You seem to be saying that Krugman is wrong because some unspecified part of Obama's plan may fix the flaw Krugman identifies.

Beyond not identifying the fix, so that we don't know if it fixes the gaming problem, there are at least two major problems with this approach. (1) It plays into the Republican's hands, making it harder to pass a good bill, (2) if the fix is to work, it will have to have substantially the same the effects as a mandate, making Obama's attack unfair or dishonest.

Look, Obama's attacks on Clinton were garbage and I would not defend them. But, he has publicly said that he would have a system of late enrollment penalties and also a system of automatic enrollment.

He has not fully specified the details, but Clinton has not specified the details of her enforcement mechanism for her mandates.

I don't consider this a problem. This is a campaign; they should be describing their general approach to policy. They can't pin down every last detail at this stage.

"That works for healthy people, but it would destroy the system because the only people buying insurance would be those with relatively high bills."

Sorry Dean, but I think this is a gross overgeneralization and a misunderstanding of how people view their health insurance.

Normal folks (i.e. not economists) do not see their lives as an exercise in game theory, as your post implies.

There will be outliers of course (so I don't overgeneralize).

Anonymous was me - not trying to hide.

What new and novel theory will be put forth to show that the constitution gives the power to force others to buy health insurance?

Dean wrote:
"Clinton has proposed a mandate as an explicit part of her plan. Senator Obama has attacked Clinton for this mandate (sometimes unfairly)."

The truth is Obama's attacks and political ads on this point are almost alway unfair.

Having read his recent book, I think Krugman has decided Obama, as an African American can't win the general election, and that Hillary can. All the rest is his way of avoiding discussion of this main criticism of the Obama candidacy. I also think Krugman is wrong about Obama's chances and that Krugman should stick to economics.

Robert

Dean, you're looking at this from a purely economic standpoint. I think you're missing the progressive agenda part of what Krugman is saying. Obama's plan gets away from universal coverage, which is where Krugman wants to go.

This is a reaction to Paul Krugman's column which I tried to post on his blog, which unfortunately does not accept comments. Certainly agree with Robert that Krugman shouldn't be handicapping the race the way he seems to be doing.

Mr Krugman,

Of course mandates matter. But they are not the ONLY thing that matters. Obama's and Clinton's plans are not identical save mandates, and his is more aggressive on cost containment and transparency, repealing the MA ban on direct price negotiation and allowing reimportation, which hers does not do.

I'm no fan of the Obama mailer imagery, but unlike Team Clinton's abortion mailers, at least it's truthful. If you believe it's not truthful, you should explain it. Comparing it to the Harry and Louise smear campaign without rebutting its assertions makes it look (to people who are not on your side already) like you've chosen your position and don't feel the need to do any work to bolster it. And you're obfuscating and exacerbating an important problem: the majority of Americans hear the word "mandate" and freak out. It's a liability in the general election and it will continue to be unless people like yourself can get outside this polarizing, self-righteous rut and explain it to people.

The more important point is that mandates will be easy to get through Congress if they truly do not cause hardship, but cost controls will not. You are accusing Obama of selling out the most important elements of any healthcare plan when Clinton has sold out elements that are just as important, in a different way. The difference is that the element Clinton has omitted (transparency and aggressive cost control) would hurt her with business interests, while the part that Obama has omitted would hurt him with voters. In this way Obama's plan manages to be both shrewder and more idealistic than Clinton's.

Given the fact that you repeatedly focus on mandates to the exclusion of all other aspects of the Obama and Clinton plans, I can't help but suspect that you, Dr. Paul Krugman, have decided Hillary Clinton is the better candidate and are lining up your arguments to support that thesis, regardless of the facts. Your columns about Obama's vulnerability to the Republican attack machine certainly support this suspicion. And while I truly understand that after seeing so many swing voters make such a stupid choice twice in a row you might have a cynical view of their ability to resist negativity, but I believe the majority of Americans are not stupid, are not racist, and will resist the politics of division and fear if they're presented with a compelling enough alternative. If you disagree you disagree, but please be straightforward and balanced about the differences between their plans instead of harping on the weakness of his and ignoring the shortcomings of hers.

