I'm confused, why do you need a mandate for universal coverage? Why can't it be incorporated into the existing tax structure?

Of course, the argument about "individual mandates" is essentially a legal fiction, unless you plan on actually enforcing it.

With car insurance, there's a simple mechanism...when you register your car, you offer proof of insurance. When the cops pull you over, you have to provide proof.
Exactly when would you force proof of health insurance? At the emergency rooom? When you sign up for college? Through a national ID program? How would you penalize 20 year olds who don't bother to sign up?

It's true, by uttering the word "mandate", health care plans are able to check off the "universal" box...but that's it. Unless there's an enforcement mechanism, a legal mandate isn't worth the paper its written on...and you don't end up with anymore insured that you would otherwise. People will sign up because the want health insurance. Even California's plan will leave many uninsured...not to mention the illegal immigrant question.

Clearly Obama's focus is on creating the mechanisms for universal healthcare and doing it quickly. He doesn't appear to want to waste his time on debating legal fictions. Obviously, not the answer that liberal pundits were looking for, but perfectly defensible.

We'll actually get a pretty good test run of these concepts in MA this year, so we'll see how that plan shapes up. It boggles the mind that approaches which are not yet tried in practice are assumed to be the only "acceptable" approach.

"So if you want universality -- and the base certainly does -- you're sort of stuck with the individual mandate."

No no. The base does not want "universality." The base wants *free.*

People who have insurance at work to which they contribute from their paycheck, *complain, complain, complain* every single time their contribution increases.

They want something *better* than than work based insurance (or leave it alone).

So, you could *hide* the costs in income tax. (Roll back the Bush tax break on the rich). Or you could make something available to individuals that might be less expensive than what's available now and they can buy it if they want.

But you can't force them to buy it on the market in a market that is already notorious for both gouging the consumer and getting special favors in Congress. (How good will price regulation really be, realistically?)

I think the people who are "praising" these plans are not the people who will comprise the bulk of the voting public.

Wyden's plan? Get real.

Ezra...please note that Ben Smith has offered a correction on the point you link to:

"And I'm quite sure that Obama intuited all this because, merely a year ago, when he was still but a hyper-popular liberal Senator from Illinois, Barack Obama channeled this conventional wisdom and called for...a mandate."

Obama apparently was quoted incorrectly by the paper...he was merely describing the mandate aspect of Massachusetts plan without endorsing the concept. So he wasn't for a mandate-for-all back in 2006 either.

It's irresponsible to continue to link to The Politico story without noting the correction.

Obama said a larger pool drives down costs. He cited the mandate in the Massachussetts plan AS AN EXAMPLE, not as his own plan.

Obama: "That's [Romney's MA plan] just one example - you'd still have private insurance companies involved. What they did over there, is they set up a pool, just like Federal employees have a pool, that drives the cost down so that any individual subsidy given to any individual family could be lower. The point though is that if you get everybody in that drives down costs for everyone. Now. What is the level of coverage that everybody gets? Well, it's not going to be a Cadillac, it's going to be a Corolla, and then if you want a Cadillac you've got to pay extra. That's just one way of doing it. You could do the same concept through Medicare, just adding more and more cohorts through Medicare. We could start by at least making sure that all children are covered, and i think this is where Governor Blagoiovich has the right idea, by saying that there shouldn't be any child in Illinois that doesn't have coverage."

With or without mandates larger pools drive down costs - Obama was making a basic policy point in the speech where he was misquoted.

Great. Let's throw more people in jail and destroy lives for the "crime" of not wanting to purchase health insurance.

Insurance should be available to all who want it. For those who would rather pay on a cash basis, they should have that right.

And don't give me BS about how all healthy people would opt out. No they wouldn't. Only a small percentage of people, mostly healthy, yes, would go without insurance, maybe 1-2%. Let them. This is America, and last I checked we had rights and liberty and all that stuff.

IMU wrote:

I'm confused, why do you need a mandate for universal coverage? Why can't it be incorporated into the existing tax structure?

You have really two choices of funding for universal medical coverage - general fund and mandated coverage. The smarter policy choice would be to fund the medical coverage out of the general fund. That would make signing up for coverage always in a person's best interest, make the policy more progressive and avoids the problem of having to throw people in jail for not paying their mandated bill. With a mandate, the middle class spend more as a percent of their income on the coverage than the poor and the rich.

My guess is that a mandate is seen as an easier sell. People pay for their medical insurance today and with a mandate, they would continue to pay for their medical insurance. It's a way around an attack of "tax and spend" policy.

The Obama campaign is further elaborating on the plan they released on Tues. Over at the Campaign for America's Future blog, Obama '08 health care adviser and Harvard economics professor David Cutler posts that, "All Americans will be covered automatically under this plan. And the resources are set aside in the plan to do whatever is necessary to guarantee affordable coverage for every American."

For the details, check out Cutler's post http://commonsense.ourfuture.org/advisor_describes_obama_health_plan at the Campaign for America's Future blog -- which will be giving all the presidential campaigns the opportunity to elaborate on their health care proposals, so we can have a healthy health care debate on how to bring about affordable, quality coverage for all.

I want health insurance, and the longer I go without the more I want it, but I don't want to be mandated to get it. If the price is more than I can afford, I don't want it, and I'll resent having to purchase it. Period. And I'm a liberal. Obama's plan is smart to avoid a mandate, politically for sure, probably overall. Remember the backlash over the prescription drug plan? We want to avoid that kind of experience. I don't trust even a liberal politician to create a mandatory health care program without screwing me over. And I hate Ron Wyden's health care plan. It's practically Rovian, from what I've heard.

My guess is that a mandate is seen as an easier sell. People pay for their medical insurance today and with a mandate, they would continue to pay for their medical insurance.t's a way around an attack of "tax and spend" policy.

Republicans will have a lot more success by exploiting fear and uncertainty with a mandate - "the government's going to throw you into some cockamamie, cross-eyed government health plan and you CAN'T GET OUT!!!"
- than they will arguing tax and spend. Tax and spend, as an attack line, is all but played out, especially considering that no one's even contemplating raising taxes on the bottom 80%.

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