I thought this was the most enlightening exchange we've had yet on the mandates issue. Folks have convinced me over time that Obama's got this wrong on the merits ... his notion of a mandate-less big-picture reform sounds appealing, but it's fundamentally unworkable. Indeed, by the same token (and for the same reasons) you could never get it passed into law -- if you want guaranteed issue, you need a mandate.
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Mandates
05 Jan 2008 09:32 pm
Comments (32)
I would prefer the mandate in theory but I think what he is offering (including the newly mentioned penalty) is certainly the plan that has the most chances to be voted and implemented.
Oh, frigging joy.
Do you really think there is MORE chances for a health care package - that will need Rep votes in any combination of Congress we can think of - with a mandate than without ?
Yes, I do. Guaranteed issue without a mandate is an absolute disaster for the insurance companies. Guaranteed issue with a mandate isn't something they'll like, but they'd be able to survive.
I think Obama's plan is basically to subsidize private insurance, which solves both problems--the subsidies keep the market profitable rather than falling into the adverse selection death spiral everyone loves to dread, and, being subsidies, make laws easier to pass. Basically, a mandate IS exactly such a subsidy. It's just paid for in a particular regressive way, through insurance premiums.
The question is, is a mandate the best way to subsidize the private insurance market? I don't see how it possibly could be.
Matt, how in the world do you enforce mandates?
Will we throw folks in jail if they don't sign up?
Will we fine them if they don't sign up?
And what if we do both or more or whatever and they still don't sign up?
Explain this to me and I will gladly concede Obama is wrong.
Yes, I do. Guaranteed issue without a mandate is an absolute disaster for the insurance companies. Guaranteed issue with a mandate isn't something they'll like, but they'd be able to survive.
I understand. However arguing for mandates because that is what is most palatable to insurance companies isn't exactly going to sell that to Democratic voters.
I guess I am more attuned to the politics of it (and a mandate is SO easy to caricature) than the policy.
Let's remember that Obama will create a plan with the help of Congress, and unlike Edwards, of the insurance companies. If they really want the mandate, they will make sure to stand for it publicly and it might be easier to pivot later on. Remember he never completely closed the door in the mandates. He said he is uncomfortable with them, philosophically and because of implementation issue, and that maybe down the road we will need them.
It may be wishful thinking on my part but I see wiggle room there.
It feels like there's a sentence missing at the end, something like "you'd need a mandate ... but you can't pass anything with a mandate"?
Come on Matt, LOOK AT HIS PLAN. He has a what is in effect a fine - the cost of insurance goes up if you wait to get it. This is as much of a mandate as the others, except better because he's actually proposing a penalty, and it's a workable penalty in reality.
You and Kos withdrawing your Obama endorsements - from a guy who holds almost all the policies you're in favor of, and whom you are in strong agreement with philosophically on the big issues, and who tactically can clearly win and govern - over, what was it again? I forget (oh right, a Krugman gambit to pull in more netroot readers) - aren't you a little embarrassed?
Sheesh.
Who cares what the netroots think?
Their blessedly short time as the kingmakers of the Democratic Party is over. Voters knows the score - Obama is well on his way to securing the nomination and the presidency.
Guaranteed issue without a mandate is an absolute disaster for the insurance companies. Guaranteed issue with a mandate isn't something they'll like, but they'd be able to survive.
Well, there's a political thumbsucker. We're for a mandate that takes money out of people's pockets under the color of law in order to preserve the business model of the insurance companies?
It may be that you have to do this in order to get your healthcare plan passed, but at some point you have to wonder whether it's actually a pretty shitty thing to do. Please tell me there's a better reason for this than sucking up to a special interest for political expedience.
That's why I hate primaries. See, I am a big Obama supporter but I don't see the need for all that bile some of the Obamaites feel the need to spout in comments sections (not that they are the only ones who are guilty of this but in this thread they are).
Now I am annoyed at kos because he seems to complain about everything these days and I found his post about it to be particularly self-involved, but Yglesias explained why he stepped back from his Obama interest. He thinks Obama has fallen prey to a Republican-sounding framing of the issues and he is not comfortable with that. He explained it simply and not angrily as far as I can remember.
I don't agree, both on the substance and on whether framing should be a reason to withdraw an "endorsement" but I don't find it particularly interesting to turn this into a hateful conversation about the netroots.
And it is not helpful either since that motivation for withdrawing the "endorsement' was flimsy enough it would be easy to get him back on our side ... which calling him names and accusing him of having a selfish agenda does not exactly entice him to do.
What happened to civil conversations about disagreements ? urgh.
HRC just killed herself on the 10:10 question.
When asked about change, she used Clinton in his first term raising taxes and balancing the budget as an example of achieving change.
