in a policy sense but with respect to the president's level of concern. This will reduce the partisan salience of the issue.

The next step would be to offer a plan aimed at the middle class. Bush should propose a plan that would address the issue of preexisting conditions and the high cost of COBRA payments. The president could do this by fostering the creation of high-risk pools for those who have been denied coverage due to a preexisting condition and enacting tax incentives for those who are making COBRA payments while they are between jobs.

These suggestions, of course, do not get to the root of the problem, which lies in the market perversions of an employer-based third-party-payer system. However, some immediate proposals are necessary. The president as a matter of principle should provide relief for those middle class families trapped in the tangled web of employer-based health care. In addition, for the president's own political survival, he must dismantle one of the Democrat's most fearsome policy weapons.

On the other hand, Bush should not go too far and make it his top issue. National security is far more important. But health insurance must be a vital part of his overall economic message. A fusion of health care with tax relief could cause real problems for the Democrats. Imagine, if you will, the panic in liberal political circles should Bush combine the issue of payroll tax relief with the high cost of private insurance premiums and out-of-pocket costs for office visits and prescriptions.

The 2002 elections demonstrated that conservatives have the strategic high ground on national defense, crime, and social issues. However, no modern political movement, no matter how energetic and principled, can sustain being perceived as indifferent to four-person households with $75,000 of income being priced out of the health insurance market. The Republicans must address this issue or risk defeat in the next election.