Mandates: Eh

Jacob Hacker says Obamacare's lack of a mandate is no big deal. To be fair, I think the main concern wasn't so much with Obama's initial lack of a mandate. His plan, as written, might or might not leave a hard-to-guesstimate number of people without health insurance depending on various details that will, necessarily, need to be worked out by congress. It's possible that once such a plan went into effect, that it would work in some problematic way that could be fixed by a mandate, and then a mandate could be added.

The trouble is that having put out the sort of nasty anti-mandate mailers his campaign has sent around, he's now arguably closed that door, and committed himself to a policy vision that's likely to prove unworkable. I think people are probably overstating the extent to which it would be problematic to pirouette on this topic in the future, but the concern is about the future not the short-run significance of the mandate.

Comments

The trouble is that having put out the sort of nasty anti-mandate mailers his campaign has sent around, he's now arguably closed that door, and committed himself to a policy vision that's likely to prove unworkable.

Matt, this is nonsense. Have you had your coffee yet? You really think those mailers will have tied his hands a few years down the road?

Posted by Jake | February 28, 2008 9:32 AM

I think he mentioned during the debate that he was open to Hillary helping him with healthcare during his presidency. He believes it is a difference of opinion and sounded like he was amenable to change as far as his policy positions go.

He is not gonna turn around and say"Hey, remember those mailers we put back last year? We can't go back on them!!"

Posted by KC | February 28, 2008 9:37 AM

MY, today:

The trouble is that having put out the sort of nasty anti-mandate mailers his campaign has sent around, he's now arguably closed that door, and committed himself to a policy vision that's likely to prove unworkable.

Paul Krugman, February 4, agrees:

But while it’s easy to see how the Clinton plan could end up being eviscerated, it’s hard to see how the hole in the Obama plan can be repaired. Why? Because Mr. Obama’s campaigning on the health care issue has sabotaged his own prospects. ... You see, the Obama campaign has demonized the idea of mandates — most recently in a scare-tactics mailer sent to voters that bears a striking resemblance to the “Harry and Louise” ads run by the insurance lobby in 1993, ads that helped undermine our last chance at getting universal health care. ... If Mr. Obama gets to the White House and tries to achieve universal coverage, he’ll find that it can’t be done without mandates — but if he tries to institute mandates, the enemies of reform will use his own words against him.

Which is why Obama's uncritical use of right wing talking points is of concern to many; right wing talking points are poison pills for progressive policies, as they were designed and funded to be.

Krugman draws the obvious conclusion: Obama's painted himself into a corner on the single most significant domestic policy issue there is, and is unlikely to deliver on it:

If you combine the economic analysis with these political realities, here’s what I think it says: If Mrs. Clinton gets the Democratic nomination, there is some chance — nobody knows how big — that we’ll get universal health care in the next administration. If Mr. Obama gets the nomination, it just won’t happen.

Of course, reasonable people can disagree on this, as Matt does:

I think people are probably overstating the extent to which it would be problematic to pirouette on this topic in the future,

But I do note that, operationally, "change" and "transformation" that we keep hearing so much about depends, on an actual policy that is of life and death concern to many, on the successful execution of a "pirouette."

Surely I'm not the only one who's concerned by this?

Posted by Lambert Strether, Philadelphia, PA | February 28, 2008 9:39 AM

Politically, you will never be able to sell a mandate forcing people to buy medical coverage. Ain't gonna happen, so the point is moot. I don't know Obama's reasons for leaving mandates out of his plan, but whether from luck or calculation, he has the politics right.

Posted by jbd | February 28, 2008 9:43 AM

This is silly. Does anyone really think there's a big enough consensus at present in the country to get mandated coverage for all? It's not like Hillary -- or Obama -- can just issue an ukase and do it. There's Congress, too -- including the Senate, where it now takes 60+1 votes to get anything major done. Even though I happen to agree that ultimately mandates are necessary to get fully universal care, I think Obama's approach is more workable for now. First, establish the principle of "universal care"; then, if the lack of mandates leaves some uninsured, fight a different battle to close the gap with mandates.

