WASHINGTON — Polls suggest a majority of Americans are open to the idea of a federally run "public option" to help people who don't have health insurance obtain it.
But neither the Democrat nor the Republican running for Northern New York's congressional seat is using that term much these days, and neither appears to want to talk much about it.
On one of the biggest issues going into the special election to replace Rep. John M. McHugh in Congress, government-run health care has taken on a third-rail quality. In interviews and on their campaign Web sites, Republican Dierdre K. Scozzafava and Democrat Bill Owens spoke mainly in generalities about the need to make health care more affordable and ensure that people with pre-existing conditions can still obtain insurance. Only the Conservative candidate, Doug Hoffman, spoke openly in an interview about the government taking an active role in health care — and then to express his doubts about the need for any such involvement, including in the traditional programs of Medicare and Medicaid.
"The first thing is do I believe there's a need for reform? Yes," said Mrs. Scozzafava, citing the large numbers of uninsured people and shortage of top-notch doctors in the north country.
In a telephone interview, Mrs. Scozzafava lamented the high cost of lawsuits and lack of competition in the health-care industry. She said tort reform and competition are her top priorities, a popular refrain among Republicans who are uncomfortable with a public option.
But Ms. Scozzafava, a political moderate, did not explicitly say she opposes any government-run option, either in the interview or on her campaign Web site. And her Web site emphasizes her support for Medicare, saying she opposes cutting that program to help pay for a health care reform plan.
Mr. Owens said he has several criteria he would weigh in deciding whether to support a plan, including controlling costs for the middle class, preserving affordable insurance plans for small businesses and letting people keep the plans they already have. But he repeatedly declined to say whether he supports a public option to ensure that everyone is covered, or a government mandate that everyone have insurance.
He said he would not automatically rule out the idea of an insurance mandate, returning to his campaign mantra on the issue.
"I'm always going to be judging it upon those criteria," Mr. Owens said. "There's no doubt in my mind that we must move forward on health care reform."
Mr. Hoffman was open about his disdain for government-sponsored health plans, saying Medicare and Medicaid reimburse hospitals so poorly that other patients have to pay more. More than a third of children up to age 18 in New York are covered by Medicaid, the Urban Institute and Kaiser Commission on Medicaid and the Uninsured reported, citing Census figures.
"I do have conceptual problems with Medicare and Medicaid," said Mr. Hoffman, who has spent several years as a volunteer director at Adirondack Medical Center. "Even nonprofit hospitals have to make money to stay in business."
Statistics tell part of the story of Northern New York's health care challenges. Between 15 percent and 20 percent of the region's population under age 64 does not have health insurance. Jefferson County's rate is 19 percent, the Census Bureau reported. In Hamilton County, the congressional district's least populated county, one in four people of that age does not have health insurance.
A lack of health insurance means quicker death. A Harvard Medical School study in September found that 44,789 Americans of working age die every year because they do not have health insurance and have a 40 percent greater risk of death than privately ensured counterparts, sharp increases from previous studies.
According to Sen. Charles E. Schumer, D-N.Y., who supports a public option, nearly 30,000 people in Northern New York spend more than a quarter of their income on health care — and yet the great majority of those people do have insurance, his office reported.
Mr. Schumer has argued that a government-run option would lower insurance costs for everyone by creating competition for health insurance companies. But the companies advocates in Congress say the government has such control it could put the companies out of business.
The lack of competition is clear in New York. GHI and Empire Blue Cross and Blue Shield alone control nearly half the commercial market in the state, Mr. Schumer's office reported.
For all the negative talk about "socialized medicine" from the political right, though, polling on health care suggests voters support a public option — depending what the term means and how the question is framed. In the latest poll by USA Survey, funded by the pro-public option MoveOn.org, 77 percent of respondents said they support having a choice between public and private plans. But when pollsters for NBC took out the word "choice" and asked if respondents support a government-run plan to compete with private insurers, just 43 percent were favorable.
Whether the candidate who is elected will have to vote on a public option remains unclear, although the idea has greater momentum in the heavily Democratic House. The Senate Finance Committee defeated efforts to include a public option but does have a provision for health cooperatives, another idea generating skepticism from Mr. Hoffman. The committee's final vote on its bill is scheduled for Tuesday.
Some agricultural bargaining cooperatives have spoken out in favor of a cooperative plan, as long as it protects plans they already have in place.
Another idea brewing is to create a government-run alternative as a last resort, to be triggered only if necessary. That idea, supported by some moderates in both parties, is borrowed from the Republican Medicare Part D law passed during the Bush administration.
The north country candidates' reticence to directly address public health insurance may reflect the bitter tenor of the public debate, including the disruptive behavior at some congressional "town hall" meetings during the summer. Mr. Owens recently skipped a health care forum in Plattsburgh sponsored by a conservative "Tea Party" group, letting Ms. Scozzafava and Mr. Hoffman handle it on their own. He had already committed to another campaign appearance across the district, his spokesman said.
In a telephone interview, Mr. Owens said the economy — not a health care system overhaul — may be the top priority in helping people afford care.
"The problem that most needs to be fixed is we need to create jobs here," he said.
Ms. Scozzafava said she opposes requiring people to have health insurance. The problem with most of the health care overhauls she is aware of, she said, is that they seem to shift costs rather than reduce them.
"There's not enough that deals with the escalating cost," she said. "At the end of the day, I think the problem is still there."
That is why, Ms. Scozzafava said, she wants to focus on tort reform and improve competition.
"If you can focus on the cost, you can solve the problem," she said.
For people who cannot obtain insurance through employers, Ms. Scozzafava said, she favors a tax credit to help people can buy their own insurance.
Mr. Hoffman said he blames trial lawyers — a popular target among Republicans — for making health care so expensive, because of large damage awards given by juries in malpractice cases. Limits on such damages would bring down costs, he said.
"I believe people should be compensated but there should be reasonable damages," he said.