She just completely undercut her own argument. Bill was the inexperienced candidate in 1992. But he brought change. So, clearly, you don't need experience for change.
Also, it really looked like she was taking credit for that success. Which she needs to be careful of.
Well, it sure seems to me like the role of the health insurance companies is almost a wholly parasitic one, providing little or nothing of logical value.
Now parasites which skim off a point or two can certainly be tolerated, but don't the ones in our current health system absorb something like ONE THIRD of all the dollars, when we aggregate administration, paperwork, advertising, profits, and wasted consumer time? That's just too much, and really necessitates some thorough political fumigation!
It seems to me that the easiest and cheapest strategy is just to realize that in modern corporate America there's frequently a massive disconnect between what's good for the CEO and what's good for the companies or stockholders.
Therefore, wouldn't just a few billion dollars of government money be well spent simply bribing the health insurance CEOs into gladly accepting some sort of plan which "rationalizes" their companies pretty much out of existence? I suspect that for a quick $1B "hardship" bonus-check, even the most staunchly free-market CEO would agree that National Health was the way to go.
After all, Ayn Rand always preached that "Greed Is Good", didn't she?...
Hmmm, I agree the debate could be more civil, but, on the other hand, I have not seen Matt Yglesias really post anything substantive on why he thinks Obama is wrong. I feel that Obama is more flexible than Hillary, and that being less doctrinaire is a better place to start. I certainly don't buy the Edwards "by the power of righteous indignation I will save the world" shtick either, but I don't see Clinton having the skills or personal prestige to force through her mandate, which seems to be unpopular with the public as a whole, and will be harder to find votes for. Could Matt write something long and reasonaed on this issue?
Guaranteed issue without a mandate is an absolute disaster for the insurance companies. Guaranteed issue with a mandate isn't something they'll like, but they'd be able to survive.Well, there's a political thumbsucker. We're for a mandate that takes money out of people's pockets under the color of law in order to preserve the business model of the insurance companies?
No. The reason isn't to preserve the insurance company business model; it's because insurance companies can't survive on any model without something effectively identical to a mandate, and consumers are reluctant to go over to single payer and give up their current insurance.
As for Obama's proposed penalties for late purchase of insurance: if there are sufficient subsidies to make insurance affordable and the penalties for late purchase are high enough to work and prevent a death spiral of increasing premiums, then ipso facto such penalties will function as a mandate. That's the very definition of a mandate in fact: a sufficient penalty for late purchase to make the whole system work. Obama's recognized that he screwed up on mandates, but he doesn't have the backbone to admit his mistake and call his proposal a mandate, so he's proposed an inefficient form of mandate just to be able to differentiate his proposal from others' and not to have to admit mistake. After the last seven years I'd really like to have a President who's willing to just admit errors and not force second best or worse solutions just to cover his own ass.
@R Johnston
Alternatovely, you could say that Obama is pragmatic enough to makes necessary changes, and that demanding some sort of apology for being pragmatic is a little farfetched. As for calling it inefficient to do it his way, people by and large seem to think it more workable - and better for poorer people who may not be able to afford mandated healthcare from the get-go.
As for Obama's proposed penalties for late purchase of insurance: if there are sufficient subsidies to make insurance affordable and the penalties for late purchase are high enough to work and prevent a death spiral of increasing premiums, then ipso facto such penalties will function as a mandate.
Emphasis added. You said "and", but you should have said "or". Obama plans to try the first and then implement a mandate or penalty if that doesn't work. And he's always been open to a mandate if it turned out to be necessary. And, if the subsidies do encourage enough people to sign up, then it might not actually be necessary.
There's no reason to think he would oppose mandates if it turned out they were politically necessary, indeed accepting a "concession" on the mandate issue might actually be politically useful on the negotiating table.
The problem is individual mandates are a bad policy idea, because they don't solve the health care crisis, which is that 40 million Americans lack the right to health care. Thus, the solution is for the government to either provide it or buy everyone a policy.
Individual mandates pretend that the real problem is adverse selection, i.e., that people all can afford insurance and just aren't participating. But that's only a subsidiary problem that exists if you refuse to offer universal coverage through the government. And individual mandates, instead of asking the rich to pay higher taxes to pay so that everyone is insured, ask the poor and middle class to pay the cost of health care "reform".
They are the wrong solution for the wrong problem, cooked up because nobody has the guts to propose actual universal coverage purchased or provided by the government for every American. Obama's plan may not do anything positive, but at least it won't make the system worse by punishing poor and middle class Americans for a problem that was created by politicians and insurance companies.
A mandate will never work because Americans simply won't accept being told by the government that they must spend their hard-earned cash on health insurance. Even people who could afford to and would choose to buy it anyway. It's government paternalism gone mad.