Posted by Traven | February 28, 2008 9:50 AM

Politically, you will never be able to sell a mandate forcing people to buy medical coverage. Ain't gonna happen, so the point is moot. I don't know Obama's reasons for leaving mandates out of his plan, but whether from luck or calculation, he has the politics right.

Indeed. People tend to make the assumption that Clinton would be able to get her plan passed. I think this is very debatable.

Posted by Jake | February 28, 2008 9:50 AM

He has mandates in his plan.

Mandatory Coverage of Children: Obama will require that all children have health care coverage. Obama will expand the number of options for young adults to get coverage, including allowing young people up to age 25 to continue coverage through their parents' plans.

Therefore, he's also given a blueprint for attacking his plan, right down to mailers where it's possible to just do a search-and-replace for Clinton to Obama

Posted by Alex | February 28, 2008 9:53 AM

Lambert Strether @ 9:39 said exactly what I would have.

Campaigns matter. Once you win the nomination where the one big domestic policy difference over your opponent was mandates, it is very very difficult to say "Just Kidding".

Universal Health Insurance is dead, again.

Posted by PDX Pete | February 28, 2008 9:54 AM

The trouble is that having put out the sort of nasty anti-mandate mailers his campaign has sent around, he's now arguably closed that door

That's just baloney.

His mailers said that Hillary's plan mandates coverage even if you can't afford it. And he has consistently, when addressing the topic, tied the problem with mandates to affordability, and specifically the fact that Hillary's plan is very short on specifics concerning affordabilty. "Refundable tax credit"? Puhleeze.

So, Obama has left plenty of room to approach "mandates" or some other mechanism (single-payer anybody?) once the affordability bridge has been crossed.

Posted by Brautigan | February 28, 2008 9:58 AM

People tend to make the assumption that Clinton would be able to get her plan passed. I think this is very debatable.

Quite so. Obama's plan wasn't designed to be the greatest public health care plan ever, it was designed to survive public debate and be passed into law. These comparisons between the Clinton and Obama health plans where it is assumed that both would become law are necessarily biased in that they've already assumed away the weakness of Clinton's plan and the strength of Obama's.

Posted by J.B. | February 28, 2008 9:59 AM

Obama's plan is to have a very open health care reform process: a national discussion and debate with lots of televised hearings, panels, meetings etc., with the president guiding and setting the agenda for the debate with his bully pulpit power. That leaves him a great deal of flexibility to adapt to any emerging public or expert consensus that might differ from his current set of proposals. I don't think his campaign statements box him in at all.

The excessive emphasis during this campaign on the Krugman-driven policy blueprint aspect of the health care debate has taken far too much attention from the political process aspect of the debate. But the latter is really the thing Obama has tried to emphasize over and over, to little avail. His incessantly reiterated point has been that the policy differences between him and Clinton pale in comparison with their differences over the best approach for getting the very daunting legislative job done.

You would think that in a camapign in which one of the two main candidates had already failed spectacularly in this effort back in the nineties, the media would pick up more on this issue, and begin to examine the question of which candidate has a better understanding of how to accomplish these changes, and the communication, organizational and coalition-building skills necessary to transform that understanding into successful action. Changing the health care system in this country will be a huge task, and runs up against a massive wall of powerful, wealthy, organized interests who all have a stake in that system. The President is not some sort of Czar who can enact health care reform with a stroke of the pen by executive edict. Nor will a reform plan pass directly from an academic economist's blackboard or a policy maven's briefing book into law. And yet so much of the debate has been inordinately focused on policy jibber-jabber that seems to presuppose just such an unrealistic picture. In all of his criticisms, has Krugman said anything to acknowledge the political realities here, or to show that he has a mature grasp of the required political strategy?

Posted by Dan Kervick | February 28, 2008 10:02 AM

If purchasing health insurance became mandatory, wouldn't that be, like, the one and only thing that was absolutely mandatory in this country? A person doesn't even have to pay taxes or file income tax returns, if they make below a certain amount of money. You don't have to buy car insurance if you don't drive a car. Is there any other law that forces all people to buy something or pay something? Suppose someone wanted to live completely off the grid -- they would be subject to punishment on this one subject?