I have lived in the US and Europe, and am amazed how ideological American liberals can be . In Netherlands, before the new model with mandates for self-insurance was instituted - 99% people had subsidized healthcare or VOLUNTARILY purchased healthcare. Moreover, 95% have opted-in to buy supplemental insurance for dental care etc. This indicates that people are very risk averse when it comes to healthcare (obviously the insurance must have adequate coverage for people to find it a worthwhile hedge)

A study in Belgium on supplemental health insurance (i.e. health top-up plan), found very weak correlation with health status and strong correlation with income. In other words, if people did not buy health insurance, it is because they couldn't afford it.

In fact, the problem in Netherlands is that insurers are trying to game the system and weed out the sick, by having very limited provider networks.

Actual real-world examples (vs. game theory) shows that mandates do not matter, and the real issue lies with insurers gaming the system, rather than ordinary people

>>What new and novel theory will be put forth to show that the constitution gives the power to force others to buy health insurance?

Good Lord, you don't expect Clinton or Obama to care about the constitution do you? Not when it comes to something as trivial as economic rights?

Paul Krugman has a follow-up post on his blog. I'm wondering if his follow-up addresses what Dean has said here.

It's too bad that Krugman has made such a big deal out of this issue, and that the Obama campaign is going negative on it, thereby escalating the problem. The odds are that it won't matter that much when it comes down to real legislation. This will be a matter of horse-trading and politicians have been known to reverse themselves. What approach it is best to take at that time may depend on the tactics of insurance companies and other interested parties. But if a Republican is President, the legislation will surely be less progressive, or there will be none at all.

In the absence of a completely tax-supported plan like SS (which by the way nobody is saying should be made optional), what is absolutely critical is to get the cost of minimal insurance down to where everyone can afford it. Whether some people opt out is secondary at best.

Baker: I don't consider this a problem. This is a campaign; they should be describing their general approach to policy. They can't pin down every last detail at this stage.

Moreover, and hopefully, neither Clinton nor Obama is likely to repeat the 1993 mistake of developing the details behind closed doors. Nor is Congress likely to leave any proposal unedited.

Krugman resigned himself some time back to the fact that no candidate but Kucinich was proposing a single-payer plan. IIRC, his argument went along the lines that the plans on the table were a step forward, and that their flaws would become apparent in execution, leading inevitably to single-payer.

In that context, the Clinton-Obama differences are pretty trivial.

The dishonest sniping, in both directions, on this and other subjects, is sad.

I am insured though my small business, and had the recent misfortune of having to be admitted to the hospital (1st time ever). A 3-day stay, which I later found was needlessly preventative, was billed at $ 20,000 (my negotiated rate was about $ 6,000 through my insurance/HSA deductable I paid $ 5,000). 50% of the bill was for 2 very expensive antibiotics (3 days at about $ 8,000), that I later found out should not have been given together (only served to pad the bill). I was only hospitalized, I later found out, to administer one of those uneeded antibiotics, so the hospital stay was uneeded. The insurance company made a profit off me for the year and the last 15 prior years, the hospital filled a bed, and the drug companies profited heavily. I am a financial loser, the doctor made very little, and we are all pretending the system is not stacked in favor of the drug companies and corporate hospitals. Can someone explain why in a "first class" system it takes over a month sometimes to schedule an appointment with a specialist. We are already rationed in a quasi-free market system. We are not patients, we are profit centers -- and hospital/drug companies make more money giving critical care, than offering preventative services. Can anyone tell me why universal coverage in the country is better than some form of subsidized coverage state-by-state (focusing on preventative care)? Any states in the country that have a successful system? Can we advance the discussion beyond blind idealogy? Did I mention they tried to bill me for turning on the tv!!!

Dean,
I think the press should ask whether the campaign contributions the candidates are getting from the health insurance companies are influencing their "mandates" for health care change. By my count, health insurance companies are giving overwhelmingly to Democrats this election cycle.

I don't support either the Clinton or Obama plans; either way the insurance companies scim 30% off the top... I was a fan of Edwards' ingenious model of allowing choice between a single-payer vs. multi-payer plan, in which scenario he assumed eventually everyone would migrate to the most efficient one, i.e. the former. It employed both good economic sense and played to the American psychology of choice. (By the way, if only employed people get insurance in Obama's plan, what about the unemployed?) I plan to stay uncommitted at our upcoming caucus to leverage the candidates toward Edwards' ideas.
Dianne Foster, RN, ARNP
Democratic PCO

Hello, Dean...