If there's one thing both parties can always be counted on to do when they gain power, it's overreach. They always act as if they have more support than they really do. Pushing an unpopular mandate is the surest way the Democrats could shoot themselves in the foot on health care reform.
As for Obama's proposed penalties for late purchase of insurance: if there are sufficient subsidies to make insurance affordable and the penalties for late purchase are high enough to work and prevent a death spiral of increasing premiums, then ipso facto such penalties will function as a mandate.
Nonsense. There is obviously a huge difference between a financial incentive created through pricing and a legal requirement to purchase. A "late purchase penalty" could be calibrated dynamically to provide whatever level of incentive and subsidy is deemed necessary to keep the system workable under various conditions, whereas a mandate would make criminals out of people simply for refusing to buy something just for....being alive. As Tim Noah has pointed out, the latter is unprecedented in American law.
Mixner's 12:35am post sums up the Obama argument best.
I think it's reasonable to discount future MY Obama healthcare slams as hollow/uninformed without some specifics from MY on why Obama's late purchase penalty is so fatal vs a mandate (on the contrary, Mixner makes an excellent case that the penalty is both as effective as a policy matter, and beats the mandate on being more doable, politically).
I really think you need to look up "slams" in your dictionary. I think my coverage of Obama has been very favorable over the months ... unlike, say, Krugman I think this is a pretty minor point.
As for political feasibility, I especially don't care who's right about that. The politically difficult thing, favored by all three candidates, is the guaranteed issue provision. Whether that proves easier to get through congress with or without a mandate is just something we'll have to wait and see.
In terms of the general election, though, Obama's plan definitely seems to have more political appeal.
It seems to me that Obama is being inconsistent by calling tonight for all Americans to sacrifice in the context of our energy policy but not in the context of our healthcare policy. It's axiomatic that the more people that pay into and purchase health insurance, the lower all of our premiums will be and the better distributed the pools of the insured will be, which is why a mandate is so important. If we're going to tackle the big problems in meaningful, "transformative," ways, let's do it! Isn't Obama being inconsistent here? Aren't we supposed to be talking about both the "right" to health care as well as the "responsibility" individuals have as part of the system?
Having said that, I'm not sure that most Americans are going to focus on those kinds of details. I've bounced back and forth between being an Obama supporter because of his charisma and ability to inspire people versus being a Hillary supporter because of her domestic and foreign policy experience. I think very highly of Hillary Clinton and I think she performed well tonight. But I think that all three of the other candidates demonstrated more personality, passion, and a home-spun quality that appeals to people on a gut level. She is the ultimate policy wonk (and Richardson and Obama at times talk like that too). I happen to admire policy wonks, but I think I'm in the minority!
It seems to me that Obama is being inconsistent by calling tonight for all Americans to sacrifice in the context of our energy policy but not in the context of our healthcare policy. It's axiomatic that the more people that pay into and purchase health insurance, the lower all of our premiums will be and the better distributed the pools of the insured will be, which is why a mandate is so important. If we're going to tackle the big problems in meaningful, "transformative," ways, let's do it! Isn't Obama being inconsistent here? Aren't we supposed to be talking about both the "right" to health care as well as the "responsibility" individuals have as part of the system?
Having said that, I'm not sure that most Americans are going to focus on those kinds of details. I've bounced back and forth between being an Obama supporter because of his charisma and ability to inspire people versus being a Hillary supporter because of her domestic and foreign policy experience. I think very highly of Hillary Clinton and I think she performed well tonight. But I think that all three of the other candidates demonstrated more personality, passion, and a home-spun quality that appeals to people on a gut level. She is the ultimate policy wonk (and Richardson and Obama at times talk like that too). I happen to admire policy wonks, but I think I'm in the minority!
There's a missing element to this wonkish debate. Although the NYT article on mandates and the difference between Obama and Clinton on healthcare convinced me, that the next plan needs mandates, there's also coattails to consider. This is the TNR argument, that the next Clinton elected President has to bring in a working Democratic majority in both houses. That can be done if the Dem candidate doesn't alienate insurance companies, and cause them to spend for. and scare, the GOP.
Matt it is true that you take pains to describe your policy objections to Obama's healthcare plan as mild, and I don't mean to conflate you and Krugman on that point.
I withdraw the word "slam" but also reassert my desire to see some accounting from a policy perspective for the Obama "late payment penalty" (contrasted to a mandate).
Regards,
Steve
you could never get it passed into law -- if you want guaranteed issue, you need a mandate
Anyone who thinks a mandate on, well, anything will make it easier to pass needs to lay off the gange.
Grumble grumble. Obama's plan has fines for late enrollment acting as a quasi-mandate without the inconvenience of enforced "Thou shalt" bureaucratization.
