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Tilting at Windmills

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November 30, 2007
By: Kevin Drum

THE EDWARDS MANDATE....Both John Edwards and Hillary Clinton include "individual mandates" in their healthcare plans that require everyone in the country to sign up for coverage. But what if you refuse to sign up anyway? Today, John Edwards explained how his plan would deal with that:

Under the Edwards plan, when Americans file their income taxes, they would be required to submit a letter from an insurance provider confirming coverage for themselves and their dependents.

If someone did not submit proof of coverage, the Internal Revenue Service would notify a newly established regional or state-based health-care agency [which] would enroll the individual into the lowest cost health-care plan available in that area....The newly covered individual would not only have access to health benefits but would also be responsible for making monthly payments with the help of a tax credit.

....If a person did not meet his or her monthly financial obligation for a set period of time (perhaps a year, perhaps longer) the Edwards plan would empower the federal government to garnish an individual's wages for purposes of collecting "back premiums with interest and collection costs."

Paul Krugman calls this a "terrific idea," but I'm not so sure. There are at least two big problems here — and probably three.

First, do we really want the IRS enforcing healthcare mandates? That's not what the IRS is for, and Americans are (rightly) suspicious of using the IRS as a quasi-police agency to enforce whatever federal law the current administration feels like using it for. This is probably not a constructive road to go down.

Second, a Rube Goldberg enforcement program like does nothing except highlight the absurdity of individual mandate healthcare plans in the first place. If you're really this serious about getting every man, woman, and child in the country enrolled, why go through all this? Why not just do it like Medicare, where the funding mechanism is the existing tax system and everyone is enrolled automatically? It amounts to the same thing and it's cheaper, easier, and less intrusive.

Third, this is a political loser. Do we really want to treat people who don't sign up for healthcare like deadbeat dads and Chapter 11 refugees by garnishing their wages? Unless I'm way off base, this is just not going to go over well. Republicans will have a field day with it.

Sometimes you can offer too much detail in a campaign, and this is one of those times. No healthcare plan will survive the election in anything close to its campaign form, so why bother offering up a detailed enforcement mechanism that's never going to see the light of day anyway? Politically it's an albatross and substantively it's meaningless. It's just a mistake all around.

Kevin Drum 2:00 AM Permalink | Trackbacks | Comments (112)

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Comments

Wow, what an awful idea. And I say that as an Edwards supporter. I really hate this idea of "universal healthcare" via fines and punishments. Who on earth on the right or the left supports such a stupid system? Only sensible centrists, bane of America.

Posted by: JD on November 30, 2007 at 2:10 AM | PERMALINK

As Atrios has often said, the simplest, smartest thing is to just enroll everyone, period, immediately, done.

Posted by: Ralph Waldo on November 30, 2007 at 2:10 AM | PERMALINK

How much are the payments for the lowest cost health plan? I presently have Christian Science HMO, which involves praying you don't get sick, but is otherwise free.

Posted by: Luther on November 30, 2007 at 2:11 AM | PERMALINK

Kevin: "If you're really this serious about getting every man, woman, and child in the country enrolled [in health care coverge], why go through all this?"

Four simple words: Blue Cross / Blue Shield.

Posted by: Donald from Hawaii, & currently in Chicago on November 30, 2007 at 2:16 AM | PERMALINK

This is just about the craziest scheme I've heard yet! Getting the IRS involved is ludicrous and the mandate idea isn't much better. Together they make the whole program sound like a big brother/big industry scam. Universal healthcare should be a right, not an obligation. I'll bet this idea has something to do with insurance company meddling and political influence.

Posted by: nepeta on November 30, 2007 at 2:23 AM | PERMALINK

Agreed 100%... these universal mandate proposals even give ME the creeps... it's not only going to hurt the candidates, it will hurt the cause of universal coverage, as people will now see it as a police state requirement... it also reinforces the right's absurd notion that the left wants to force you to do things (when it is the other way around)...

So, here's the question, though... What do they do in Mitt Romney's mandatory universal health care plan in MA if you don't enroll? Anyone know?

Thanks,

Mike

Posted by: lord_mike on November 30, 2007 at 2:24 AM | PERMALINK

Kevin, when you do coverage of the primary, why don't you ever mention that your publisher, the person who pays you, is a vocal supporter of Senator Clinton and massive fundraiser for her? I'm sure it could just be a coincidence that your coverage of the primary tends to consistently slant in the same direction, but isn't disclosure the best way to handle your situation?

Posted by: Petey on November 30, 2007 at 2:25 AM | PERMALINK

"As Atrios has often said, the simplest, smartest thing is to just enroll everyone, period, immediately, done."

