Mandates and Mudslinging
From the beginning, advocates of universal health care were troubled by the incompleteness of Barack Obama’s plan, which unlike those of his Democratic rivals wouldn’t cover everyone. But they were willing to cut Mr. Obama slack on the issue, assuming that in the end he would do the right thing.
Now, however, Mr. Obama is claiming that his plan’s weakness is actually a strength. What’s more, he’s doing the same thing in the health care debate he did when claiming that Social Security faces a “crisis” - attacking his rivals by echoing right-wing talking points.
The central question is whether there should be a health insurance “mandate” - a requirement that everyone sign up for health insurance, even if they don’t think they need it. The Edwards and Clinton plans have mandates; the Obama plan has one for children, but not for adults.
Why have a mandate? The whole point of a universal health insurance system is that everyone pays in, even if they’re currently healthy, and in return everyone has insurance coverage if and when they need it.
And it’s not just a matter of principle. As a practical matter, letting people opt out if they don’t feel like buying insurance would make insurance substantially more expensive for everyone else.
Here’s why: under the Obama plan, as it now stands, healthy people could choose not to buy insurance - then sign up for it if they developed health problems later. Insurance companies couldn’t turn them away, because Mr. Obama’s plan, like those of his rivals, requires that insurers offer the same policy to everyone.
As a result, people who did the right thing and bought insurance when they were healthy would end up subsidizing those who didn’t sign up for insurance until or unless they needed medical care.
In other words, when Mr. Obama declares that “the reason people don’t have health insurance isn’t because they don’t want it, it’s because they can’t afford it,” he’s saying something that is mostly true now - but wouldn’t be true under his plan.
The fundamental weakness of the Obama plan was apparent from the beginning. Still, as I said, advocates of health care reform were willing to cut Mr. Obama some slack.
But now Mr. Obama, who just two weeks ago was telling audiences that his plan was essentially identical to the Edwards and Clinton plans, is attacking his rivals and claiming that his plan is superior. It isn’t - and his attacks amount to cheap shots.
First, Mr. Obama claims that his plan does much more to control costs than his rivals’ plans. In fact, all three plans include impressive cost control measures.
Second, Mr. Obama claims that mandates won’t work, pointing out that many people don’t have car insurance despite state requirements that all drivers be insured. Um, is he saying that states shouldn’t require that drivers have insurance? If not, what’s his point?
Look, law enforcement is sometimes imperfect. That doesn’t mean we shouldn’t have laws.
Third, and most troubling, Mr. Obama accuses his rivals of not explaining how they would enforce mandates, and suggests that the mandate would require some kind of nasty, punitive enforcement: “Their essential argument,” he says, “is the only way to get everybody covered is if the government forces you to buy health insurance. If you don’t buy it, then you’ll be penalized in some way.”
Well, John Edwards has just called Mr. Obama’s bluff, by proposing that individuals be required to show proof of insurance when filing income taxes or receiving health care. If they don’t have insurance, they won’t be penalized - they’ll be automatically enrolled in an insurance plan.
That’s actually a terrific idea - not only would it prevent people from gaming the system, it would have the side benefit of enrolling people who qualify for S-chip and other government programs, but don’t know it.
Mr. Obama, then, is wrong on policy. Worse yet, the words he uses to defend his position make him sound like Rudy Giuliani inveighing against “socialized medicine”: he doesn’t want the government to “force” people to have insurance, to “penalize” people who don’t participate.
I recently castigated Mr. Obama for adopting right-wing talking points about a Social Security “crisis.” Now he’s echoing right-wing talking points on health care.
What seems to have happened is that Mr. Obama’s caution, his reluctance to stake out a clearly partisan position, led him to propose a relatively weak, incomplete health care plan. Although he declared, in his speech announcing the plan, that “my plan begins by covering every American,” it didn’t - and he shied away from doing what was necessary to make his claim true.
Now, in the effort to defend his plan’s weakness, he’s attacking his Democratic opponents from the right - and in so doing giving aid and comfort to the enemies of reform.
Paul Krugman is Professor of Economics at Princeton University and a regular New York Times columnist. His most recent book is The Conscience of a Liberal.
© 2007 The New York Times
Paul, your many columns on health coverage have provided the most persistent illumination.
