Health Insurance Mandates
Sam Stein reports that “Democrats are bracing themselves for a new line of conservative attack against a provision in the health care legislation once considered so non-controversial that it was endorsed by several major Republican officials.” What is it, you might ask, that these dastardly Republicans are opposing out of their racist hatred of Barack Obama?
On Tuesday, Sen. Jon Kyl (R-Ariz.) described the health care legislation being considered by the Senate Finance Committee as a “stunning assault on liberty” due to a provision that would require individuals to buy insurance. Earlier in the week, the individual mandate also came under attack when Tim Phillips, who heads Americans for Prosperity, described it as an assault on individual liberty. “When you have health care, that’s a choice that impacts yourself,” Phillips told MSNBC’s Hardball. “Drivers’ insurance impacts other drivers you may have accidents with.”
The attacks have confounded Democrats in and out of government, who noted quickly that mandating coverage was, until recently, a relative given when it came to health care reform. “It’s f–ing ludicrous,” said one health care reform activist, who noted that when Finance Committee Chairman Max Baucus (D-Mont.) asked committee members to air their disagreements with an individual mandate during a meeting on May 5, no one chimed in.
Indeed, for months it was presumed that a relatively ironclad deal was in place: in exchange for the government mandating coverage, private insurance companies would agree to cover individuals with pre-existing conditions. The arrangement was all but blessed by prominent figures from within the GOP ranks. In mid-August, the ranking member of the finance committee, Sen. Chuck Grassley (R-Iowa), announced that the way to get universal coverage is “through an individual mandate.” “That’s individual responsibility,” the senator told Nightly Business Report. “And even Republicans believe in individual responsibility.”
So, Chuck Grassley and at least six other Republicans currently in the Senate support — or at least are willing to sign off on — a law forcing Americans to buy health insurance. But that hardly renders it “non-controversial.”
Indeed, this provision was incredibly controversial during last year’s Democratic presidential primaries. Indeed, only John Edwards and Hillary Clinton supported mandates. Among those opposing? Barack Obama and Joe Biden who, as some will recall, went on to win the presidential and vice-presidential nominations, respectively, of the Democratic Party and go on to win election to those offices.
John Judis for The New Republic in June 2007:
Obama’s health care plan, which he announced last week, has been widely criticized by liberals for not making health insurance mandatory. Challenged by Edwards, Obama explained why a mandate is not a cure-all. “If you look at auto insurance, in California there’s mandatory auto insurance,” Obama explained. “Twenty-five percent of the folks don’t have it. The reason is because they can’t afford it. So John and I, we’re not that different in this sense; that I’m committed to starting the process. Everybody who wants it can buy it and it’s affordable. If we have some gaps remaining, we will work on that. You take it from the opposite direction, but you’re still going to have some folks who aren’t insured under your plan, John, because some of them will simply not be able to afford to buy the coverage they’re offered.”
Ron Chusid summarizes the intra-liberal debate on the subject in Liberal Values, February 2008
Paul Krugman continues his vendetta against Barack Obama’s health care plan due to its lack of mandates. The consequence of lacking mandates is unclear as nobody knows for sure how many people would still go without insurance if it was affordable but voluntary, and nobody really knows for sure how many people would remain uninsured despite mandates. It does seem reasonable to assume that achieving near one hundred percent compliance with a mandate would require yet another new bureaucracy and the expenditure of funds which might better be used for actual health care.
There are a variety of views as to whose plan would really insure more people. Robert Reich has argued that more people would wind up being covered under Obama’s plan than Clinton’s.
Using mandates to achieve universal coverage seems like quite a cop out to me. Regardless of whether the plan is good or the plan stinks, universal coverage is achieved because the government forces you to join up. In contrast Obama takes on the challenge of offering a plan so good that virtually everyone will want to participate to receive health coverage. There is also a clear philosophical difference here in that Obama isn’t obsessed with having every single person sign up. In contrast, a self-proclaimed government junkie like Hillary Clinton just can not live with the fact that somewhere, someone decides they do not want her help. Clinton will help them whether they want her to or not.
I know Clinton supporters will scream that I’m using right wing frames here, but again I must point out that freedom and choice should be considered virtues, not right wing frames. Liberty is what liberalism is ultimately all about, which explains whey Clinton prefers to label herself a progressive and not a liberal.
Some on the far left claim that Democrats lose when these alleged right wing frames about freedom are employed. They got it all wrong. Democrats lose when they concede traditional liberal values such as liberty to the right. If an election is framed so that one side is allowed to be defined as the party of freedom, that party will win virtually every time. Democrats have lost so many elections not because of using right wing frames, but because of conceding values such as freedom to conservatives, even though conservatives talk about freedom without really supporting it.
Ryan Lizza explains why Biden agreed to be Obama’s running mate for The New Yorker in October 2008:
Biden was impressed that Obama’s proposals seemed to be written with an eye toward passage in Congress. (For instance, the lack of a mandate in Obama’s health-care proposal could make the idea more palatable to Republicans.) During the primaries, Biden often played the role of policy grownup, the candidate who liked to chide the unrealistic plans of his rivals.
On July 17th, PoliFact’s Truth-o-Meter awards Obama a full-on flip flop on the issue:
Walk back with us through the mists of time to early 2008, and you might remember then-candidate Barack Obama defending the rights of hard-working people so they would not be forced to buy health insurance.
Obama’s position was different from his two nearest rivals, Hillary Clinton and John Edwards, who included mandates for individuals to buy health insurance in their plans for reform. It was an issue that got downright contentious on the campaign trail.
At a debate in South Carolina, Edwards said Obama’s plan really wasn’t universal health care, since it didn’t have a mandate to ensure everyone was covered.
Obama replied that his plan was universal (a claim we rated Barely True ) and explained why he was against a mandate: “A mandate means that in some fashion, everybody will be forced to buy health insurance. … But I believe the problem is not that folks are trying to avoid getting health care. The problem is they can’t afford it. And that’s why my plan emphasizes lowering costs.”
Obama said at the time it was possible some people would refuse to buy health care under his plan.
“It’s true that some people could game the system by just waiting till they get sick and then they show up,” Obama said. “But keep in mind that my plan also says children will be able to stay on their parents’ plan up until the age of 25. And so I don’t believe that there are a whole bunch of folks out there that will not get coverage. And John, both you and Hillary have a hardship exemption where, if people can’t afford to buy health care, you exempt them so that you sort of don’t count them.”
Now, I don’t much care about the flip-flop. The debate has moved over the past two years, as has the political make-up of the Congress. Obama may well have been legitimately persuaded that his best chance of getting what he wants it to accede to a mandate.
But let’s not rewrite history, either. Forcing Americans to buy health insurance regardless of whether they want it or can afford it is extremely controversial, with not only Republicans but most of the Democratic contenders for the presidency in 2008 opposing it.
UPDATE: Headline of the Day honors go to Bill Quick for “Mandating Change Without Hope.”