I’m trying to think my way through this. Here goes.

There is a tacit social contract under which the sick or injured receive a degree of care even if they can’t pay. This tacit arrangement is the reason desperate uninsured persons can get emergency help. Legally, I believe that those receiving such care are indebted to the provider even though they may be indigent.

Thus we already have a de facto mandate under which every one who can pay is required to, through a hidden mechanism: The public/private health system transfers costs to taxpayers and insured persons.

One way to eliminate this hidden mandate would be to deny care in all cases to those unable to pay, but denial of care already occurs to the margins of public acceptance. A rational dispute about mandates would be about how to rearrange them, not whether to have them.

Public policy changes are complicated by the fact that the “private” health care system is really a part of the government insofar as it can steer public decisions through our sophisticated system of legalized bribery.

When insurance is mandated, the tacit social contract is in effect codified and private insurers become quasi-governmental entities, doing paperwork and collecting premiums that are actually taxes.

Some solution along the lines of “Medicare for all” automatically suggests itself but the insurance establishment would then have little function and would oppose it. Also, many who are employed by the insurance industry are decent people working hard and faithfully under the present system. Their lives would be disrupted by any sudden change under which insurers could no longer collect premiums or quasi-taxes.

So the answer is probably a gradual evolution into an overt tax-paid social insurance system, or at least one in which insurers have been subsumed by government in a cost-effective way. I am under the impression that both the Clinton and Obama plans have a way for this change to get started voluntarily.

I’m finding it unrewarding to balance Baker against Krugman, Clinton against Obama, on this cloudy mandate question. I’m pretty sure, though, that universal health care will not be achieved and health costs will not be contained under a Republican president or even under a Democratic one taking power after a close general election. I hate to say it but I think a landslide is essential.

First off Dean, full disclosure needed. Are you advising any political campaigns or your partner in economic wizardry, Jared Bernstein?

Now for the problem with what you've just outlined. Even healthy people who think nothing will ever happen to them wind up falling off skateboards, destroying some body part in all sorts of sports activities, throwing out their back cleaning the garage, getting shot, knifed or otherwise mugged, hit by a bus, burned using gasoline to do something while working on a car.....the list goes on and on. I didn't even mention riding a motorcycle without a helmet and many of the seriously expensive conditions that result in young men requiring tons of care and having no health insurance. They there are the young women who have no health insurance and find themselves pregnant. For that reason alone, I think all young healthy me should have to pay into the system even if they never need it for themselves. If there were no young healthy men, fewer uninsured women would find themselves pregnant. Fewer kids of those same women who are probably single mothers, would end up uninsured.

It seems to me that Obama's argument is that some people just cannot afford health care, no matter how subsidized it is, so we cannot force them to buy it. How will those people pay penalties when they cannot afford not to have it (i.e. they have an accident or chronic condition requiring insurance?)

Penalties would necessarily need to be high enough to encourage healthy young people to responsibly get insurance. But that would mean that they would be too high for the very people Obama thinks cannot afford insurance under Hillary's plan.

I'm supporting Obama, but Krugman is right on this issue.

Dean

I actually wish you and Krugman would have this debate in private. And I wish Hillary and Obama would stop and think.

They are destroying the Democrats chances by making health care look like a new way to tax the people and deprive them of choices about their lives.

This is not to say we don't need universal health care. And it is not to say that the people don't need to pay for it. But there is such a think as political reality.

I offer a suggestion that I think gets around at least some of this... though there may be other ideas at least as good:

require employers to make a one time cost of living raise... about a dollar and a half an hour, or 3000 per year. This money goes to the employee and in his name is immediately subject to a payroll tax dedicated to health insurance. Employers already paying for health care can simply redirect the money. Employees not currently paying health care would have to stop being free riders (paying a below subsistence wage) but they would, as they keep telling us, pass the costs on to their customers, or restructure their payrolls and suffer no harm.

The government would assign people without regard to prior condition to blocks of insurees and then aution the contracts for detailed management of these blocks to insurance companies, and would oversee the performance of those contracts in a manner analogous to the way highway contracts are monitored by the state.

I think this should solve both the political problem and the actuarial one...but it might take some serious discussion to settle that.