That's exactly what the Edwards plan does.

The Clinton plan hints at doing that, but Senator Clinton doesn't have the backbone to actually lay out the mechanisms.

The Obama plan doesn't cover everyone, so it can't enroll everyone.

Posted by: Petey on November 30, 2007 at 2:27 AM | PERMALINK

why go through all this? Why not just do it like Medicare, where the funding mechanism is the existing tax system and everyone is enrolled automatically? It amounts to the same thing and it's cheaper

I suppose for the same reasons mandatory auto insurance is also not provided by the government: The presumption that people will be better off if they can choose a policy from competing insurance companies. (Different deductibles, for one).

But this is a tough thing to sell either way. You either do what Kevin suggests (and you'll be accused of being a socialist) or you do what Edwards suggests, and you will be crucified for the reasons Kevin suggests. I see no easy way. And I agree with Kevin -- avoid details in a campaign. That's not really what the people want to hear. Details paint targets on your back but don't earn you any votes.

Posted by: JS on November 30, 2007 at 3:08 AM | PERMALINK

If being "accused of being a socialist" is such an undesirable fate, perhaps the surest way to avoid it is to refrain from proposing socialist programs?

Posted by: sammler on November 30, 2007 at 3:13 AM | PERMALINK

At the risk of being accused of seeking the perfect at the expense of the good--the problem with these plans is that they all provide for universal (or nearly universal) health care insurance coverage. Rather than universal health care.

I see I'm only repeating what New England Peter (or is it New Economic Plan Estimated Time of Arrival?) and Lord Mike have already said. LM's question is a good one. And here are two more along the same lines: What is Schwarzenegger's plan? And what is the Democrats' proposal in response to it? I look forward to some spirited wonkish discussion of an issue we all need to know much more about.

Posted by: Henry on November 30, 2007 at 3:16 AM | PERMALINK

Awesome, using the IRS as health insurance cops is a great idea! And the prospect of the IRS garnishing your wages if you can't afford health insurance premiums will make the people stand up and vote for Edwards.

I don't know about you but the IRS is this American's favorite government agency!

Posted by: Old Hat on November 30, 2007 at 3:23 AM | PERMALINK

Re. Kevin's points, yes, yes and yes. And Krugman usually has better judgement than this.

Just do it like other countries do it. Universal and non-intrusive.

Posted by: snicker-snack on November 30, 2007 at 3:25 AM | PERMALINK

Worst Health Care Proposal Ever!

Posted by: Michael Buchanan on November 30, 2007 at 4:08 AM | PERMALINK

Why would Democrats want to nominate someone so willing to commit political suicide? Why doesn't Edwards just say he doesn't want to be president? There's candor!

Posted by: Mina on November 30, 2007 at 4:54 AM | PERMALINK

Kevin is right, of course, but only up to a point.

On of the problems we face in whenever we decide to go from where we are to where we want to be. Now, in the U.S., most people get their health care by means of their employers' insurance programs, vast organizations employing hundreds of thousands of recent liberal arts graduates.

We need to transition as smoothly as we're able from the existing mess to the promised land, and it's a sure bet that we won't be able to get there without a few compromises along the way.

That being said, I don't like Edwards' plan either.

Posted by: bad Jim on November 30, 2007 at 4:58 AM | PERMALINK

Petey - I'm all in favor of disclosure, but this discussion ain't likely to be helpful to Clinton. After all, Clinton co-opted Edwards' plan, mandate included. Now Edwards has specified how he'd enforce the mandate, which she had avoided doing. I'm sure she'll dance away from this somehow, but it's a discussion she clearly doesn't want.

Posted by: Rebecca on November 30, 2007 at 5:06 AM | PERMALINK

"On of the problems we face in whenever we decide to go from where we are to where we want to be" has to be among the candidates for the most incoherent sentence ever posted here.

The first question you face whenever you decide to go from where you are to where you want to be is whether you can get from here to there. The second is, if you can get from here to there, how.

The third through fifth questions are routine: what year is it, who's your daddy, how long have you been doing that.

Posted by: bad Jim on November 30, 2007 at 5:12 AM | PERMALINK

Garnishing wages is going to be about as popular as circumcising teenage boys. How could it help people who can't afford health insurance?

If America is short of money, isn't the first place we ought to look for it is among people who have lots of it? The income tax is the appropriate means of paying for health care.

Tying health care to Medicare runs the risk of tying it to Social Security and payroll taxes, which lets various income streams escape taxation.

