Harry And Louise -- They're Back!

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THE PLANK FEBRUARY 1, 2008

Harry And Louise -- They're Back!

A quick follow-up on last night's debate over health care reform -- and then a new development.

1. A substantial group of 80 intellectuals have signed a letter arguing that the mandate debate is overblown and that "There is simply no factual basis for the assertion that an individual mandate, by itself, would result in coverage for 15 million more Americans than would robust efforts to make health care more affordable and accessible."  And while not everybody on the list qualifies as a heatlh care scholars -- I'd love to see Harvard Law Professor Laurence Tribe on the Supreme Court, but when did he start studying insurance mandates? -- it includes a lot of people I know and respect, including Henry Aaron from Brookings, Stuart Altman at Brandeis, and Ted Marmor at Yale.  I'm also a fan of the University of Chicago's Harold Pollack, who posted the letter at Huffington Post -- where you can read it

Read what they have to say; take it seriously.  Since I've certialy had my say on this, and then some, I'll give only a very brief response.

Last night, I concluded my item by saying "about the policy question asked during the debate -- whether this mandates make a difference -- the overwhelming consensus among experts is that they do."  This was overstated.  What I should have written was that it's the overwhelming consensus among economists who model these propoals -- i.e., people who have worked closely with the actual available data on this and projected the impact of various policy levers.  (Whether or not you put faith in that judgment, it's worth mentioning that, when it's time to actually pass legislation, everybody will have to go by the estimates of the Congressional Budget Office. And CBO will use a similar model for making its estimates.)

I'll also point out that, as proof of their point, the letter-signers reference a paper by Sherry Glied, a Columbia University economist.  It's the right place to look for answers -- she's very well-respected and has looked at this issue closely.  I know, because I consulted that paper, too.  And then, to go more deeply on this issue, I contacted Glied herself.  I wrote about that in one of my original articles, which you can read here.

(For more on this specific dispute, see another Huffington Post entry -- this one by Clinton campaign advisor Gene Sperling, who is also a senior fellow at the Center for American Progress.)***

The letter also makes a broader point: That the similarities between Clinton and Obama -- and the relative difference between them and the Republicans -- are far more impotant than the mandate dispute.  I agree.   As I've written many times, I think Obama's support for health care reform is genuine and that, overall, his plan is still very good.  And there are aspects of this mandate issue, particularly the political elements of it, that are open to genuine debate.  On the other hand, I continue to think that Clinton (and John Edwards before her) have been bolder, at least on paper, when it comes to health care.

Of course, that doens't mean I like the way Obama and his campaign have sold his plan lately.  Which brings me to this...

2. Like Ezra Klein, my inbox this morning contained all sorts of mail from folks about this new Obama mailer on mandates. 

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And Ezra says pretty much everything I would say about it.  It's one thing for Obama to defend his position, which (I believe) he genuinely prefers to Clinton's.  And in the heat of the campaign, it's hard to avoid saying things that might ultimately come back to hurt your opponent if he or she becomes the nominee.  So I'm happy to cut some slack there, particularly since he's been on the receiving end of all sorts of campaign trash lately.

But a presidential candidate who believes in a reform has to avoid making statements that could undermine that reform down the road.  And that's precisely what Obama has done here.  Even he has admitted, in some instances, that a mandate might be necessary in order to get everybody into a universal health care system.  (And he already has one for kids.)  But this mailer -- with all of its unmistakble echoes of Harry and Louise -- makes that task much harder. 

--Jonathan Cohn

*** This item has been corrected.  Due to an inadvertent cut-and-paste, the item originally identified Gene Sperling as part of the Congressional Budget Office. 

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