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OBAMA AND MANDATES. Great catch by Ben Smith over at The Politico, who finds Obama telling an audience last year, "It's time to accept that we must offer some form of basic health care to every American. Health care should be like auto insurance - mandatory for all Americans. A larger pool of subscribers would drive down health care costs." He's right! So what changed?
Well, he's running for president. And mandates make some folks uncomfortable. They're somewhat controversial, and they can force health care purchasing on individuals who would prefer to remain outside the system, or covered by barebones plans (at least until they get in an accident, and we all pay for their care). For that reason, I'm unconvinced that by Smith's interpretation of this, that "it's interesting to see that [Obama's] instinct was apparently toward individual mandates, before his wonky friends at the University of Chicago convinced him that there's a better -- if, perhaps, less easily sold -- way."
My hunch is that it's quite the opposite. I know nary a health policy expert who doesn't believe you need a mandate of some kind. But I know more than a few who are leery of the political consequences of mandates (albeit in a general election rather than primary). My guess isn't that anyone convinced the campaign that there's a better way than mandates -- Obama certainly didn't offer an alternative policy solution -- but that someone convinced the campaign that they'd be better off politically without a mandate. That's actually a very defensible approach, just not one I agree with.
I should add,that Obama's staff is firm in upholding that they'd happily revisit the mandate issue later on, and that Obama's commitment is to full coverage by the end of his first term. I'm skeptical, though, that after passing a universal health care bill that fails to deliver on its promises, Obama will have the capital to come back to Congress in three years and ask for a purely punitive measure to enhance coverage. Maybe I'm wrong.
--Ezra Klein
COMMENTS (16)
"Health care should be like auto insurance - mandatory for all Americans."
Huh? First of all, insurance ISN'T mandatory everywhere. Second of all, some people don't carry auto insurance for the same reason they don't have health insurance - they can't afford it.
Posted by: eric | May 31, 2007 12:06 PM
I'm really surprised that Obama failed to deliver a universal plan. Health care policy is pretty complicated, and few people will grasp all the differences among the plans, but one thing everyone undestands is the difference between a plan that will cover everyone and one that does not. Now Obama will have to endure not only Edwards but also Clinton--Clinton!--attacking his plan from the left.
What happened? Is this one more case of Obama running the General before the Primary? Or is he worried about cost? What is the additional cost of trying to cover everyone? Edwards estimates that his plan will cost 90 - 120 billion while Obama puts his plan at 50 to 65 billion. Is Obama overly worried about the budget? Is this neoliberalism rearing its ugly head?
I'm really curious about the source of this huge political and policy blunder.
Posted by: david mizner | May 31, 2007 12:16 PM
Second of all, some people don't carry auto insurance for the same reason they don't have health insurance - they can't afford it.
Then they shouldn't own a car.
Similarly, if you can't afford health insurance, you shouldn't be able to live and act in an irresponsible fashion. Hardworking, healthy, careful, thrifty Americans shouldn't have to pay for the carelessness and recklessness of others. Clog your arteries? Not my job to pay for your heart surgery. Wreck your car? Not my job to replace it. Learn to live within your means, or suffer the consequences.
Posted by: Reasonable thought | May 31, 2007 12:17 PM
Dickens would be proud.
Posted by: Whispers | May 31, 2007 12:25 PM
It sounds to me like you're equating poor people with irresponsible people.
Posted by: Sean | May 31, 2007 12:28 PM
Sorry, I was referring to "reasonable thought" there.
Posted by: Sean | May 31, 2007 12:30 PM
"Then they shouldn't own a car."
And get to work how? They can't get to be "hardworking Americans" without transport.
"Similarly, if you can't afford health insurance, you shouldn't be able to live and act in an irresponsible fashion."
I think what your really intended to say there is, "Similarly, if you can't afford health insurance, you shouldn't be able to live[.]"
What's a republican like you doing reading Tapped? Shouldn't you be at work or being thrifty or something?
Posted by: eric | May 31, 2007 12:35 PM
I'm emboldened to write "what atrios said." When I read this post originally I thought--why use a word like "mandates" instead of "universal coverage" and why force people to buy coverage which we *know* is inadquate and which we know is going to be as corruptly administered as auto insurance is why *not* do what atrios suggests and just go ahead and insure everyone and pay for it from a payroll/income tax? Just go ahead and do it. Its not like the american people care about how they get their health insurance or who pays for it. They haven't made a peep about paying for the Iraq war and they aren't suddenly going to become more concerned and cranky when they are offered comprehensive, french style (or senate/congress style) health care UNLESS WE CEDE THE DEBATE to the right wing and use their unappetizing and frightening language.
aimai
Posted by: aimai | May 31, 2007 12:45 PM
You can be as hardworking, healthy, careful and thrifty as you want to be, and won't none of that keep you out of the hospital if you're in a bad car accident.
In other words, go fuck yourself, "Reasonable" Thought.
Posted by: ned fucking flanders | May 31, 2007 3:04 PM
"They're somewhat controversial, and they can force health care purchasing on individuals who would prefer to remain outside the system, or covered by barebones plans (at least until they get in an accident, and we all pay for their care)."
Not true. You only pay for their care if they're really, really really poor. This is more true than ever now that individuals can no longer readily declare bankruptcy.
So, you're paying for care for the poor either way. No need to shove a mandate down my golden throat. I'll decide how I pay, thank you very much.
Posted by: Anonymous | May 31, 2007 3:26 PM
As I thought Ezra pointed out on his blog, enforcing a mandate is virtually impossible unless there is simply a universal plan, government financed, that covers everyone. Perhaps that could be in the form of an opt out provision (you are in unless you opt out and prove in some fashion that you have provided for your own coverage although policing the maintenance of coverage is problematic just as it is with auto insurance; there is a reason that your auto policy still has uninsured motorist coverage.) Isn't the real problem the political one of inertia with respect to existing coverage (typically through an employer) and nervousness of those with coverage that a change may not be beneficial to them?
Posted by: JackD | May 31, 2007 7:12 PM
Health care should be like auto insurance - mandatory for all Americans.
Others have already said it, but it's worth repeating - what a terrible, terrible analogy. My god Obama is turning out to be a disappointment.
Posted by: Jason | May 31, 2007 8:24 PM
Nice story, except Obama never said it. Ben Smith has corrected his post.
Oh, well! Made for nice mind-reading commentary anyway.
http://www.politico.com/blogs/bensmith/0507/Obamas_mandate.html
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