Posted by David | February 28, 2008 10:02 AM

Campaigns matter. Once you win the nomination where the one big domestic policy difference over your opponent was mandates, it is very very difficult to say "Just Kidding".

Universal Health Insurance is dead, again.

Not just the one big difference, but the difference he constantly attacked whenever he could for at least a couple of months now. To the point where a majority of his supporters have internalized an argument that mandates are bad and the only good form of universal health care is a single-payer system. A dream of universal health care is dead for at least the length of his Presidency, and probably longer than that.

So... has he explained the enforcement mechanism for mandatory health insurance for children yet, or is this something that only Hillary has to do? I'm predicting it gets called a birth tax by the Republican party unless he takes a lead on that issue.

Posted by Alex | February 28, 2008 10:05 AM

Even though I think that mandates will be part of universal healthcare, I think its clear that Obama did not include them in his plan because it'd help him with the independents he needed to have a viable campaign. The same reason he said nice things about republicans the past 20 years: the party of ideas, indeed.
Even though he has said these crowd pleasing things, should he become president he will have no trouble going with a plan that includes mandates.
Both Hillary and Obama say that its a process that has to include a lot of voices to fashion the changes needed. That process will give him or her the political cover or permission to modify and go back on things said during these primary battles.
Hillary's making an issue of mandates let her point out obama's plan lacked the will to do hard change. She isn't ultimately tied to mandates either: these aren't read-my-lips-lines-in-the sands-promises from either candidate.

Posted by Michael C. | February 28, 2008 10:06 AM

uncritical use of right wing talking points
And of course candidate Clinton would never traffic in right wing talking points.
Lambert you're a joke.

Posted by bjd | February 28, 2008 10:07 AM

How is a mandate to buy health insurance any different from a mandate to buy car insurance or subsidized flood insurance? A mandate is the only fair way avoid free-riders unless Americans want to start denying the ill treatment if they cannot or refuse to pay.

Posted by Tim K | February 28, 2008 10:15 AM

To the point where a majority of his supporters have internalized an argument that mandates are bad and the only good form of universal health care is a single-payer system.

Hmmm... I couldn't give a crap about mandates, but the only good form of universal health care is a single-payer system.

Posted by J.B. | February 28, 2008 10:15 AM

So... has he explained the enforcement mechanism for mandatory health insurance for children yet, or is this something that only Hillary has to do? I'm predicting it gets called a birth tax by the Republican party unless he takes a lead on that issue.

I'm sure that will be an effective strategy by the GOP, seeing as how everyone hates little kids.

Posted by Jake | February 28, 2008 10:15 AM

How is a mandate to buy health insurance any different from a mandate to buy car insurance or subsidized flood insurance? A mandate is the only fair way avoid free-riders unless Americans want to start denying the ill treatment if they cannot or refuse to pay.

Posted by Tim K | February 28, 2008 10:17 AM

How is a mandate to buy health insurance any different from a mandate to buy car insurance or subsidized flood insurance?
If you don't own a car you don't buy car insurance. If you don't own a house you don't buy flood insurance.

Posted by bjd | February 28, 2008 10:19 AM

Jake:

Well it's a fair question to ask. Why doesn't Obama have to answer the question of how he is going to enforce his mandate? He's going to "force" parents to buy insurance for their kids even if they cannot afford it *gasp* Maybe they'll have to choose between insurance and milk!

Funny how Obama talks about getting past the "politics of fear" and then tries to scare Americans about the big, bad government "forcing" them to buy insurance they cannot afford. Sounds a lot more like No We Can't than Yes we Can.

Posted by Tim K | February 28, 2008 10:21 AM

bjd:

But everyone gets sick at some point. Everyone accesses the health care system. It's not a question of 'if' but 'when.' How is this not an issue of personal responsibility?

Posted by Tim K | February 28, 2008 10:24 AM

Why doesn't Obama have to answer the question of how he is going to enforce his mandate?

I'm sure it has something to do with the media hating Hillary.