Nevertheless, much of the structure is already in place. It might work. When I look at my old paychecks it's not that easy to separate which subtraction is FISA, which IRA. (I remember going ballistic in the 80's upon noticing my SDI paycheck deduction; no way I was willing to fund Reagan's Strategic Defense Initiative.)

Posted by: bad Jim on November 30, 2007 at 5:47 AM | PERMALINK

Kevin

Don't be a fool. Evaluate plans that exist, not plans you want. If you would like to compare Clinton's plan to Edwards, by all means do so. If you would like to compare Edward's plan to Obama's, by all means do so.

But -- comparing Edward's plan to the platonic ideal of a health care plan is stupid.

That kind of comparision short circuits any debate and favors candidates that talk least about their proposals. And you wouldn't want to favor such elitist, uncommunicative candidates, would you?

Posted by: Adam on November 30, 2007 at 6:01 AM | PERMALINK

How do other countries implement universal healthcare? Maybe we should ask them.

Posted by: pol on November 30, 2007 at 6:28 AM | PERMALINK

Michael Buchanan--
The worst health care proposal ever is to keep the current system. However, Edwards comes close.

Posted by: reino on November 30, 2007 at 6:42 AM | PERMALINK

I'm very liberal but I also have healthy libertarian streak running through me. I suspect that is the case with many liberals/progressives. Mandating healthcare insurance without really cracking down on healthcare costs will be like forcing folks to subscribe to cable broadband. What happened to the idea of freedom and choice? Why can't someone talk about empowering individuals and communities with liberal goals such as universal coverage and a less aggressive outlook on the world? The reason folks like Rush Limbaugh are so effective is because even liberals don't trust big government all the time. Look no further than the Medicare prescription drug fiasco, the true cost of which will be born by our grandchildren. Come on! we all know that there is really no longer a political left and right in Washington. We have the powerful and we have the raving nutwing powerful. Is there any real daylight between "let's stay in Iraq for 30 years" and "we need to stay there and be responsible." Jeebus! Modern government in Washington is susceptible to powerful interests with narrow agendas and lots of money to spend. There is an opportunity for a candidate to step up from the left with an argument for liberal ideals (universal healthcare, energy independence, free pre-primary education, whatever) with post-liberal (post DLC) really progressive approaches to policy. That's the real reason I will never, ever vote for a Clinton.

Posted by: huh? on November 30, 2007 at 7:02 AM | PERMALINK

It sounds like a bad idea to implement a good idea. It is so sad that details of a plan to provide health care can torpedo a candidate's hopes while not providing details of a plan to use military force can get one re-elected. We live in an upside-down world.

Posted by: The Conservative Deflator on November 30, 2007 at 7:07 AM | PERMALINK

pol: How do other countries implement universal healthcare? Maybe we should ask them.

We couldn't possibly do that! We're 'Murricans and we couldn't possibly admit that someone else could do better than us. After all, we do health care better than Slovenia.

Posted by: natural cynic on November 30, 2007 at 7:13 AM | PERMALINK

yes, not to change the subject but sents when did we the american people do a mass vote to being taxes through the our states lottery system? I have been playing the lottery for the past 12 years and I've been whiching how many winners come out in that time.
One winner every drawing for the past 12 years all a quick pick ticket. I have the same numbers one dollar and a dream. Do you know what the odds of that are. Why do they give you other numbers to pick from then? There's sure a lot of talk about being cheated why not start here at home first. Boy-cott the lottery there un-fair taxes

Posted by: Inventor Mr Todd J. Tocco on November 30, 2007 at 7:31 AM | PERMALINK

I like Edwards but, ugh. Wage garnishment? Really? No. Why not just hand your ass to Rush Limbaugh already, Edwards?

Why in Jebus' name can't we find a Dem who is both progressive (for the Dems) and not completely utterly tone-deaf about how their message sounds on the trail? It's Dean all over again. Might as well throw a "YAAARGH" in there for effect. (I LIKED Dean. But even I thought he interviewed badly and was prone to awkward outbursts).

The sad thing is...I'm pretty sure that were Edwards miraculously elected, he and Congress could find a better way to do this. Instead we'll have to spend all our time keeping Hilary from creating a third rate corporate-friendly mess.

Posted by: emjaybee on November 30, 2007 at 7:36 AM | PERMALINK

Medicare for all, funded by an income tax surcharge, is the only clean solution to what should not be a problem.

Posted by: bob h on November 30, 2007 at 7:37 AM | PERMALINK

I also hate the idea.

I live in Massachusetts, which has a similar program, a MAZE for employers and employees.

It forces employees to pay for health care insurance, at a time when the prevailing wages don't cover food and housing.

