THE PLANK DECEMBER 7, 2007
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For those who aren't yet convinced Barack Obama is on the wrong side of the health care debate—like, for example, whoever wrote this piece for the Concord Monitor—my latest take on the issue is now up here. Quick and dirty version: Mandates good, Obama wrong. Of course, you'll have to read the article to see why.
I had meant to link to a few others who've written about this subject lately and, in my rush to finish the piece, forgot. But if you want to read more on the subject, here's a fine rundown by Maggie Mahar, the author of Money-Driven Medicine. And here's Paul Krugman, author of—oh, you know who he is. And here's Ezra Klein. Yea, you know him too.
I also feel compelled to emphasize a point Krugman made today: I don't like Obama's plan as much as either Clinton's or Edwards'. And I really don't like the way he's been talking about the subject lately.
But his plan is still light years better than what the Republican presidential candidates are putting up. And, at least so far, he's stopped short of saying anything that would prevent him from backing an individual mandate should he get elected and should such a measure come to his desk. (Actually, it'd be hard for him to condemn such an option completely, given that he has a mandate for kids.) I'm grateful for that.
--Jonathan Cohn
5 comments
I posted on that thread but heaven knows when and if it ever shows up (I have lost too many postings)
I disagree, mandates bad, Obama right. Mandates, beyond the idea of a Health care police of lord knows what cost, will only force young healthy people to buy the cheapest policies with the highest deductibles, thereby engendering resentment for throwing the money away, and even further every time they have to shell out their own money for minor sicknesses because their deductible doesn't cover it. So you have a Universal Health care system that is not universal (useless, cheap policies to meet a mandate is the worst of both worlds) nor Healthy (people won't take care of minor ailments because of their high deductible)
finally, the idea of mandates will be a gold mine for Republicans, they will it is one: a step towards socialized medicine, and two: a huge gift for the insurance companies. Yes, I know they contradict but when the hell has that ever stopped the republicans?
- blackton
December 7, 2007 at 3:25pm
I have to agree with blackton, we all live under situations where auto insurance is mandated, and in fact some try to dodge the mandate anyway. However, the relative costs of minimum insurance are pretty small. In the healthcare world, we are talking about serious money, even for a young single healthy adult. The possible advantage of mandates over just taxing people is that you might be able to save money comparatively, assuming the government is not as good at spending money as a private company. I think in practice though the insurance companies have NOT shown themselves to be particularly good at reducing costs, just at reducing cash outflows for themselves...witness the number of doctors who are starting to opt out of networks....
Mandates are a gift to the insurance lobby, are we really ready to give them all the money?!?!
- dbhuff
December 7, 2007 at 3:40pm
I agree with blackton and dbhuff. Have we learned nothing from Hillary's 1993 failure? The health care plan has to be politically viable. Obama's plan strikes me as a bit more moderate. Cover the kids. The idea of mandatory insurance for all adults is a bit too extreme even for me. Remember, the Democrat has to be elected for real health care reform to have a chance.
- stgla
December 7, 2007 at 3:52pm
I disagree too.
Mandates irrelevant, Obama wrong, but no more wrong than either Clinton or Edwards.
The last time we discussed this, you called me out for harping on my single payer fantasy, blackton. You argued that private insurers are here to stay. Maybe. But I'm not ready to quit smoking that pipe, and I do believe that all of the major Democratic candidates' failure to take up the cause of single payer coverage--which I'll bet dollars to donuts at least one of them KNOWS to be the optimal solution to the health care problem--reflects deep cowardice.
And ok, I'll admit that the difference between mandates and no mandates is not zero, and yes I understand the value in spreading coverage over the largest and healthiest population possible--which is why for mandates to work, you have to have some sort of anti-cherry picking scheme to prevent those 15 million young, healthy otherwise uninsured folks all from being snatched up by a few lucky insurance providers. BUT lets be realistic, the 15 million covered under a mandate scheme and left unisured by Obama account for 0.5% of the US population. While Obama's suggestion that he'll realize cost savings through disease management is BS, you could cover a 0.5% liability through improving the administrative efficiency of health insurance--not health care--itself, making private coverage more like Medicare. I just don't see that 0.5% as being terribly important economically, and as everyone already admits, most of that 0.5% will be made up of young, health people who don't really need health coverage.
- aeromonas
December 7, 2007 at 4:07pm
aeromonas, I have no argument with what you say, it is good that there are people who are pushing for what they believe to be the optimal solution. I am sure my idea of tax credits and vouchers has a ton of holes in it as well.
I am not sure if it bodes well that a lot of the most loyal readers of TNR and Jonathan's biggest fans are a bit dubious of his proposal.
- blackton
December 7, 2007 at 5:47pm