That said, let’s not loose sight (or scent) of the big elephants in the room: employer based health insurance and the private insurers themselves.
All the “big 3″ Dem candidates, for political reasons, refrain from outright slaying of the elephants. However, each of their plans are mercifully disingenuous front-ends in the evolution to a single-payer system. Private insurers will be uncompetitive with a public Medicare-style alternative.
Does mandating interim private coverage for working poor add much to the process?
Dennis Kucinich’s plan is the only one of use to me since my primary care provider is a naturopathic physician. For all the other plans, I would pay premiums for a plan I can’t even use.
Aside from that, Obama is no knight in shining armor come to save us. That would be Dennis. Obama is another packaged and marketed political animal. These are woeful times.
Dennis Kucinich’s plan is the only one of use to me since my primary care provider is a naturopathic physician.
I can’t wait to see him (or her) set a broken bone, or take out a ruptured appendix, or fix a hernia for that matter.
Should be interesting. What does he do for a broken arm, give the other one a small sprain?
Why would we want to mandate that every person in this country be required to buy health insurance as long as we have these already very profitable health insurance companies controlling this market–they have no business being between a healthcare provider and his/her patient. They need to go! And why would we want to perpetuate a health care system that is useless for preventing disease? Really, Paul, I’m disappointed.
msb2: I’m also very disappointed in this article. Paul, once again, plays right into the MSM objective by remaining silent on the dem candidate who has the best health care plan. The only candidates he mentioned are the ones his bosses have identified as ‘electable’ - Edwards, Clinton, Obama.
Paul, your silence about Dennis Kucinich and Single Payer is deafening. I expect much better from you.
Krugman is shilling for the insurance companies and he’s doing it for a reason. Wall Street would collapse overnight if these parasitic “institutional investors” were cut off from their health care slush fund. Krugman is just as corrupt as David Brooks and that’s saying something.
Mooser,
Here in France, where EVERYONE benefits from universal healh care coverage, my primary physician is a homeopath. But if I require treatment in the ER or if I require a surgeon (since obviously my homeopath is not a surgeon, that too is entirely covered. Dental and mental health as well. No problem whatsoever. Why can’t americans understand this? The absence of basic logic in American minds is…, well, it’s mind-boggling.
Krugman is one of the better MSM guys. He is not promoting anything here. He’s just pointing out that Obama is not telling the truth about his proposed health plan.
Kucinich’s plan obviously is what we should be promoting. GO DENNIS!
By the way, the plan put forward by Edwards is also taking a beating in the press. Edwards intends to use the IRS to enforce the mandate for insurance. Jeez!
Does that mean we get stuck with Hillary’s plan? Let’s end the corporate welfare for the insurance companies and big pharma, shall we? All three of the plans put forth by the Big Three Dim’s are worthless!
Forcing Americans to have health insurance… or else? I haven’t had a cold, flu, or injury in 20 years - is PK suggesting my efforts to keep myself healthy are irrelevant because so many others do not? Will there be Health Insurance Police (HIP) who can pull you over and cite you for not having a health insurance plan? So we’ll have the right to smoke, get drunk and gorge on crap food - but not to not have health insurance? What about dental insurance - will we be FORCED to carry that as well? Why not force all to have life insurance, too? And travel insurance. And renter’s insurance. And flood insurance. And earthquake insurance. And alien invasion insurance. Maybe a little nuke insurance, just in case…
How does that jive with “freedom” again? Here’s a better idea - rich folk like PK should be kicked from ALL gov programs, period. Then, close all the gaping tax loopholes the wealthy are rewarded with, stop all off-shore money laundering - er, I mean banking, set the IRS loose upon all those earning, say, over $1M/year, and every corporation, and cease all gov “pork” spending.
Then we take all that money and create a British-style system where EVERYONE, incl. the rich if they so chose to abuse said system, receives “free” health care when needed.
Or we can FORCE Americans to carry health insurance whether they want to or not.
