coffeeUntil two days ago, the health care debate between Democratic candidates was mostly over. Hillary co-opted Edwards, and that defined the boundaries. But with their proposed agreement, the United Auto Workers and General Motors expanded the boundaries, advancing the health care debate beyond where the front runners thought it safe to go.

John Edwards deserves credit for his plan for universal coverage. He pushed the debate, getting Obama, Clinton and others to come up with their own plans. But none of these plans lays out the full scope of the debate many Americans are now waiting to have.

Americans are unhappy with their health care system. And it's not just because 47 million American don't have health insurance. As Jane has courageously discussed here, those who are insured are also frustrated -- they're angry -- because medications, testing, and treatment that their doctors are telling them are medically necessary are being routinely denied coverage by an insurance industry whose financial health depends on such denials.

We have a system that largely depends on insurance companies, but the financial interests of insurance companies are directly at odds with the interests of people who need health care. This conflict is pervasive, pernicious, and fundamental, and it cannot be easily overcome through "reforms" that keep private insurance in the central role, no matter how well conceived and implemented.

Hillary Clinton, following safely in Edwards' footsteps, has a universal plan premised on insurance coverage for all. And like Edwards' plan, Clinton's plan includes features that could, over time, expand the public health care system by making it an option for those without employer-provided private insurance or who cannot otherwise afford insurance payments.

The core of the leading Democrats' plans is thus reliance on employer-provided private insurance. The candidates have accepted that core, because it's the core system now, and they assume that's the best they can get. But the GM-UAW agreement suggests they've been too timid.

The details of the GM-UAW plan are not available, but what it appears to do is to set up a company-wide health plan trust for GM-UAW retirees which would initially be funded mostly by an endowment from GM. I see two important concepts at work in this proposal.

First, after GM's initial funding of the trust, GM would be relieved of a major financial burden that, along with other retirement commitments, has combined to make GM's products less competitive. As soon as GM announced the agreement, perceptions of its increased competiveness caused its stock price to jump.

I don't know if this will "save" GM, or Ford or Chrysler, but the concept has relevance for many industries in America. Moving health care costs off the corporate books is a necessary first step in restoring their competitiveness and keeping jobs here. But our candidates are moving in the opposite direction, seeking to force employers to provide health insurance coverage.

Second, the UAW members and their families will still get health care, but it will be funded primarily by their trust system. Unless I'm mistaken, this looks conceptually like a single-payer system limited to GM-UAW employees.

If that's the concept, then one can see it expanded to Ford and Chrysler and other segments of the auto industry . . . and other industries. Anything that large has to be run in an open, transparent manner, subject to independent oversight. So we're talking about something that will eventually evolve into a quasi-public funding institution.

While the Democratic plans also include publically financed systems, including expanded access to Medicare and/or the Congressional health plan system, they could have gone further in laying the foundation for a transition to something like a single-payer system for basic health services, but they were afraid to get too far out in front.

The GM-UAW plan looks like it is based on quasi-public concepts that go beyond the candidates' employer-based plans. And by shifting the cost burden from a financially pressed industry to a pool-based, quasi-public concept called a "trust," the agreement provides room for the candidates to improve their plans and change the health care debate for the better.

emptywheel has another take at TNH.

Btw, I thought the Democrats had an excellent "debate" last night. Good discussions about Iraq, Iran, health care, etc. and the overall impression helps the Democrats, IMO. Any reactions?

Photo: from Carsten Bleicker's Photosteam