Barack Obama released an opp doc on NY Times columnist Paul Krugman last Friday, hopefully the climax of a battle between progressive columnists and the Obama campaign on one of the stickiest points of health care reform: mandates.
I've previously mentioned my anxiety about health care mandates when I posted about Clinton's health care plan - if done badly, a health care mandate only serves to make the system worse, much worse, for those without health care than it is today. On the other hand, some sort of mandate will eventually be required of a health care plan; that is part of the basic idea behind a single-payer health care system (the other big part being the elimination of any need to go through private sector insurers for basic health care, something none of the top three Dems support).
The mandate is the biggest difference between the top 3's health care plans - Clinton's has an individual mandate (people are required to enroll in private or public health care), Edwards has been more detailed and sounds more like a government mandate (people who don't sign up will be signed up for public health care), and Obama doesn't have one at all. Paul Krugman explains why a mandate is important:
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.
Not to mention the increased costs in health care by those who forgo preventative care because they choose not to sign up for health care.
But while not having a mandate is OK, can come up later, and can be negotiated, Obama's been trying to turn his lack of universality into a selling point, making it harder to believe that he'll come behind a mandate later.
He argues that the reason people don't have health care isn't because they aren't being forced to, it's because they can't afford it. True, but that doesn't address the fact that there will always be people who don't see the benefit of health care coverage, no matter how cheap it gets, because they're rich enough to pay for any procedures themselves, because they think that they're too healthy to need health care, or because they just don't want to participate in what they see as "confiscation" or "big government".
His answers to Clinton on the mandate sound like he's responding to mandate-done-badly - if a health care initiative does in fact make health care cheap enough for people to afford, then a mandate isn't a bad thing, it's necessary for substantive reform. As someone living under a system with a government mandate (France), I can tell you that it's not stifling if part of a progressive tax system.
So this sort of rhetoric is more than just grating, it seems to put any chance at single-payer off the table in an Obama presidency. From Jonathan Cohn:
When Obama first announced his plan, he suggested he was eschewing a mandate primarily because he wanted to take things a little more slowly--to put his other reforms in place before actually requiring everybody to get insurance. If it turned out he needed a mandate later on, he made clear, then he would do it.
Lately, though, he has been arguing as if his decision on a mandate, considered by some (including me) to be his plan's chief failing, is actually a virtue--and that he, frankly, has a better understanding of this whole problem than his rivals do. As he recently said in Iowa, "Their essential argument 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. ... What I have said repeatedly is 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."
But it works for him. His opp doc links to a favorable editorial in the libertarian leaning Concord Monitor, showing, I suppose, the power of triangulation. This sort of talk might quell fears from small-government types regarding health care, but only by hamstringing the process (from Ezra Klein):
Well, it was one thing when Obama simply didn't have a mechanism to achieve universality. It became a whole other when he began criticizing mechanisms to achieve universality. Previously, he'd gotten some flack for buying into the conservative argument that Social Security was in crisis. Now he was constructing a conservative argument against far-reaching reform proposals. And he kept doing it.
But back to the original issue - the fact that the Obama campaign has set its sights on attacking on one of the best known progressives in the mainstream media. What this says about the Obama campaign, to me, is that they're looking to the national election where progressive policy is going to be a hard sell. From Digby:
Running to the right on health care and social security combined with the anti-gay gospel singer, taking Robert Novak smears at face value, repeating Jeff Gerth lies and now going after Paul Krugman, leads me to the niggling awareness that this is a conscious, if subtle, strategy. Any one of those things could be an accident, and perhaps some of them are. But taken as a whole, conscious or not, liberal fighters in the partisan wars are being sistah soljahed. Unlike the big issue of Iraq where being on the right side is being on the left side, these little digs and policy positioning are all sweet spots for the Village --- and sore spots for the base.
Perhaps that's the smart move. It has long been known by just about everyone who matters that the rank and file activists of the Democratic party are a huge liability. And anyway, where are we going to go? Mike Huckabee? Ron Paul? We have no choice. So, no harm no foul. Running to the right of even Hillary Clinton on health care and social security and using GOP talking points and symbolism is probably all upside. It may be the best way to insure a win in the fall. But I can't say that it looks like either a transformative inspirational politics or a willingness to fight the conservatives and win on the merits.
Oh, well. It was fun while it lasted. Anyone can do the "transcendent politics" blah blah blah (remember "uniter, not a divider"?), but let's learn to examine policy instead of soaking up the rhetoric.