Posted by Jake | February 28, 2008 10:25 AM

(Note: I'm a different Alex than the one posting above.) This conversation has become disastrous. First, for those with a penchant for drama, universal health care is no more dead than it's ever been, and certainly no more dead than it would be if Clinton were the nominee. What may be dead is the idea of universal health INSURANCE, which is a system unlike any other we think of as universal health care. Second, Obama specifically attacked the potential cost burdens of the plan, not the use of a compulsory mechanism. HE AND HIS ADVISORS ARE OPEN TO MANDATES, they just think we should deal with cost first. (And to those who unthinkingly claim that costs won't go down without increasing the risk pool, I suggest you read a textbook on insurance. Increasing the risk pool--and it's already pretty big, by the way--will be meaningless unless healthcare costs are low). Third, the criticism that Obama is providing a line of attack on his policy is absolutely fair. He is. It's absurd, of course, to think that republicans wouldn't thought of this on their own. But it's a political move on Obama's part, and is as lamentable as all such moves always are.

Posted by alex | February 28, 2008 10:25 AM

I would agree that Obama likely excluded mandates from his plan because of a political calculation that they wouldn't fly. As to whether he is now "locked" into that position, well that is largely because Clinton decided to attack on that point. Krugman kept up a pretty blistering assault on Obama in the Times as well. Once they started pushing the lack of mandates a major failure, Obama had to fight back in support of his plan. The only way to do that was to vilify mandates.

I wouldn’t blame Clinton for the strategy. Attacking Obama on mandates – one of the few points of difference between the candidates – makes sense if your goal is to elect Hillary Clinton president. If your goal, however, is to enact universal health care regardless of who is president, it was a bad choice. That’s why I’m a bit more disappointed in Krugman. He decided to treat the mandate issue as a fatal flaw in Obama’s candidacy and tried to use the issue to defeat (or at least advocate for the defeat of) his campaign. Now that Obama is the likely nominee, Krugman has likely lost any ability to influence the direction of the campaign. If Krugman had chosen to advocate for the mandates without the attacks on Obama there might still be somewhere to go on the issue.

All that being said of course, there is nothing to stop Obama from moving to a full mandate (or even single payer) over the next four or eight years if he is elected. I think the whole “locked-in” thing is a bit overrated.

Posted by Merle | February 28, 2008 10:26 AM

Alex:

It is my understanding that under Obama's plan even though there would be no individual mandate, insurance companies would be required to insure people with preexisting conditions... they wouldn't be able to deny coverage. Doesn't that create an incentive for people to wait until they are sick to begin paying premiums?

Posted by Tim K | February 28, 2008 10:30 AM

People have very short memories. It won't matter. Aside from that, I'm not entirely convinced that mandates will work so perfectly either.

For one, somebody raised the example of auto insurance - well, we mandate that, and millions of people still drive without insurance; the government doesn't find out about it until they have an accident, and it will be the same with medical insurance because both plans still rely on private insurers rather than a single-payer system.

Second, the Massachusetts example is somewhat valid. If you have to exempt some people from a mandate, you're not achieving "universal" coverage anyway.

Third, I don't think HRC has adequately made the case that a mandate will reduce the costs of insurance to people, which is the only thing that matters. No voter who currently lacks insurance, but wants it, gives two hoots about whether "everybody" has insurance - they just care that they will be able to buy it at lower cost for themselves. She's made the argument about indigent costs and the burden this places on people who do pay for insurance. But removing costs from the system doesn't necessarily lower prices, it could just as easily accrue to the bottom lines of hospitals and insurers. The only thing that lowers prices is competition, and you'd need a perfectly competitive environment to capture a large percentage of those savings for policyholders rather than shareholders. There's also the argument that mandates could allow health care companies to raise prices, because you've created a market with zero demand elasticity. What incentive does any business ever have to lower consumer prices if consumers are required by law to purchase their product? There's usually a tradeoff between volume and price that at some point along the curve maximizes revenue. With "volume" equal to 100% of Americans buying a policy regardless, there's no curve - price increases would always grow revenue.

Third, there are ways to solve the "free rider" problem without a mandate, although I admit they are less straightforward and potentially more problematic.

Posted by TH | February 28, 2008 10:31 AM

What is said in campaigns does matter. It always comes back to haunt the person later. Especially on issues like this. Obama has painted himself (and the rest of us, if he is elected) into a corner. His first mistake was starting out from a weak position. His proposal represents the bare minimum of what we should expect. Any real program that makes it through congress will be watered down from the starting point. Water his program down and you have nothing left. If he is elected and persists in this 'reach across the aisles' BS, then everything will end up that way. Half-assed.