The laws regarding health care in America won’t be written by our political D.C. whores. They will make it the law, but it will be according to the needs of big business. Corporate America doesn’t want to take care of all American citizens. Corporate America wants to take care Big Pharma. Big Pharma will decide what kind of patients Americans become in the future. We can clearly already see you’re going to have to be rich to get some medical attention. So all this talk about what Clinton would do or what Obama isn’t really about mudslinging, except on the part of the New York Times. America is going to take Big Pharma’s medicine even if it doesn’t want to.
Hoa binh
We’ll see if the internet makes the difference this time when the liberal majority votes for Kucinich.
As long as insurance is any part of healthcare, why should we be satisfied in the least? Yet another reason why, like most of the other Democratic candidates (and all of the Republican ones), I cannot back Obama.
Kucinich or Green, my friends.
frank1569 November 30th, 2007 3:43 pm
You raise some very valid points about universal health care and I think I understand where you’re coming from, though I would make a few points.
“Forcing Americans to have health insurance… or else? I haven’t had a cold, flu, or injury in 20 years - is PK suggesting my efforts to keep myself healthy are irrelevant because so many others do not? Will there be Health Insurance Police (HIP) who can pull you over and cite you for not having a health insurance plan? So we’ll have the right to smoke, get drunk and gorge on crap food - but not to not have health insurance? What about dental insurance - will we be FORCED to carry that as well? Why not force all to have life insurance, too? And travel insurance. And renter’s insurance. And flood insurance. And earthquake insurance. And alien invasion insurance. Maybe a little nuke insurance, just in case…”
Yes, I think people should be forced to carry insurance, in a universal public scheme. Here in Ontario, we pay for it directly as an addition to our income tax bill. It’s preferable for people to put less stress on the system by taking care of their bodies (if doing for their own sake wasn’t enough). There is talk of including a tax credit/deduction for healthy activity (there are privacy concerns of course, but I think they mean gym memberships and things like that).
In that respect, it’s about the public good. And health is a public good.
Living in Ontario, I think of what would have happened had SARS broken out in a major U.S. city instead of Toronto. In its early stages, I can imagine many people getting sick with flu-like symptoms, and not being able to afford medical treatment (and/or perhaps not believing they’re sick enough to need Emergency care), stay at home and infect their families, or worse (because either way, they might infect their families), they go to work where their co-workers also can not afford health care and perhaps brush off SARS as a flu. Public health care allowed Torontonians of all income brackets the ability to see a doctor if they thought they had something like the flu, because doctors know that the symptoms can be those of something else.
“How does that jive with “freedom” again?”
Concerning freedom, people have certain human rights. They are worded slightly differently in every country, but in the U.S., they are the rights to life, liberty and the pursuit of happiness.
Let’s consider happiness. Or well-being. You have the right to pursue your well-being. But your pursuit of well-being should not infringe on someone else’s right to well-being (public good). What constitutes well-being? There’s a lot we can say about it, but surely most would include health. I don’t think many unhealthy and/or sick people are happy.
Freedom. You give up freedoms in a society. We can’t seek our own form of justice if someone wrongs us; we have to go through the law. You give up the freedom to seek your own ideal of justice, to protect yourself from other people seeking that justice (potentially on you). In the same way, we should expect (and welcome) giving up the freedom to seek and pay for your own health, to protect yourself and others from illness (esp. epidemics). If you don’t need to use the system often, then a lot of it has to do with your lifestyle, but it also has to do with the disease environment and the system in place to confront that environment.
Life. That should not require much examination.
Regards,
Paul.
Senator Baraq Hussein Obama is a Muslim by religion. (His biological and step fathers were both proud Muslims, and his mother embraced them.)
One cannot expect a good judgment on any national policy from a Muslim whether it is related to healthcare or socialist security; because, Islam and democracy are not compatible. In fact, not a single Islamic country on earth is democratic.
When Senator Baraq Hussein Obama speaks, he reminds people Mr. Malcolm X of the Nation of Islam.
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Unknown_Unknownable November 30th, 2007 9:32 pm
Senator Baraq Hussein Obama is a Muslim by religion. (His biological and step fathers were both proud Muslims, and his mother embraced them.)
One cannot expect a good judgment on any national policy from a Muslim whether it is related to healthcare or socialist security; because, Islam and democracy are not compatible. In fact, not a single Islamic country on earth is democratic.