Meanwhile, I don't think the current discussion is serious, or very imaginative.

couple ot typos above that could confuse

employers not employees free riding.

auction not aution

Perhaps we could shift the talk from insurance company control of health care to the benefits of a single payer plan. For openers there is the fact that insurances companies are doing clerical work, collecting, accruing and disbursing fees. Insurance companies charge thirty cents of the health care dollar for this clerical work. Medicare does essentially the same work for less than five cents of the health care dollar.

save_the_rustbelt wrote, "That works for healthy people, but it would destroy the system because the only people buying insurance would be those with relatively high bills." Sorry Dean, but I think this is a gross overgeneralization and a misunderstanding of how people view their health insurance.

No, unfortunately, Dean's portrayal is accurate; it's a standard problem in insurance.

tomboy wrote, How will those people pay penalties when they cannot afford not to have it (i.e. they have an accident or chronic condition requiring insurance?)

Penalties would necessarily need to be high enough to encourage healthy young people to responsibly get insurance. But that would mean that they would be too high for the very people Obama thinks cannot afford insurance under Hillary's plan.

I agree---there are all sorts of problems with this penalty system.

nick wrote,

We are not patients, we are profit centers -- and hospital/drug companies make more money giving critical care, than offering preventative services.

True. Looking at the insurance side of things alone doesn't address that very important issue.

Can anyone tell me why universal coverage in the country is better than some form of subsidized coverage state-by-state (focusing on preventative care)?

Universal coverage is the best system in terms of the insurance side of things, because risk is pooled as broadly as possible, and administrative costs are far smaller.

But, again, you have to separate the insurance side of things from the actual delivery of care. Of course, you can try to get providers to e.g. emphasize preventative care via incentives provided through the insurer(s). But in principle they're separate issues.

Any states in the country that have a successful system?

Not really. But there is an extremely successful system; it's called "the VA".

What new and novel theory will be put forth to show that the constitution gives the power to force others to buy health insurance?

There's this newfangled thing called the Interstate Commerce Clause.

Why should everyone have to pay the same amount for health insurance? If someone wants to pay out of pocket, how does that hurt things? There is no proof of it. I'm 31 with Type 1 diabetes, why should a healthy 31-year old have to pay for my illness? That's what is not fair! Me having to pay more is the only fair way. I've got an idea! Let's make all cars cost the same, that way I can buy a Mercedes for a Kia price. Cause its not fair I can't pay for a Mercedes.

Many of the comments thus far seem to presume that some sort of solution will come through employers purchasing insurance from private insurers. If this is the solution, then there is, what I feel, a large unspoken cost: the disincentive for creative, entrepreneurially minded folks to begin new ventures. Using the prevalence of diagnosis of Type II diabetes and the fact that many insurers will either not cover individuals so diagnosed, or will charge prohibitively high fees for individual coverage, many of these individuals will opt for the certainty provided by the corporation. This is a loss to the economy in so many ways, not the least of which is that the creative ideas of these people are less likely to be acted on by the larger corporation, and, indeed, if the individual does not feel he/she will be rewarded properly for their ideas, will not pursue them in that setting. It seems only universal insurance that can be taken with you no matter how your employment situation changes can only be well met by mandated coverage, and probably only by a single (government) payer. This coverage can even be fairly minimal, thus allowing a place for private insurers that reduce the cost of deductibles and co-pays, shorten the time to care, provide more luxurious care, could still have a place.

Can we stop calling the reaction of healthy young people to a plan like this "gaming the system"? The fact, as any economist will tell you, is that it would be utterly irrational for a young, healthy person -- especially one with a marginal income, not at all uncommon among even the educated professional class in their twenties -- to pay for healthcare insurance without a mandate. It would be an act of altruism on their part. This is why Obama's plan is intellectually disingenuous. It won't happen; and if it doesn't happen, the economic foundation of his plan falls apart. This is true *even with* late penalties, because the total outlay of such people would still be substantially less than it would have been had they purchased insurance from the beginning -- again, it's to their economic advantage to wait. Without a mandate, this plan is nothing more than a government subsidy to people who are currently unable to afford healthcare -- and an expensive subsidy at that. And that's exactly what the republicans will call it in the general.

Oh, and the mere fact that Obama is suddenly talking about penalties -- when he wasn't before -- should clue people in to the fact that the plan is not viable, and even he knows it.