Its great for older guys like me, that get subsidized when a younger employee joins the company's group.

The insurance model (whether private or governmental) gives a blank check to health care providers. I'm a CPA, so I've seen doctors' pay increase from affluent to aristocratic.

That in itself, and the bloat of expensive services, makes us SPEND more on healthcare than is necessary.

I recently had a condition that an insightful holistic physician diagnosed in a half-hour conversation with me, that the medical profession spent $20,000 on tests and six months to figure out.

The point is not to fetishize the particular skill of the holistic doctor, but to suggest that his knowledge is useful and efficient, and better use of funds that could be confirmed by medical tests rather than fishing.

Posted by: Richard Witty on November 30, 2007 at 7:44 AM | PERMALINK

The debate between Obama and Edwards over how they're going to implement health care is remarkable because the criticisms each has of the other is exactly on target.

As Edwards argues, Obama's program is terrible because it wouldn't guarantee that everyone is covered. As Obama argues, Edwards' program is terrible because it comes with heavy handed, often perversely unfair penalties.

What is the only correct conclusion from this? That the basic system they both espouse, which essentially relies on preserving the current insurance industry and payment structure, suffers from an inherent, fatal flaw.

It amounts to a powerful, indirect argument by elimination in favor of Medicare for All.

Posted by: frankly0 on November 30, 2007 at 7:50 AM | PERMALINK

I believe this provision is intended for conservatives. You know, "no free ride for the poor".

Posted by: david on November 30, 2007 at 7:50 AM | PERMALINK

#1 - You are right!

#2 - Your are right again!

#3 - You are doubly right!

Posted by: Mark-NC on November 30, 2007 at 8:09 AM | PERMALINK

When Mitt Romney and the Democratic legislature introduced this in Massachusetts, it was one big reason for me leaving. (I was a freelancer at the time.) I can't imagine why Edwards wants to be the Democratic Romney. And the idea setting up a whole new layer of "helpful" state agencies reminds me why I'm a Libertarian.

I was sort of pulling for Edwards until I read this post.

Posted by: Equal Opportunity Cynic on November 30, 2007 at 8:09 AM | PERMALINK

Hate to rain on Edward's plan but . . . .

A significant number of poor folks never file income tax returns.

Posted by: Bruce in Norte California on November 30, 2007 at 8:13 AM | PERMALINK

Many unviersities have been doing something like this for years with good success. It is called a "hard waiver".

Don't discount this idea too quickly.

Posted by: BigRed on November 30, 2007 at 8:16 AM | PERMALINK

I've made this point a million times by now, but the most perverse aspect of the sort of penalties that Edwards proposes is that they are most likely to hit the people in the worst position to handle them.

Suppose you are laid off from your job, and can't find work for a long, long time. Immediately upon losing your job, your income plummets, of course, and you can barely manage, if at all, to pay your pre-existing bills. But here's the additional rub: beyond everything else, you must now pay for health insurance. But where is the money going to come from to cover that? Presumably, if you don't have the money to cover it, you just drop your health insurance. So you are now not covered. What in Edwards' plan deals with this? How is the individual helped?

Now let's assume that Edwards' plan at least says you can somehow sign up for some kind of low cost insurance, be charged premiums, but not make payments and yet not be thrown off the plan. Now, very few people are going to be comfortable with getting behind on their payments like that even if they know they're not going to lose access to health insurance.

But of course the real sticking point is that they are indeed piling up a debt exactly when they can least afford to do so. Someday, that debt must be paid. The Edwards' plan turns that obligation into the most oppressive kind of obligation of all: one that is enforced by law by a governmental agency. In the best case, that debt is still one more major hole one must dig oneself out of when finally one is employed again -- if one can indeed secure further employment. Given the incredible amount of money one must pay for medical insurance, it could be over ten thousand dollars if one is unemployed a year or more. Worse yet, the IRS is going to employ even further penalties and interest on top of those major costs if they can't be paid on time.

There's no getting around how badly that is going to be perceived by the general public. God only knows how many real life tales of authentic misery this will engender for the Republican Party to use in its crusade against the evils of "socialized medicine".

Posted by: frankly0 on November 30, 2007 at 8:19 AM | PERMALINK

Politically, there is no sense in offering too much detail at this point. 535 congress-critters will want their input on any healthcare legislation. At this time, candidates should only present the primary features and goals of their plans. Edwards blew it on this one.

Posted by: Marvyt on November 30, 2007 at 8:40 AM | PERMALINK

This is the kind of plan Democratic politicians like Clinton (and now unfortunately Edwards) come up with when they confuse "being more moderate and mainstream" with "being more comfortable for the insurance companies and other business lobbyists."

