Sept. 15, 2000 (Washington) -- The presidential candidate who, if elected, would change the U.S. health care system most dramatically is not going to win. He's not even going to come in second.
The candidate's name is Ralph Nader, since the 1960's America's symbol of consumerism and environmentalism. He has strong views on health care issues, and if elected, pledges to make substantial changes in how health care is delivered, including a government-run universal health care system.
Nader, however, won't be the next president. He does not have the broad political support provided by the two leading parties. He won't even get as many votes as Ross Perot did in 1992 and 1996, according to the present polls.
He also has no money. The joke circulating in Washington is that the amount budgeted for Starbucks coffee in the Gore and Bush campaigns is larger than the entire "Nader for President" war chest.
But more than anyone else in the country, Nader may determine who will be the next president.
Nader is drawing 3% to 4% of the voters in some key states, enough to shift the balance between Al Gore and George Bush. The presumption is that Nader will draw most of his votes from Gore, and a few percentage points mean a lot in an election that is now regarded as a toss-up. So Nader could be the difference between victory and defeat for Gore. Nader's goal is to get 5% of the vote, which would make his Green Party eligible for matching federal funds in 2004.
A recent issue of Rolling Stone summarized in a sentence Nader's presumed role: "Ralph Nader is so fed up with corrupt Beltway politics that he is willing to sacrifice Al Gore."
Nader is especially strong in California, which Gore must win if he is to be elected. He has the endorsement of the California Nurses Association, the most powerful state nurses union, as well as trade unions in non-health areas.
Nader's positions on health care issues are clear. He favors universal coverage with a single payor, the government. He favors a nonprofit approach to health care. He wants price controls on prescription drugs. He believes Americans, particularly children, are overmedicated.
Nader and his sidekick, Sidney Wolfe, MD, have been gadflies on the Washington medical policy scene for more than 30 years. Wolfe formed Nader's Public Citizen Health Research Group in 1970 and still directs it. Seldom does a week go by without some high-profile attack from the group on FDA drug decisions, unsafe drugs, medical malpractice, or high medical costs.
I've known Sid Wolfe since he started his group in 1970, fresh from a stint doing research at the NIH. A graduate of Case Western Reserve University School of Medicine, an internist by training, he is a man with a clear agenda who uses the media with great skill.
Wolfe is the ultimate Washington spin doctor. Always quotable, highly opinionated, Wolfe is a media darling among Washington reporters and is on TV and quoted in the press more often than any private physician in the U.S. I have appeared on radio or TV talk shows with him half a dozen times this year.
On health policy matters, Nader's views are not radically different from Gore's, except that politicians like Gore have come to understand that the American public and its congressional representatives feel more comfortable with incremental, gradual changes. Nader is an impatient man who wants change immediately.
The key question for the future is how much influence Nader and Wolfe will have on health care policy matters under the next administration. My guess: not much. They will continue to derive their influence from their access to the media, not to high officials.
Should Gore win, he and his associates will not take kindly to Nader's current opposition. Should Bush win, his policies will be far removed from Nader's health care agenda. Thus, no matter who wins the election, neither Nader nor Wolfe will be invited to the inaugural balls.
But their influence still will be felt in the next administration as they push their agenda for expanded health care programs and more government involvement in health care delivery.
Wayne L. Pines, WebMD's Washington columnist, is a former associate commissioner and chief spokesman of the FDA. The opinions expressed in this article are not necessarily those of WebMD.