Mark my words: if he is the nominee, and this is the plan he goes into the general election with, we will get no meaningful healthcare reform at all. He's not a magician.

magine a future in which families were mandated to buy a health plan -- some purchase the one with the $10,000 deductible (the cheapest legal option?) -- okay; they have obeyed the law -- but now those families end up in the emergency room MORE OFTEN, instead going to their family doctor's office, because they were forced to use up their family doctor money buying what Obama correctly calls "home insurance."

Subsidies tend to be set at a multiple of what -- in reality -- should be a doubled fed poverty line: $20,000 a year for a family of four (the official line based on three times the price of an emergency diet). $40,000/yr is more like the -- real -- barely above poverty line for a family of four, while $55,000/yr is roughly median family income these days. Most families are not far from poverty -- though their numbers might sound just fine -- as med insurance climbs and climbs. Forcing rising premiums down the throats of families with shrinking real world incomes is flirting with disaster in many cases -- and would impose disaster outright upon many hanging by a thread families.

Unmentioned by progressive policy wonks is that ever population elephant in the room: Medicare for All -- which for some reason which nobody can every explain to me, a 4 decade political junkie, is supposed to "politically impossible" -- opposition from special interests with a few thousand votes somehow out guns the preference of hundreds of millions. ???

If you get off hypotheticals for a minute:
a) Health insurance is different from other types of insurance - it is NOT the same as a car insurance - every case study shows that people are more risk averse with healthcare than their car, house etc.
b) Young people will buy insurance if it is affordable AND provides good, comprehensive coverage - afterall, young peple realize that they may have an accident or sudden illness (the fact that young people are also risk averse when it comes to healthcare is borne out by data from European countries)
c) People opt-out of insurance if they feel they are not getting adequate value for their money - e.g. if your insurance has a $5,000 deductible and a high co-pay for acute care, why bother? If you cannot afford the co-pays, why get the insurance at all?

This is not rocket science, and there is plenty of data available so that people do not have to indulge in hypotheticals...

The other reason people currently get insurance is because the penalty implicit in not getting coverage due to lack of insurance is much higher than what would exist under Obama plan. E.g. - if you do not have insurance currently -- better not have a house to lose before you get that transplant.
Under the Obama plan - hell, even if I pay double premiums for the last twenty years of my life, I'd still think I can take a chance until 40.

I liked Obama. He is shooting himself in the foot on this one.

Obama's plan gets away from universal coverage, which is where Krugman wants to go.

I have to disagree here. The mandates require that you buy insurance, not that you have insurance. The difference is subtle, but just as millions of people don't have auto insurance (despite laws mandating it), millions of Americans may also fail to buy health insurance.

The simplest way to make coverage universal would be to make coverage universal: tax everyone on the front end and create a single payer system.

Hillary's plan is no more universal than Obama's.

El Viajero - What new and novel theory was put forth to show that the Constitution confers the power (on whom?) to force others to buy into the Social Security System?

What new and novel theory was put forth to show that the Constitution confers the power (on whom?) to force others to buy into the Social Security System?

That's a good point. But not really pertinent to the difference between Clinton's plan and Obama's. I've never in my working life opted into the Social Security System. The taxes get taken out automatically. The mandate isn't mine to meet. It's my employer's.

It's actually the easiest and least painful way of running the system. So why aren't Krugman and Clinton calling for a similar mechanism to create universal health care?

Jinchi,
"What new and novel theory was put forth to show that the Constitution confers the power (on whom?) to force others to buy into the Social Security System?"

It may be that Medicare for All is the only constitutionally valid health plan -- if you have to compare health mandates with Social Security for justification -- the gov collecting and the gov paying out is valid (I know why the gov can collect constitutionally -- wonder why it can constitutionally pay S.S. back out -- better not let the Bush Court hear this discussion or they might make a late attack on S.S.).

Wonder if the Bush Court would lean towards invalidating mandates because they are liberal -- or lean towards validating them to fend off Medicare for All because the latter is not private business? Funny feeling: this may be what the Court would decide by.

One thing that I never hear anyone from either side talk about is decoupling health insurance from employment. Not only is the rising cost of health coverage crippling employers, it makes no sense to have your health care handled through work. And in a world where we move from job to job many times through our lives with our same bodies and health issues that are handled differently by whatever increasingly byzantine plan our employer has chosen to sign up with. I have stayed in a terrible job because it had health benefits. Why should your career decisions be linked to your health care concerns. It's ridiculous.

