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AMERICAN VALUES AND THE NEXT PRESIDENT

'The general welfare'

December 28, 2007

Most Americans cherish an abiding conviction that we live in a land of opportunity -- for all, not just a few. We often wrap this conviction in the mantle of liberty: Because we are free, we can pursue our dreams, change our lives, change our world.

But there are prerequisites to opportunity. To live productive lives, we must enjoy health. We must have access to the knowledge we need to be successful. And we must have a sound understanding of the rules of the society we live in.

With this editorial, we consider the presidential candidates' positions on healthcare, education and immigration, issues that may seem unrelated but that, in starkly immediate ways, determine our ability to pursue our American values -- notably, promoting the general welfare.

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Healthcare

A sick America can't be a working America (or a studying America, or even a purchasing America). And changes to the healthcare system will be necessary to keep us in good health. Nearly 50 million people in this country lack insurance. Many neglect preventive care and wind up in emergency rooms instead of doctors' offices, passing the burden of paying for their expensive care along to everyone else. Each year, more businesses drop coverage for workers, citing runaway costs. And those who still have coverage find that paying for it and ever-increasing out-of-pocket obligations gets harder every day. The Congressional Budget Office reported this month that rising medical costs, which far outstrip inflation, pose the No. 1 threat to the country's ability to balance federal budgets in the future.

In July, this page stated its preference for a plan that would achieve universal coverage through an individual mandate, requiring every American to buy health insurance. We called on business, taxpayers and the insured to share responsibility for paying for coverage. We hoped that states would take the lead on reform -- as California has begun to do -- but stipulated that the federal government has a responsibility to offer guidance and financial support. We also urged candidates to be frank about cutting costs.

With the exceptions of Dennis J. Kucinich, who'd like to set up a single-payer, public system for all Americans, and Mike Gravel, who advocates a more centralized, voucher-based system, the Democrats line up with our approach. They seek to expand coverage and to create new purchasing pools to expand choice. They would cut costs by improving administrative technologies and by making medical decisions based on outcomes -- not on what procedure may net a doctor the highest fee. And along with Republicans Rudolph W. Giuliani, Mike Huckabee, Fred Thompson and John McCain, they push preventive care.

Much has been made of the differences between Democrats Hillary Rodham Clinton and Barack Obama on healthcare, but these are minor. Clinton, like John Edwards, would mandate insurance; Obama would not. Ultimately, all three want to expand coverage, and all three offer subsidies to assure that lower- and middle-class Americans won't break the bank paying for it.

Republicans hew to President Bush's position that any expansion of government involvement in healthcare leads to "socialized medicine." The GOP candidates prefer market-based solutions such as health savings accounts, tax refunds for those who buy individual coverage (an idea Clinton and Edwards have supported too) and boosting citizens' ability to spend wisely by requiring greater transparency on prices and outcomes from healthcare providers. These are appealing ideas in theory. But alone they will not improve care for all Americans. Market-based solutions can't work when the market is as broken as this one is -- plagued by wacky pricing, uneven outcomes and misdirected incentives. McCain deserves praise for taking an aggressive stance on cutting costs and admitting, at least implicitly, that it might be painful.

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Education

For all the flaws written into the No Child Left Behind Act, Bush emerged as a true "education president" by insisting, in word and deed, that schools had to do better. As we contemplate his successor, we look for candidates who consider schools a national priority, who will press for high standards and uphold such basic values as the separation of church and classroom. This means a firm public stand against school prayer and the teaching of creationism and "intelligent design." And it means withdrawing the millions of dollars the Bush administration has devoted to abstinence-only sex education.

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