Health Coverage Mandates and Subsidies

Paul Krugman opinion piece today focuses on health coverage mandates. I think it sums up the argument for mandates fairly well, but I am less sure about some of the arguments against plans without a mandate. For example, Krugman writes,

"The second false claim is that people won’t be able to afford the insurance they’re required to have — a claim usually supported with data about how expensive insurance is. But all the Democratic plans include subsidies to lower-income families to help them pay for insurance, plus a promise to increase the subsidies if they prove insufficient.

In fact, the Edwards and Clinton plans contain more money for such subsidies than the Obama plan. If low-income families find insurance unaffordable under these plans, they’ll find it even less affordable under the Obama plan."

The claim "that people won’t be able to afford the insurance they’re required to have" isn't false. Unless you are willing to offer some free and/or near free adult health coverage, beyond Medicaid and Medicare, the claim is actually true. Affordability is subjective of course, but it is not difficult to see how, even with some subsidies, health coverage can be too expensive. In criticizing Sen. Obama's plan in particular, Krugman responds by arguing that Obama offers less in subsidies. Now, if that's true, that seems to be more troublesome than the lack of a mandate--unless the Obama proposal compensates by doing more to contain health coverage costs in general. I'll look for the data on it and post it as soon as I find it...

But one other point: Krugman closes his column by saying,

"I’d add, however, a further concern: the debate over mandates has reinforced the uncomfortable sense among some health reformers that Mr. Obama just isn’t that serious about achieving universal care — that he introduced a plan because he had to, but that every time there’s a hard choice to be made he comes down on the side of doing less."

Now, while I've outlined an argument for leaving out a mandate, and I nevertheless prefer a mandate--at least in the long-run--this accusation about Obama's intentions seems incredibly implausible at best, in light of . Obama's campaign announcement speech, as well as his pre-Presidential campaign record, including, for example, his push for universal coverage while in the Illinois Senate.

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