Since Joe is still waiting to be convinced by Obama — and Paul Krugman continues in his quixotic project to convince us all that Barack is actually Bob Dole, once again due the lack of mandates for universal coverage in his health plan — I thought I’d share a recent exchange between one Anna Levine and me on an Obama mailer that slams Hillary’s emphasis on mandating that each American be insured.
If you missed this mini-controversy, the concern is that Obama is using imagery and anti-government rhetoric uncomfortably similar to the infamous Harry and Louise ads that helped destroy Hillary’s first health care reform plan. Ezra Klein summarizes it well here. So I wrote to ask Obama-supporter Ms. Levine what gives. Here’s her qualified defense:
Obama’s health care proposal cannot be called ‘universal"’because it
does not mandate that people obtain insurance, and that anyone who
elects not to obtain insurance, whether or not it was available to them
and regardless of the reason for their decision, cannot be said to be
covered by the health care proposal. They argue that whether the
mandated coverage is affordable is an issue that will have to be
decided secondarily. Obama’s campaign disputes that definition of
universal, asserting that "universal" means "available to everyone who
wants it" and that if insurance is affordable, people will buy it. They
argue that affordability has to be decided before mandates.
mandates. I’m not sure how I come out on the debate. It would help if
Clinton, or Krugman, or anyone else would explain how mandates would
work and why affordability isn’t an issue, or even just isn’t a
sufficient concern, balanced against the problem posed by the people
who do not choose to purchase insurance under the Obama plan. Anyone
who’s going to sell mandates to the general electorate is going to have
to answer that question, or at least come up with a better
counter-argument than, "How dare you– that’s just like the Harry and
Louise ad!" To me, the brouhaha over this mailer highlights the fact
that they haven’t.
mechanism would be through referral by the IRS, which has the benefit
of clarity. On the other hand, I have some mixed feelings about
entrusting the IRS with such a job, given the way that punishing poor
working people has become the agency’s dominant auditing concern in the
EITC era; it would make much more sense to me if everyone were enrolled
and had their wages garnished, as for Medicare, since at least then the
IRS would have no discretion and no prerogative to weed out and punish
"misbehavior." Hillary hasn’t offered even Edwards’s explanation.
obtained, the Obama mailer is terrible. If universal means universally
available, and mandates are a trivial distinction in two otherwise
extremely similar plans, this mailer is not so terrible. I don’t
believe it sinks any effort at health care reform or is particularly
right wing. I do think the mailer will make enforcing mandates, if they
turn out to be necessary, more difficult, and is therefore a bad idea,
on balance: it’s short-sighted to preclude a policy option that Obama
campaign has hinted may be necessary down the line. But given the vast
expansion of government subsidized health care that Obama proposes,
which no right-winger will love, calling Obama a right-wing panderer
seems equally ill-advised."
So what do folks think? Krugman makes the case about why healthy people will elect not to buy coverage even if it were affordable, unless there are mandates. And as distasteful and intellectually dishonest as some of Krugman’s attacks on Obama have been, I do share his concern on the mandate issue. This seems like a genuinely important policy issue, in which everyone in the country has a vested interest.
Accidental Blogger 
One response to “The Obama-Mandate Kerfuffle (Andrew)”
I don’t know how effective a single payer system would be for a good quality affordable health care system – mandatory, universal coverage and affordable. Has there been a study? Can Medicare and the VA serve as a model? No political candidate will touch that volatile issue. I think taking out the “for profit” insurance companies out of the equation would be one of the best ways to cure the ills of our current system. Private doctors and hospitals could still operate but they will have to get paid fully by the patients who seek them out for “boutique” care.
As for the approaches of Obama and Clinton, I agree with Anna that they are very similar in what they promise. Obama is shying away from the word “mandate” to keep the Republicans at bay. By the way, Clinton did admit last week that she will consider garnishing wages to fulfill the universal mandate.
Here is one little known secret I wish to share here. I have known small business owners who are well able to afford health insurance but do not buy it because they choose to pay out of pocket for regular doctor’s visits and count on the emergency room for more serious conditions. It is not just the poor and the “illegal” immigrants who are gaming the system. In view of that Hillary’s plan does sound better. But any Deomocrat will be a vast improvement over any Republican.
Not many of us remember that Clinton began her presidential campaign with a promise for universal health care in her “second” term. The calculation was that she didn’t want to remind voters of her failure to achieve health care reform during her First Lady days. (She was spooked by the prospect of a replay of the dreaded “Harry and Louise at the kitchen table” ads. It is funny that they have appeared any way, this time at the behest of a Democrat!) Clinton was pushed into taking her current stance by the challenge that Edwards posed.
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