Maybe if the proponents of mandates did a little better job of assuaging the fears of the unemployed, the working poor and the just-barely-hanging-on-by-their-fingernails-middle-class beyond the tired and wholly ineffectual refrain of "tax credits", none of it would be necessary. But you-- and they--have not.

Brautigan, they don't actually seem to care that people in those situations have fears and concerns. People like Ezra look at people like that as children. Clearly, if they could make their own decisions they wouldn't be in a bad situation in the first place. Wonks always think they have the right to make other people's decisions for them because they know better. Their hearts are in the right place at least, I think anyway.

People like Ezra spend so much time making sure that their plans are acceptable to a narrow elite that they forget that they have to make sure that their plans are acceptable to the American people.

Ok Ezra, you might be right on the politics, but any criticism of Obama on mandates is incomplete (more like null and void) without some accounting for why a late signup penalty isn't:

a) the same thing, in effect, as a mandate

b) more workable in reality as a mandate

and
c) politically more sellable than a mandate

So in short, if a late signup penalty has all the benefits of a mandate and also deftly sidesteps a major point of contention that Republicans could use to run entire campaigns on, isn't the Obama "mandate" better in every way?

a) nothing assauge fears of cost like someone else paying for it. hence, subsidies.

b) if you want to know fear, go to an an emergency room in pain, but not sure it it will constitute an 'emergency.'

Even with subsidies, are they really going to make a difference. Are they going to be in tandem with cost of living? And moreover how are people going to obtain subsidies? Through their filing income taxes or pay check stubs and the like? I ask these questions because the word "subsidies" is bandied about but one never talks about how are they going to be implemented. And whether or not getting a subsidy is quite burdensome for the person that he or she decides to forgo getting one.

Akaison, please. Subsidies? Are you kidding me? If the government wants to pick up the check, they should just pick up the check. But it's a joke to say that offering a tex credit, or offering to bay 20-60% of the bill is going to do much. All it does is make the plan less onerous on some of people who can't afford the burden. It still leaves a big chunk of people afraid.

It's hard not to believe that's the point. Peel off as many people as far up the economic ladder as you can and fuck the people who are the worst off. It's the Democratic parties version of social justice.

party's rather.

Ezra,

Could you give a quick assesment some time of what the plan might look like (to the average person) in california and what its political chances are at the moment? For a moderate income uninsured Californian I have been paying far too little attention.

Thanks,
greg

Expand Medicaid and SCHIP: Medicaid and the State Children's Health Insurance Program (SCHIP) play essential roles in helping low-income Americans getting the health care they need. Edwards will strengthen the federal partnership with states supporting these programs, committing the necessary federal resources to allow states to expand Medicaid and SCHIP to serve all adults under the poverty line and all children and parents under 250 percent of the poverty line (about $50,000 for a family of four).

Ezra, why do you keep talking about mandates as if it is a liberal idea? The one group that LOVES mandates is the health insurance industry. Very few products have laws requiring you to purchase them; what a windfall when a corporation can get one passed!

The only reason mandates are useful is the prevent people from gaming the system. There other other, less draconian techniques available.

What system- including single payer- doesn't require mandates?

The anti-spam images sucks. The images report errors all the time. It fails to display g's and q's differently.

What system- including single payer- doesn't require mandates?

There's quite a difference between single-payer that provides services with little or no out-of-pocket expense, and a mandate that requires out-of-pocket expenditures to be repaid in whole or in part through a tax credit.

But I think you know this.

And if you don't, I envy your cash-flow.

Akaison, please. Subsidies? Are you kidding me? If the government wants to pick up the check, they should just pick up the check. But it's a joke to say that offering a tex credit, or offering to bay 20-60% of the bill is going to do much.

Soullite: all three of the Democratic "big three" include a Medicare-like government insurance plan as an option. We're obviously a long way from seeing the specifics of any eventual UHC legislation, but it seems to me the easiest way to implement subsidies would be to a)tie them to the Medicare-like option by b) capping premiums as a percentage of income. That way there's no crushing upfront expense while "waiting till next year" for the tax credit to give relief.

these arguments except for the one requiring manadates are mostly form over substance. several of the posters here know the nature of the various candidate plans as they have been told this before. and if they hadn't heard it, they should have looked it up. this isn't about that. it's about wanting single payer or not wanting any government healthcare at all- the question becomes will we let the poles define the debate, will we let their idea of perfection hinder the good. nearly everything jaspers has written- i've seen without trying thousands of time. both sides play on ignorance about what the plans actually say in favor of fear factor manipulation.