Not to mention contingency workers. I work in publishing, where there are many, many freelancers and "permanlancers" who can't simply sign up through their employers. How can candidates continue to ignore such growing groups of workers.

There's a wonderfully true allegory in yesterday's "Dinette Set":
http://www.arcamax.com/newspics/4/468/46834.gif

If Mr. Obama has a penalty for those who "game' the system, then THAT IS a mandate. So, it seems he is stretching the truth just a wee bit...

All it takes is one slip on ice, one car accident, one infection or one diagnosis of something you didn't know you had, for the "young healthy person" to stop *being* a "young healthy person" and turn into someone with a chronic health condition.

The problem is that most young people - as well as those of us who aren't quite so young any more - is that they're also young *poor* people, which means they CAN'T afford to buy insurance, no matter how much it terrifies us.

It's not a choice between insurance and luxuries, for most of us (the most of us not being in the top 15% brackets) but between insurance and food, or insurance and *rent* - and somehow being homeless feels pretty darn unhealthy to us uninsured (as I was until very very recently, being unemployed, and have been for a large portion of the past few years, even when working 2 part-time jobs and more than 40hrs per week) but hey, what do we know? We're just "gaming the system" - or rather, dicing with the Reaper, as we damn well know.

You know, I thought "liberal elitism" was a myth created by my former conservative confreres, but I've come, since venturing into the blogosphere, to realize that it's no chimera, but all too real a monstrosity...

The Obama plan, like the Clinton plan, calls for substantial subsidies for low and moderate income people. It will also create a public plan that should keep costs down by eliminating administrative expenses. Therefore, there should not be people who really "can't" afford to buy insurance.

Reposted from Ezra Klein's (and Angry Bear's). Help anybody? Dean?
**************
Medicare is cheaper than private insurance per enrollee?! That is remarkable as Medicare takes care of people when they need care the most: over 65 years old. That is quite a record.

Question we amateurs are batting around over on Angry Bear -- now complicated by the above remarkable stat:
GDP $14 trillion; all medical spending 15% of GDP = $2 trillion.
140 million workers.
$2 trillion divided by 140 million = $15,000 per worker paid toward all medical spending -- on the average.

We thought Medicare and Medicade taking up the old and the disabled might explain why family insurance is "only" $10,000 per family (while costing $15,000 per worker). But, now we see Medicare pays out less per enrollee than private coverage.

Who the hell is paying in the $15,000 per worker? ??? (I keep looking for a disappearing digit, but I can't come up with one.)

From the real world to the Ivory Tower: Hello!

I've voted liberal Democratic all my life and at 40K a year I can barely pay my taxes and to have Hillary force me to pay another 5 to 10 thousand to a corrupt health insurance system. As one of the "uninsured", I'll be staying home or voting for McCain like millions of other uninsured. Never voted Republican in my life..but this mandate could force me.

Answered!:

The Medicare v. private insurance comparison was about procedure v. procedure, not overall costs.

Brad R wrote, The fact, as any economist will tell you, is that it would be utterly irrational for a young, healthy person -- especially one with a marginal income, not at all uncommon among even the educated professional class in their twenties -- to pay for healthcare insurance without a mandate.

Depends on what you mean by "insurance".

If the insuree can get a cheaper price because (s)he is younger, and can have a really high deductible, then it would be ill-advised for them to avoid health care insurance.

OTOH, if the package is such that they're implicitly cross-subsizing a lot of other people, then you have a valid point.

Kathryn wrote, Not only is the rising cost of health coverage crippling employers, it makes no sense to have your health care handled through work.

Absolutely right.

The only thing going for employer-sponsored health care is that it's a convenient way to pool risk over a group of people who are likely to be relatively healthy.

drew

answered not the original question:

where is the 15k currently coming from?

vorontsov

the novel constitutional theory that forces you into the social security system is the government's power to tax.

what confuses you is that with the SS tax you get your money back. so you must be wondering what novel constitutional theory allows the goverment to give you your money back.

Today on CNN's American Morning Obama likened Clinton’s health care mandate proposal to eliminating homelessness by requiring everyone buy a house. If this isn't demagoguery, what is? I'm waiting with bated breath for Dean Baker's impassioned rebutal of this nonsense.