As bjd says above, If you don't own a car you don't buy car insurance. If you don't own a house you don't buy flood insurance.

We all have bodies and health issues and we should all have to buy insurance. Period.

Posted by JAB | February 28, 2008 10:33 AM

Third, the criticism that Obama is providing a line of attack on his policy is absolutely fair. He is. It's absurd, of course, to think that republicans wouldn't thought of this on their own. But it's a political move on Obama's part, and is as lamentable as all such moves always are.

They would have done it on their own. But it's a lot easier for the GOP to mount the attack on Obama's health care plan by using quotes from Obama about health care.

Posted by Alex | February 28, 2008 10:38 AM

Conservatives and Republicans are always talking about individual responsibility. I think that's the way to sell mandates.

Individual mandates to buy health insurance are part of every individual's responsibility to pay their own way in society. Right now we know there are people who can afford health insurance and yet refuse to obtain it. That IS irresponsible and represents a hidden tax on everyone else.

Posted by Tim K | February 28, 2008 10:42 AM

Lambert Strether and his good quotes address the need for mandates and the consequences of Obama using far-right and libertarian scare tactics being in the end, no health care reform at all.

This replays Mitt Romney and Kennedy's people battling over mandates as essential to end "free riders" to make insurance affordable. Just as car owners seek to avoid "unisured motorist" premiums on their own bills or keep them as low as possible, Kennedy's people carried the day with Romney as he looked at the burden on premiums if he allowed "free riders". (People that wanted to opt out but nevertheless betted that the idea of leaving uninsured by the curbside to die was unthinkable...and others would be forced to pick up the slack.)

Free riderism is a rational choice. Why spend 3,000 -5,000 a year on insurance when you have no assets to sue for, want to spend all you make on consumer goods and luxuries? If people could, a third of motorists would bet that they could go without insurance, enjoy 2 great vacations to Cancun and Carnival in Rio instead, and go without car insurance in the certainty that society would be morally bound to screw other taxpayers and insured - to cover their asses. That is why we mandate car insurance - to force "Me 1st, always" people that lack responsibility and a sense of doing their fair share to do so anyways.

Politically, you will never be able to sell a mandate forcing people to buy medical coverage. Ain't gonna happen, so the point is moot. I don't know Obama's reasons for leaving mandates out of his plan, but whether from luck or calculation, he has the politics right.
Posted by jbd

Despite what libertarians say, or "Me 1sters", 80% of the American public will go with health insurance. If there is no mandate, and they must pay for parasites who could afford it but who wish to game the system for free, I suspect that employers and insurers explaining that each person has to pay an extra 80, 100, 140 dollars a month for parasites who refuse to pay for health care - would leave that 80% demanding that their elected reps impose mandates.

Posted by chris ford | February 28, 2008 10:44 AM

Obama's plan tries to strike a balance between a broad progressive outline for healthcare and a set of flexible points where compromise and dealmaking are possible. For me, that's what makes his plan a lot more appealing in light of the fact that Congress is going to substantially modify ANY healthcare plan -- and probably not in very progressive ways. Frankly, this is what scares me about Clinton's plan: the mandates are non-negotiable, but she allows flexibility in the subsidies and regulation intended to make them affordable. A mandate without adequate subsidies and regulation is exactly what the Obama mailers say it is: a law forcing people to buy insurance they can't afford.

Conversely, I don't think it would be all that hard for Obama to spin an eventual plan that included a mandate. He hasn't disavowed the idea -- he's just attacked Clinton's decision to prioritize universality over affordability (or, more charitably, her decision to view universality as an adequate means to achieve affordability). Obama can always say "my mandates are different because we have $X billion in low-income subsidies and we've established the Department of Y" -- which he'll be more able to do because those elements are the core of his plan.

