THE TREATMENT DECEMBER 16, 2009
Liberals frustrated with the decision to drop a public option are now attacking a core principle of health care reform: the individual mandate. Greg Sargent and Ben Smith quote Jim Dean, brother of Howard, in an e-mail that just went out to Democracy for America:
Senate leaders are all over Washington claiming they finally have a healthcare reform bill they can pass, as long as they remove the public option. After all, they say that even without a public option, the bill still "covers" 30 million more Americans.
What they are actually talking about is something called the "individual mandate." That's a section of the law that requires every single American buy health insurance or break the law and face penalties and fines. So, the bill doesn't actually "cover" 30 million more Americans--instead it makes them criminals if they don't buy insurance from the same companies that got us into this mess.
Well, ok, I suppose that's true in a technical sense. But the people making (and listening) to this argument should know that it's equally true of several universal coverage systems abroad.
The Netherlands and Switzerland require their residents to purchase health insurance from private carriers. Residents who do not are subject to fines. Yet most knowledgeable followers of health care policy have only good things to say about the Dutch system and mostly (though not always) good things to say about the Swiss counterpart.
The Dutch system, in particular, is widely considered among the world's best and achieves most of the goals liberals in this country want: The insurance is universal and comprehensive, access to care is convenient and easy, the quality of medicine is high.
Now, the reforms moving through Congress won't produce a system as comprehensive as what the Netherlands or Switzerland has. But that's not because of the individual mandate, which actually makes a lot of sense. (Read here if you want chapter and verse on that.) That's because the subsidies and regulation in these bills aren't as generous and strong as they could be.
The public plan would have helped make up for these deficiencies. That's why it's loss is truly regrettable--and why its supporters should be angry. But the best response wouldn't be to demand the politically impossible--that is, to insist upon a restoration of the public plan that simply doesn't have the votes it needs to pass. It would be to demand some other things, like better subsidies and regulation, that do have political potential and could actually make the final bill better.
I'm all for a loud, angry left. If nothing else, we need it to balance out the loud, angry right. But there's a fine line between being constructive and destructive. This latest gambit, I think, crosses it.
Follow Jonathan Cohn on Twitter @jcohntnr
Another update: Jon Walker at Firedoglake takes issue with my post, arguing that the Senate reform would produce a system nowhere near as comprehensive as what the Dutch have.
To be clear, I agree there's a difference here. In fact, I think I said that, both in the item above and in my original article on the Dutch system, to which I linked. (Here it is again.) Where Walker and I and disagree is over the size of the gap--and the quality of the insurance the Senate bill would yield.
He seems to think the Senate bill would take us only one or two tiny steps towards something resembling the Dutch system. I think it would take us one or two really large steps--and that, once we've taken them, we'll have created a system that, whatever its flaws, is light years better than what we have now.
I'll have more to say on that shortly.