For progressives, it's exciting to see that at least all of the leading Democratic Presidential candidates have issued thought plans for affordable, quality, universal health coverage. The Edwards plan and Clinton plan are broadly similar. One striking difference between the Obama plan and the Clinton and Edwards plans is that Obama's does not require insurance for all adults. This, in Paul Krugman's view, among others, makes Obama's plan less comprehensive. The main reason for this sentiment is that without a mandate, some people will not choose to purchase insurance, with their bills falling in part on society at large when they seek medical care. I am enormously sympathetic to this view, but I think what matters here is the total share of the population covered and that the differences in that share under the Obama plan on the one hand and the Clinton and Edwards plans on the other is not fully known in the abstract. Keep in mind that even a "universal" plan with a mandate may not in reality cover many immigrants, lawfully or not lawfully present, and even a mandate cannot practically ensure that all adults are covered. Obama's plan relies on the expectation that coverage will be so affordable that few people will not sign-up for it. Additionally, mandates may largely punish lower income people who find coverage costs to be prohibitively expensive, even under plans like those proposed by Edwards and Clinton. Today's Progressive States Network's Stateside Dispatch highlights this concern, relying in part on the Massachusetts experience, concluding, rightly I think, that "As a means to achieving quality and affordable health care for all, individual mandates are problematic absent strong affordability protections for consumers."
[In the interest of full disclosure: I have contributed to Senator Barack Obama's campaign.]
19 November 2007
Universal Health Coverage and Mandates
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2 comments:
hey, good post, indi. from an
anti-poverty standpoint (which is arguably the most important when it
comes to health care), i think you're absolutely right. why mandate coverage that could potentially penalize the poor when we don't have a good sense of what would actually be affordable yet. instead of starting with a mandate, we should make health care affordable to everyone as best
we can guess, and then offer more affordable options or enforce a mandate later if it's needed. which is what BO is proposing. it might mean the process of covering everyone takes longer than with a mandate, but we have no evidence to suggest that.
the BO approach also seems better from a political standpoint, too, which i've mentioned before. i think it
would win over more moderate dems and republicans to pass a universal
health care plan with teeth. but that's mostly guessing on my part.
still, i believe it's more likely to get through even a more democratic congress. the political disadvantage, though, is that BO's plan can be attacked as NOT universal (even in theory). which is what HRC's been saying. it's wrong to say that, though: they're both incrementalist approaches in reality -- HRC's just has the advantage of sounding more
universal in rhetoric because on paper it requires EVERYONE to buy in.
that's a lot of ramble, sorry, esp since i don't think i said anything
new.
forgot to mention earlier, but in the interest of full disclosure, i am a staffer in Senator Obama's personal office in DC.
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