Sperling v. Reich on Mandates

Here is former Labor Secretary Robert Reich's defense of Sen. Obama--and attack on Sen. Clinton--focusing particularly on Senator Clinton's criticisms of Sen. Obama's health plan and its lack of a mandate for all adults (Hat Tip: Nicholas Rathod). Gene Sperling forcefully defends Sen. Clinton while criticizing Secretary Reich. Note: Talso some interesting debate about social security in those two links.

Reich's most compelling point is that "that mandates still leave out a lot of people at the lower end who can’t afford to insure themselves even when they’re required to do so." Of course, a mandate would surely leave out fewer people. My bigger concern with a mandate is over the severity of the possible penalties for non-enrollment and how fairly distributed those penalties would be along the socio-economic spectrum.

Sperling offers a few good links to articles, papers and testimonies laying out a strong case for the need for mandates in a universal system:

"I encourage Bob or anyone else interested in this issue to review the overwhelming consensus of credible independent experts who have found that an individual requirement is a necessary component of any plan designed to cover all Americans. [E.g. Jonathan Gruber, MIT (12/05/07); Diane Rowland, Kaiser Family Foundation (New York Times, 11/25/07); United Hospital Fund (December 2006); California Medical Association (July 2005); Henry Aaron and Bruce and Virginia MacLaury, Brookings Institution (CQ Congressional Testimony, 9/11/07); John Holahan, Urban Institute (October 2005); Len Nichols, New America Foundation (US Fed News, 6/26/07); Drew Altman, Kaiser Family Foundation (New York Times, 11/25/07)]."

I have previously defended as "reasonable" Sen. Obama's decision to not initially include a mandate in his health plan. I have to wonder if big enough subsidies--to the point of nearly paying for private insurance for some--under any of the Democratic plans can't attract lots more folks than models now show, and I do think there is a plausible story of how the lack of a mandate might boost support for increasing these subsidies, as I noted in my earlier post. Nevertheless, the research cited by Sperling underscores the argument that mandates are probably eventually necessary to achieve universal coverage, at least in a non-single payer system. Maybe there's good reason to begin without a mandate, work to address concerns about disproportionately affecting those lower on the socio-economic spectrum, and then introduce a mandate?

[In the interest of full disclosure: I have contributed to Senator Barack Obama's campaign.]