Thanks Obama, who needs the insurance industry to attack health care reform when the country has you to do their dirty work for them.

Aside, but related -- one of the people I love to hate (because it's just too damn easy to take him apart), David Brooks is at it again. In today's NYT:

"But there are serious health care economists on both sides of the [coercion] issue."

I'm sure he's right. But what does this prove? Not a thing -- my guess is that most of the economists against coercion are also for "free trade", protection for white collar workers, and have healthy off-shore accounts which "protect" their assets from taxation.

But it's all okay -- Brooks is a self-proclaimed "not a Hillary hater."

Signed,
No fan of Hillary

I've got an idea:
If for some unknown (craven, political) reason we absolutely, must base universal coverage on private insurance: wouldn't VOUCHERS (remember those) be a lot more practical than mandates? Less likely to cause mandate-suicide?

More on VOUCHERS instead of mandates:

If you don't get a voucher even though you really deserve one because of your peculiar circumstances (at X income level) at least we don't force you pay for something you cannot afford (avoiding mandate suicides); instead you just land back in the old ER -- a distinctly less uncomfortable bad outcome.

Mebbe I missed something here, so help me out.

Isn't the point of insurance to spread the risk as widely as possible, to make the pool of insureds as large as [possible, thereby lowering the percapita cost to any individual?

Isn't it also true--as with public education--that one way or another you're going to have a stake in it, either as a someone ill now, or someone who will be ill later?

So what is the sense in arguing that younger, healthier people have some kind of a right to opt out until such time as they find themselves needing the protection?

We are all in this together, folks. In sickness and in health, as long as we all shall live.

Woody--

The purpose of insurance is to prevent a catastrophic loss by paying a guaranteed fee up front. It is NOT to spread risk and you could think of it as a kind of stock (put) option.

Spreading risk is performed by the insurance contract writer to turn a profit (and prevent their own catastrophic loss as they have an unlimited downside).

It is the writer who has entered into a contract whereby he/she/they are OBLIGATED to pay a certain amount to the insured if the insured satisfies certain requirements (dies, becomes ill etc).

By forcing the young and healthy to "contribute" to a universal pool, one has created not an insurance contract, but a coercive transfer of money and property from the young and healthy to the old and sick. In effect, the government is stealing from the young for the benefit of the old. And unlike Social Security, there are no defined benefits - just an unlimited cost potential.

Just as it is unethical and blatantly dishonest to state as fact that the employers are obligated to provide health care (or insurance) to their workers, it is just as unjust to require one group of people to work for the benefits of another group. And that is what will happen if it is mandated that everyone have health insurance as in Romney-land.

We used to call that SLAVERY (working for the benefit another against your will) and outlawed it over a century ago. If it wasn't such an expensive lesson to learn, it would probably be a 2 minute monolog on Letterman.

Tim, get off it - paying to have a good system is not "SLAVERY".

You're pretending that healthy young people will never get old and never get sick. That sounds just great if you're 17. By the time you're 25, you should be over all that.

You're probably going to get old and you're probably going to get sick. It may be harder to believe when you're young, but that doesn't make it any less true. All we're asking is that you contribute to the system while you can so that we can all - including you - benefit from it when you really need it.

Because if you don't contribute to it while you can, that means I have to pay for you anyway when you do need it.

And please don't whine about how it's okay with you if we let you die. Your dead body on my street is still a price I have to pay.

I like paying taxes to prevent beggers from sleeping in my streets, sick people from spreading their diseases and dying in pathetic circumstances, children from being illiterate and having to beg and steal to live. I like having healthy, prosperous neighbors who work together with me to have a nice world to live in.

If you don't want to pay your dues to live in a good society, go live on a mountaintop somewhere and get out of the way.

Tim,
Just as S.S. retirement benefits constitute a REVERSE Ponzi scheme because the doubling of per person income every two generations means your grandkids can soak their grandkids for even more than you are soaking them for (the sucker generation will be the one that is destroyed by the alien invasion)...

...the medical version of REVERSE Ponzi is even more spectacular because scientific knowledge doubles every 10 years (!) and presumably medical knowledge keeps something like the same pace (the suckers may be the generation in which all diseases are eliminated).

Dean, you're looking at this from a purely economic standpoint. I think you're missing the progressive agenda part of what Krugman is saying. Obama's plan gets away from universal coverage, which is where Krugman wants to go.