If your going to have single payor what's the purpose of an insurer at all? If Medicare is paying every claim and responsible for all risk why wouldn't you make all providers salaried employees and completly eliminate the cost of billing, claims processng, fraud, and everything that goes with risk transfer. Insurance is the transfer of risk, in single payor there is no risk thus no need for insurance.

Ezra,

INDIVIDUAL MANDATE, n,: def.--a dangerous scam pushed by insurance corporations, to force middleclass and poor people to purchase their health insurance products, with no controls on cost, or standards for quality.

Dear Ezra,

I am very disappointed in you for comparing California's nurses to the Republican National Committee. RNs are patient advocates, meaning we are ethically and professionally obligated to fight for our patients, from the bedside to the statehouse. A lot of our time is spent defending patients from their merciless insurers. Passing new laws to give insurance corporations more power, including the ability to garnish wages or put a lien on your home, is hardly an attractive option for our patients.

Think, Ezra: why are individual mandates supported by almost every single insurance corporation? Because they know it's a sweetheart deal for them.

Have a happy and safe new year,
Deborah

Are you claiming your only interest are those of yoru patients? That you have no other interests?

"Single payor there is no risk "

Is this what people think? That if you get single payer, that ends risk? Seriously?

Obama's clips may be used to kill mandates -- not universal health care. Killing mandates would make Medicare for all the only way left to go -- the way most Americans want to go -- the way only the health insurance industry (which inexplicably seems to have all the power here even over a majority of voters) does not want to go.

Tax supported Medicare for all being the only truly UNIVERSAL way to go (especially true if it replaces seriously low balling Medicaid payments which ever fewer doctors are willing to work for, undermining LBJ's original intention to get health care to the truly poor, not just the middle class retired).

Denis Drew, who do you think pays all the claims for Medicare? You do know around 50% of Medicare beneficaires are enrolled in Medicare Advantage plans which are ran by the "Health Insurance Industry" You know the "industry" you claim is against your plan is actually very much for Medicare for all, they make their money on administration, advantage and supplement plans and the governemnt takes all the risk.

akaison, where is the risk transfer in single payor? Just to prove the point does Medicare, VA, or Medicaid purchase any reinsurance? Do they ceed off any of the risk? Show us where there is any risk to insure, my question stands if there is no risk to insure why do this all through insurance?

This issue is a red herring, but if anyone deserves blame it is Clinton -- she smeared Obama's plan by claiming it was not universal because it did not compel people to purchase insurance!

Mandates will not be necessary if insurance is affordable post-reform. They will only be necessary if premiums are so high and coverage is so limited that healthy people rationally prefer out-of-pocket expenses. If the latter is the case, then the reform plan is no good.

Does anyone really think that the majority of the 40 million uninsured adults lack it because they think they are unlikely to get sick? It is, as Obama said, that they cannot afford it. Reform that reduces the cost will not require the mandate.

I don't personally think we HAVE to go to single payer. We could go to a system where the government buys all of us a private sector policy, or a farther left proposal where the government hires doctors to provide free health care.

Those three plans all provide universal care. An individual mandate, in contrast, doesn't provide anything. We have an individual mandate in auto insurance in California. We do not, however, have universal auto insurance.

The subsidies will be cut and will end up being insufficient to buy anything other than crappy HMO coverage that involves long waits, denials by review boards, and all the rest.

The public option will also be gutted, the same as has happened with the Direct Student Loan program.

And what will we have left. Poor people being forced to give money they don't have to the insurance industry in return for health insurance that is designed to not be there when they need it.

Individual mandates are a way to AVOID providing us with universal coverage, not a way of providing it.

Smaug – Yes it has been shown with solid data that the majority of the uninsured are not that way because of cost. Of the 47 million 10 million are not citizens. 18 million live in households with income over 50,000. Half those uninsured live below 200% of the poverty level meaning they already qualify for free care and just don’t sign up.

http://www.aei.org/docLib/20061017_OhsfeldtSchneiderPresentation.pdf

http://aspe.hhs.gov/health/reports/05/uninsured-cps/index.htm