Healthcare Mandates

There's been this reflex among pundits, when the healthcare issue comes up, to automatically assess it as Sen. Clinton's strength and an issue which hurts Obama. This needs to be smacked down.

As discussed in the Los Angeles/CNN debate, the proposals of the two campaigns are very similar... except, of course, on the issue of mandated coverage. That is the lynchpin of Clinton's plan, while Obama opposes it. I oppose it as well and-- bear with me-- I will explain why.

For the record, I fully support universal health-care... meaning the type of traditional, single-payer system that most European nations have. It's not only actually universal in the true sense of the word, but it's also far more economically efficient (as blogger Atrios has noted, "close to 5% of our GDP is spent on people pushing little bits of paper back and forth between doctors and insurance companies.") Sen. Clinton's mandates would merely force every citizen to obtain some form of health insurance-- our current system and options would change little-- with some limited subsidies from the government to help ease the cost(s). The theory here is that, by forcing everyone into the pool, you can control costs better and foster responsibility among all parties.

But that's not universal healthcare... it's universal health insurance, and not even, because everyone would still have something different (different policies, costs, and standards). It's the same broken system that we have now, except we'd all have no choice but to be a part of it. Her proposal would not change the reality of a having a profit-based healthcare system. And-- unless I have misheard her (please do correct me if I am wrong)-- this is her endgame. She has no larger plans to repair this system, she simply believes that it will run smoother if we all are a part of it. This requires a serious leap of faith.

On 'Democracy Now' last week, economics journalist Robert Kuttner criticized the naivete of this position. Ignoring even how subsidies can possibly help people who are broke, he notes that-- to the insurance industry-- cost saving comes in the form "less care rather than in the form of less waste." Moreover, he states that such a forceful approach (mandates, garnishing wages) "signals that governnent is being coercive, rather than being helpful."

Sen. Obama, meanwhile, is on the record of having a single-payer system as his endgame. The Concord Monitor wrote last year that-

Obama said if he were starting from scratch, he would probably propose a single payer health care system, but because of existing infrastructure, he created a proposal to improve the current system.

He's also said that "over time it may be that we end up transitioning to such a [single-payer] system. For now, I just want to make sure every American is covered... I don't want to wait for that perfect system." This makes his proposal not just the more liberal one (good for us), but also the most pragmatic in approach (good for, you know, actually getting it passed).

So in the end, I do want universal care. But let's do it right. A half-assed approach will only damage us long-term.