Posted by NS | February 28, 2008 10:45 AM

I think the Nathan Newman post at TPM Cafe address the issues that have been missing in the debate on mandates and affordibility. My problem with this debate is how abstract it has been. I think that Newman address issues that Krugman et al ignore.
http://tpmcafe.talkingpointsmemo.com/2008/02/27/mandates_versus_affordability/

Posted by Micheline | February 28, 2008 10:49 AM

If Obama is president, he can compromise WITH SENATOR HILLARY CLINTON to get his plan passed. With freakin' man-dates, if there's enough support on the low end to pay for them.

If Obama wins with strong enough coattails, he can use his open forum to move towards single payer, which as Hillary pointed out he was in favor of a few years ago.

I find it shocking that people believe that the candidate who is literally nodding at Ohio while winking at Canada over NAFTA can't find a way to tweak his health care plan even slightly.

Posted by dbt | February 28, 2008 10:49 AM

How is Obama able to make the argument that Clinton's plan doesn't provide adequate subsidies when she has said her plan would cap premiums as a percentage of income, and her plan costs almost twice as much as his.

Posted by Tim K | February 28, 2008 10:49 AM

bjd writes:

Lambert you're a joke.

Ah yes, the "casual poetry" of the Obama campaign. Respect, empower, include and all that. Well done, all!

Posted by Lambert Strether, Philadelphia, PA | February 28, 2008 10:49 AM

"We all have bodies and health issues and we should all have to buy insurance. Period."

You have to buy car insurance, not for your own car but just in case you destroy somebody else's car/property/body. I also have to purchase uninsured motorist insurance because of the strong possibility that the person who hits me lacks car insurance, so mandates aren't a way to ensure universal coverage regardless. I should also be able to choose not to purchase an expensive comprehensive insurance plan, when all I really need is some sort of disaster insurance.

Without a strong and intrusive enforcement mechanism a mandate is useless. Unless the policy is willing to allow the government to garnish wages if an insurance company doesn't report you as insured then you might as well not have a mandate and give opponents a talking point.

Posted by JordanT | February 28, 2008 10:53 AM

JAB,

The correct conclusion to draw from the examples you cite is that if don't have a body, you don't buy health insurance. It in now way follows that if you have a body (as I suspect you, for example) do, you should have health insurance. My wife is French and doesn't have health insurance because the French system is single payer. That's universal health care.

TimK,

Your question about pre-existing conditions is an excellent one, and I one that I anticipate. There are several ways to handle it (none great, admittedly), but I think the honest answer is that this is a problem that will be solved with some kind of back payments. However, it's the kind of problem that's easy to focus on, but not necessarily a big deal in the larger scheme. Most people will get insurance if its cheap simply because they want to protect against emergencies. But still, I think it's a fair question, and one that need to be addressed in more detail. Note that I don't the problem is more acute here than it is with mandates, since in both cases there needs to be an incentive for buying insurance, whether the incentive is avoidance of a penalty ( as with mandates) or avoidance of high medical bills.

Posted by Alex | February 28, 2008 10:57 AM

Ah yes, the "casual poetry" of the Obama campaign. Respect, empower, include and all that. Well done, all!

Wouldn't it be amazing if a candidate for president controlled the actions and words of every one of his millions of supporters, including their random comments on crappy political blogs? That would be quite a feat. Then his campaign could be responsible for everything that any supporter ever said about anything.

And people think Obama's supporters view him with a messiah complex. Sheesh...

Posted by J.B. | February 28, 2008 11:00 AM

Alex:

Okay, well I think it is a serious question and it's one that mandates do solve.

What do you think about Obama's mandate on small businesses to either offer coverage or else pay into a fund? Couldn't that force small businesses that cannot afford that mandate to lay-off employees?

Posted by Tim K | February 28, 2008 11:06 AM

I'm a little unclear on how the Obama campaign can run Harry & Louise-style flyers trashing mandates, and at the same time be "OPEN TO MANDATES," as one commenter shouts.

And I'm also a little unclear on how Obama supporters can wrap their heads around the idea tha Obama runs flatly wrong flyers in a primary, but let's not worry, nobody will remember them when he's elected. ("Hey, remember those mailers we put back last year?") Leaving aside the fact that the flyers are up on YouTube, Google, in on various blogs, how is this rather realpolitik mindset the new kind of transformational politics we were promised?