I love how people just talk about the mandate vs. no mandate features of the various health care proposals as if they were in total isolation. Obama's proposal is decent. He wants more regulations on the insurance companies (community rating), more subsidies for low-income Americans to purchase health insurance and to help the health care industry modernize its recordkeeping, an employer mandate, and a public option for those who are left out of the system.
It's much better than the current system, but Edwards and Clinton have many of the same features, plus a public option that all Americans can buy into (not just those left out of the current system) AND enough subsidies so that low-income Americans will not be forced to purchase any insurance out of their own pockets.
Anonymiss - Bill was the inexperienced candidate in 1992. But he brought change. So, clearly, you don't need experience for change.
Bill Clinton had 13 years executive experienceas a statewide elected office leader. Barack Obama has zero, but talks swell. Hillary may not be much better in foreign policy experience or executive experience - but she is better than the Magic Nergo who will Redeem Guilty Liberals - on those measures.
Mixner - A mandate will never work because Americans simply won't accept being told by the government that they must spend their hard-earned cash on health insurance. Even people who could afford to and would choose to buy it anyway. It's government paternalism gone mad.
Wrong.
Government mandates auto insurance even though many of us have never had an auto accident where we are at fault and many of us would like to dispense with it, especially when we were young and had to spend our hard-earned money on it and we were pretty unsuable in our teens and early 20s. I wished I was a "free rider" back then, with the taxpayers picking up for me - but the penalties for violating the mandate were too high to risk.
Health insurance will not work unless all Americans who can pay in, do so. That is true even in Mitt Romney's state example, and he believes some sort of mandate in each State system is unavoidable.
Americans are ready to be told that people must join a health care plan rather than accept 1/6th of our workers and their families being uninsured, people barred from private insurance on pre-existing conditions, changes to bankruptcy law where no asset but a house in certain states is safe from bill collectors after a major medical condition. An America that used to rank in the top 10 in life expectancy and infant mortality now slipping down into the "40s" rankings of nations, behind all advanced nations in the West and Asia in those measures but the UK and Thailand..
Americans are ready because employers are screaming that it has to change because they can no longer compete when the cost of each product or service they offer contains the US healthcare burden other nations goods and services providers do not factor into their costs.
The libertarian-Far Right argument that health care = socialism, is dead. The jingoistic boast that Americans have the best health care in the world overall, because oil shekhs that can afford the best that a majority of US citizens cannot, come here - is bullshit.
It will come in, with mandates and heavy financial penalties for not insuring based on income - because Americans are fed up with the middle class now facing unaffordable private insurance costs (my wife and I are self-employed and our insurance has gone from 363 bucks a month in 2002 to 642 a month on our last bill.) My neighbor has talked about getting all his assets out of the USA or in trusted relative's names except a home in Florida because his wife had breast cancer, has been free 3 years, and they were dropped by their insurer in the annual renewal last year. My uncle, a poor guy because very mild retardation kept him out of high-paying jobs, just got diagnosed with Stage 4 colorectal cancer because he made just enough to not qualify for free care like illegals get, but not enough for preventative tests like a regular colonoscopy.
That is all unacceptable bullshit. Americans are ready for Romney's private enterprise solution or Federal universal - the present status quo is absolutely unacceptable.
And that means forcing all who can to pay despite their claims of their "personal freedom" to drive w/o insurance, stick taxpayers with their medical bills? Let it be so. It is time to end this disgraceful aspect of America.
Government mandates auto insurance even though many of us have never had an auto accident where we are at fault and many of us would like to dispense with it
Auto insurance is fundamentally different. The mandate applies only to third-party liability insurance and is part of the contractual agreement for owning and operating a motor vehicle. No comparable contractual arrangement justifies a mandate for health insurance. It's like a poll tax--something the government forces you to pay essentially for just being alive.
And even the mandate for third-party liability auto insurance is widely ignored. A mandate to buy health insurance, which is much more expensive and has no contractual component, is likely to be even harder to enforce.
I'm still waiting for someone, Matt or anyone to explain to me how mandates are enforced.
I don't think many of us are against mandates (including Obama), we just don't see how they are a practical solution.
They look good on the accounting sheet...they balance the books. On paper is not the same as enforcing it in reality.
Make a realistic case folks...convince us we are wrong.
Comments closed January 19, 2008.
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Heads in the Sand
Do you really think there is MORE chances for a health care package - that will need Rep votes in any combination of Congress we can think of - with a mandate than without ?
I would prefer the mandate in theory but I think what he is offering (including the newly mentioned penalty) is certainly the plan that has the most chances to be voted and implemented.
Posted by Benjamin | January 5, 2008 9:41 PM