THE PLANK FEBRUARY 27, 2008
figures that one of the few times I can't watch the Democratic
presidential debate live, Hillary Clinton and Barack Obama would
spend the first sixteen minutes talking about their competing visions
for universal health care. But judging from the transcript and clips
on CNN, it doesn't look like the discussion covered much new
territory. Clinton argued why a individual mandate is important,
Obama argued why it wasn't, and so on.
most of you know, I think Clinton is absolutely right on the merits
of the argument. (See here and here.) And I was pleased to see her
use the Social Security analogy, which is not just politically
effective but also accurate. Still, I want to defend Obama and his
campaign on one key point.
the get-go, Obama and his advisers have felt they were the original
victims of unfair advertising in this argument. In their telling, it
was Clinton (and, to an extent, John Edwards) who kept harping on the
mandate issue, suggesting Obama's plan would leave out 15 million
people. And putting aside the dispute over whether that the 15
million argument is substantively correct, Obama and his advisers
felt the attacks made a second, darker implication: that Obama's
failure to include a mandate meant that he simply didn't believe in
universal health care.
himself alluded to this tonight: “I have endured over the course of
this campaign repeatedly negative mailing from Senator Clinton in
Iowa, in Nevada and other places suggesting that I want to leave
15 million people out.” (Emphasis mine.)
that quote, Obama was presumably talking about mailers like this one
(via abcnews.com) that went out in Wisconsin. That mailer featured
photos of seven people with the headline, "Barack Obama, Which
of These People Don't Deserve Health Care?." On the next page,
it says, "Barack Obama's Health Care Plan Leaves 15 Million
Americans Without Coverage. Will It Be You?"
don't think the mailer is wrong substantively. If 15 million people
end up without health insurance, then one in seven people won't have
it. It's also possible that without a mandate, the reforms may not
work as planned – in which case a lot of people really wouldn't be
able to get health insurance, even if they wanted to do so. (For
example, if insurers feel they have to protect against adverse
selection – that is, healthy people gaming the system – they'll
keep their rates higher. Those rates might be high enough so that
some people really couldn't afford coverage.)
the other hand, I can see how Obama or somebody working for him might
think the mailer does paint Obama as an opponent of universal health
care in principle – which, very clearly, he is not. You can argue that his plan
wouldn't be as effective as Clinton's. You could also argue that
universal health care hasn't been as central to his campaign as it
has to Clinton's, raising questions of just how hard he would push
for it if he became president. But you can't honestly suggest that
Obama wants people to be uninsured.
after all, devoted considerable energy in the Illinois state
legislature to expanding government health insurance programs and
putting the state on a path to achieving universal coverage for its
own residents. As a presidential candidate, he has put forward a
plan that, whatever its flaws, would still expand coverage quite
significantly – at no small cost in resources. And he has
certainly embraced the principle of universal coverage at every
the grand scheme of things, this doesn't justify the mailers his
campaign have put out – which are not only more misleading but also
damaging to the cause of universal coverage itself. But at least I
can understand why they might have felt such tactics were necessary.
And, in a perverse sort of way, there's something comforting about the fact that Obama can play hardball
when he needs to do so.
Which leads me to my final thought on this: I agree with my friend Jacob Hacker that the mandate debate has begun to crowd out other, equally important issues in the health care reform debate. If next week's contests in Ohio and Texas effectively end the Democratic nomination fight, as seems increasingly likely, then the real debate will change into a much broader -- and more important -- issue: Whether or not universal health care is a good idea in principle. Obama thinks it is. John McCain thinks it isn't.
Whatever the flaws in Obama's plan, I look forward to him making that case.