It would be nice if Obama were saying "Here's how I would lead the country to universal health care."

But he doesn't do that, and his supporters don't claim that he is.

Instead, what we hear about is "open process" and "costs first." But leaders lead. So why is Obama kicking the can down the road on this?

Posted by lambert strether | February 28, 2008 11:07 AM

http://www.iii.org/media/hottopics/insurance/compulsory/

According to this website on auto insurance about 14.6% of drivers were uninsured in 2004. They also claim that mandates on auto insurance have done little to reduce the rate of the uninsured.

The problem is the same as with health insurance. If somebody has no assets then there is little risk to forgo insurance because they can't be sued for the money.

Posted by JordanT | February 28, 2008 11:12 AM

I get the impression that Obama/Clinton supporters come to this argument by trying to justify what his/her policy is.

I have two lifetime political "wishes": universal health care and a less militarized USA.

This led me to consider two candidates: John Edwards and, uh, Ron Paul.

I've been around long enough to know that the most disillusioning thing in politics is to vote for the winning candidate.

Whatever gets the US to universal health care access is fine with me, and no, access to the ER doesn't count.

Posted by PDX Pete | February 28, 2008 11:16 AM

JordanT:

So you're saying that without premium caps or subsidies of any kind the presence of a mandate for car insurance leaves only 15% of drivers without coverage? Imagine if rates were regulated and the government helped those who couldn't afford it pay.

That's the other difference between the car insurance example and health care: people will be able to afford insurance since premiums are being capped and subsidized.

Posted by Tim K | February 28, 2008 11:16 AM

I would comment, but I've learned through experience here that it's completely unproductive to attempt a reasonable debate with Lambert.

Posted by jbryan | February 28, 2008 11:18 AM

Lambert,
Obama will be the nominee. How do you plan to vote in the GE?

Posted by bjd | February 28, 2008 11:19 AM

Lambert asks how Obama can be open to mandates. Well, listen to his health care policy advisor, David Cutler, a professor of applied economics at Harvard:

“If there are free riders, Obama is open to mandates. But what he is saying is ‘Look, mandates seem like a panacea, but that’s not where the hard work needs to be done.’ Auto insurance is a mandate, too, and not everyone has that. You’ve got to prove to the public that you’re willing to do the hard work.’”

The interview is here. It also address the silliness of the adverse selection criticism: http://sentineleffect.wordpress.com/2007/12/01/health-mandates-a-talk-with-obama-health-advisor-david-cutler/

Posted by alex | February 28, 2008 11:32 AM

"Imagine if rates were regulated and the government helped those who couldn't afford it pay."

Because I'm sure lack of car insurance is due to an inability to pay it. It's more likely an unwillingness to pay it because there is little benefit to an individual who has no assets.

Secondly, a mandate for comprehensive health insurance is a bad idea. It removes from the table options such as disaster insurance, which is more in line with what some people need. It's what I would have if my employer didn't provide my insurance already.

Posted by JordanT | February 28, 2008 11:39 AM

JordanT:

Or perhaps the lack of car insurance, or any insurance, is due to some individuals being risk-preferring rather than risk averse. It's not always about an inability to pay, it's often an unwillingness to forgo other wants and desires.

Posted by Tim K | February 28, 2008 11:45 AM

"It's not always about an inability to pay, it's often an unwillingness to forgo other wants and desires."

I was being sarcastic with the first sentence, but it probably didn't translate all that well. I agree that there is an unwillingness to pay because some people take the risk and spend the money on something else. I don't see how a mandate solves this problem without a strong enforcement mechanism that has the ability to garnish wages and place you into a government health system in the absence of proof of insurance. I'm happy with a plan that offers everyone an opportunity to have health insurance, but doesn't force everyone to have it.

Posted by JordanT | February 28, 2008 12:03 PM

JordanT:

I respect your point of view on this, I just don't think it's in the country's long-term interest to perpetuate a system in which individuals do not need to pay their own way if they prefer not to, while society is morally obligated to bail them out.

Posted by Tim K | February 28, 2008 12:16 PM

Tim K,

So you're saying that without premium caps or subsidies of any kind the presence of a mandate for car insurance leaves only 15% of drivers without coverage? Imagine if rates were regulated and the government helped those who couldn't afford it pay.