When Senator Baraq Hussein Obama speaks, he reminds people Mr. Malcolm X of the Nation of Islam.
Hey U_U,
Have anything rational, reasonable, relevant or intelligent to say? ????? Nope, didn’t think so.
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Paulitics,
Spot on with the analysis/comparison. Thanks.
I’m with Paulitics. If you read Krugman’s article, he explains why there is a requirement to be insured. The healthy (like Frank 1569) would opt out until they get sick or hurt, at which time they would opt in to a program where they couldn’t be refused for a prior condition.
I agree that the program should be entirely public, or if a public/private hybrid, then strictly regulated. But whatever kind of healthcare system we have, it must be universal in payment and benefit–everybody in–or it will fall apart.
As for Unknown_Unknownable(sic)–there should be a psychiatric benefit available also.
And still the americans just don’t get it. A just and humane society does not provide health “insurance” to its members - it provides health *care*. The whole point is that cost simply does not enter into it - if someone is sick or hurt, then the rest of us take care of them.
Yes, of course money is involved. But insurance, which at bottom is a gambling game, is not.
Presumably, everyone will eventually get sick. Those who have been healthy all their lives might wind up being in ICU before they die, and that’s all it presently takes to go bankrupt or bankrupt a loved one. And how many people suffer needlessly from a toothache because they simply cannot afford to go to the dentist? It’s interesting psychology that the same individuals who have no qualms about pouring billions into “spreading democracy” via bombing, balk at taking care of one another at home, even it be their mother, brother, wife, or husband. Another thing I often wondered if people would be more willing to donate organs knowing they’d be in line to receive one when they needed it, whether they had insurance or not. Our attitudes in regard to universal health care say a lot about us individuals and as a nation, and goes along with the attitude: “As long as I got mine, why should I care about whether you got yours or not?” I suppose it all depends on what kind of society we want.
Having met and had dinner with Obama twice (I know some of his relatives) — once right before he entered politics and again two years ago after he became a US Senator — I can tell you he professes to be a progressive populist, and he’s very intelligent, articulate and seems sincere in his beliefs.
Of course, national celebrity and the notion that he could actually be president may have changed him and made him more conservative, but it’s hard to believe he would embrace the ‘Dark Side.’ Stranger things have happened, though.
It’s also possible he’s being more ‘moderate’ because politically he thinks it’s the best way to get elected and once in office he’ll revert to his progressive ideas. I hope that’s the case.
I don’t claim to have studied the details of Obama’s or Edwards’s or Clinton’s health care proposals, because I don’t think such details matter much at this point.
But if I understand the logic of what Prof. Krugman is saying, Obama doesn’t propose to mandate universal enrollment as a burden on the individual (you must buy insurance or else), but does mandate that everyone must be allowed to buy insurance at any point (you must sell insurance to this possibly sick person or else).
That could be read as closer to universal, socialized insurance than the mandate plans, in that it would allow those unable to afford insurance to delay buying it, then buy in when they needed it. In effect, they would have been covered automatically.
I don’t understand why Krugman does not read it this way.
PAUL M & CHESSGAME: Thank you for raising points about basic humanity. Insurance companies will continue to own the power over our bodies inclusive of life and death conditions. After Moore’s “SICKO,” we ought to realize they are NOT a necessary component in this equation. They pay (lobbies) to play, but they are about profit, not health CARE.
mr. krugman, dennis kucinich is your best option for presidential candidate. not only does he advocate single payer “medicare for everyone,” he advocates something like a new works progress administration to put people to work rebuilding our infrastructure. he has excellent stands on the issues.
and may i remind michigan voters that he will be on our primary ballot?
I’m posting a link to an interesting story about Obama. I have been less than thrilled about the positions he has taken, but this story gave me more respect for him. I was especially interested in the remarks of Cynthia Canary, director of the Illinois Campaign for Political Reform.
http://news.yahoo.com/s/ap/20071201/ap_on_el_pr/obama_lobbyists
However, I’m still voting for Dennis.
canardtahiti: Why can’t americans understand this? The absence of basic logic in American minds is…, well, it’s mind-boggling.
As an American, I can confirm this; I’m surrounded by idiots…
DAVE G — I say the following in no way to attack or denigrate you personally, but I have an explanation.