Even with caps and subsidies, health insurance will almost certainly be far more expensive for most families than car insurance. I see nothing in either Hillary's or Obama's plans to suggest that health insurance would become as cheap as car insurance. Remember, we only mandate third-party liability car insurance, not comprehensive car insurance.

Posted by Mixner | February 28, 2008 12:32 PM

Tim K,

I respect your point of view on this, I just don't think it's in the country's long-term interest to perpetuate a system in which individuals do not need to pay their own way if they prefer not to, while society is morally obligated to bail them out.

Then I assume you must favor the repeal of laws that allow for personal bankruptcy protection, which are an obvious example of the system you describe. People are allowed to walk away from their debts, and the rest of society has to pick up the pieces.

Posted by Mixner | February 28, 2008 12:37 PM

Matthew,

What you are missing is the substance of Obama's criticism of mandates. For him, mandates are a bad idea not on the basis of a libertarian idealism but because we can't be sure the policies will be affordable. Once affordability is proved in practice (rather than assumed or enacted by fiat, as Clinton does) then there is no practical objection to a mandate. Obama has a mandate for kids, because we have programs in place that work for them, demonstrating affordability.

If, after the plan is in place, it's shown that the policies are affordable, and Obama pivots to say, ok lets extract the last bit of cost-savings by adding mandates, then it would be possible to attack him as inconsistent. But it would be a meaningless argument since he can point to the affordability of the program in practice and say there's no reason not to do it.

Posted by Oaktown | February 28, 2008 12:37 PM

So you're saying that without premium caps or subsidies of any kind the presence of a mandate for car insurance leaves only 15% of drivers without coverage? Imagine if rates were regulated and the government helped those who couldn't afford it pay.

Virtually every state that mandates car insurance has some form of subsidized risk pool for people who could otherwise not find coverage. Rates are also often subject to caps and other regulation. So it's not hard to imagine the situation you propose, that's basically the status quo.

Posted by J.B. | February 28, 2008 12:57 PM

If, after the plan is in place, it's shown that the policies are affordable, and Obama pivots to say, ok lets extract the last bit of cost-savings by adding mandates, then it would be possible to attack him as inconsistent. But it would be a meaningless argument since he can point to the affordability of the program in practice and say there's no reason not to do it.

He has mandates in his health care plan. Go to the health care plan on Obama's website. Search for mandatory and you'll see, in bold, that he requires children to have health care. His health care plan is open to attack by using his words against himself.

I think the most amusing this is going to be seeing all the Obama-defenders who attacked mandated health insurance as being so risky and "forcing people to buy health insurance they can't afford" switching over to defending mandates with no cognitive dissonance.

Posted by Alex | February 28, 2008 1:37 PM

What Oaktown said was right. I would be interested in hearing what Tim K had to say in response.

Also, it seems to me, in my naive and limited understanding of economics, that the more in demand something is, the more expensive it becomes.

With millions of unassembled people buying health insurance, it seems to me that demand will go up, and that prices will go up...Massachusetts had some problems in this area, and ended up having to exempt many people, since they couldn't afford it, while others have decided that it would be cheaper for them to pay fines than to buy insurance.

On the other hand, when a large employer buys insurance on behalf of it's large employee base, it's almost like buying in bulk, like at Sam's Club or something. The university gets a cheaper per-person rate, since they offer the Health Insurance Company so many subscribers.

Just mandating coverage though, would seem to be more likely to raise prices. Figuring out some way for large groups of people to ban together and get a cheaper rate per-person would be a real achievement it seems.

But I'm open to being told where I've gone wrong on my short analysis.

Posted by Jay J | February 28, 2008 9:18 PM

Alex,

Oaktown has asserted that children's health insurance has already been shown to be affordable, while adult health insurance has not.

You can attack that by saying it's inaccurate, but just responding to part of the comment doesn't seem sufficient.

It's not as if Obama has said that mandates are inherently bad, it's that you have to do the hard work in lowering prices, since mandating that people purchase something we know little about (such as the quality or price) seems like a bad idea.

Posted by Jay J | February 28, 2008 9:25 PM