Kinda like "moderate" Democrats voting for that unconscionable bankruptcy bill, and now being utterly unable to say they did anything to prevent millions of Americans from losing their homes. You tell me that alleged broad mainstream of moderate Democrats and independents really wanted them to do THAT! Those citizens' "moderation," whatever it may be, certainly was not a commitment to supporting the country's largest and most powerful industries against tens of millions of ordinary people (the very people, incidentally, who are and should be at the heart of the Democratic base!)

You're right, Kevin: individual mandates are stupid politics! Sometimes you wonder how our Democratic leadership can breathe in the morning, much less govern.

Boy, am I in a grouchy mood.

Posted by: Bill Camarda on November 30, 2007 at 8:53 AM | PERMALINK

Why not just do it like Medicare, where the funding mechanism is the existing tax system and everyone is enrolled automatically?

Well, first off, Medicare doesn't enroll "everyone"--it gets about 96% of those eligible, which is about as good as you can get with a system that relies on only one data stream, social security.

Second, Medicare enrollment doesn't work through the tax system, it works through the PENSION system. It's from SSI data. Which when you're young is the "system that takes money from my paycheck" but when you're old, it's the "system that GIVES me money." This is data that the government is PAYING you if you get it correct, so it's bound to be right. And if the data gets outdated, you can bet people are going to notice when the check doesn't come and do something about it.

The kind of people who haven't got updated SSI or tax records--people moving a lot, people with difficult lives, low-income people, young people bouncing from job to job and apartment to apartment or taking a year to travel--overlaps significantly with the uninsured.

Expecting that an enrollment system built around the one which gives old people their pension checks will work equally well for old people getting pension checks and young people who aren't getting pension checks is silly. Unless we want to build an entirely new bureaucracy, this kind of approach probably is best.

Posted by: anon on November 30, 2007 at 9:11 AM | PERMALINK

Fourth, and worst, this totally misses the people who are supposed to be the most in need of healthcare. Once again, a plan to punish those honest, hard-working Americans who file their taxes and reward those who could work but won't. This plan naively assumes everyone files tax returns annually and that is just not true. Why do it at all if it isn't targeted to the majority without healthcare. Not only a dumb idea, but an outright deception acknowledging that he believes his voters are too stupid to see how stupid it is.

Posted by: quark on November 30, 2007 at 9:13 AM | PERMALINK

With all his years fighting insurance companies in court, I'm surpirsed Edwards is promoting keeping those same companies part of the overall program. Better to eliminate private companies and create a single payer system. The LAST thing insurance companies are interested in is insuring people's health - or life.

Posted by: lamonte on November 30, 2007 at 9:15 AM | PERMALINK

I have to agree that I'm not sure that people who don't have health care at this time want to be forced to pay for it. I associate that approach with Republicans, frankly. I have to assume that Edwards has functions built into his plan to mitigate the costs that low-income people would pay in this case. I think, Kevin, that if you don't mention those parts of Edwards' plan, you do him a disservice.

Posted by: glasnost on November 30, 2007 at 9:21 AM | PERMALINK

Let's not forget that Medicare requires enrollment. And however odd and surprising as it may sound, not everyone who is legally entitled to Medicare does enroll, even in Part A. What would a "Medicare for all" system do in such cases? I'm not aware of anyone trying to address that question. There's just an assumption that it's not an issue.

Wage garnishment does not make me all warm and fuzzy especially from a political perspective. But give Edwards credit with trying to deal practically with the variety of human responses to life.

Posted by: Albany Democrat on November 30, 2007 at 9:22 AM | PERMALINK

Agreed, this idea must be changed pronto

Posted by: jim on November 30, 2007 at 9:23 AM | PERMALINK

We were forced to buy a plan for our daughter to attend college in Mass., since we don't have health care due to the fact we live in England. Which partially wipes out one of the benefits of living here. I didn't like that at all, especially since we still had to pay for her to use the campus clinic, which is where she'd go if she ever did get sick, a somewhat unlikely occurrence.

Posted by: KathyF on November 30, 2007 at 9:27 AM | PERMALINK

The more I think about it... the more I kind of like Kevin's idea of a VAT, but dedicated only to single-payer healthcare. No forms, no futzing around with health care tax credits with the IRS, etc. The VAT would apply to all sorts of economic activity and would probably be the fairest tax to fund the system for the most people. Keep the private insurance industry around, but purely to provide "gap" insurance for people who would otherwise have to top-up for elective procedures, etc.

Posted by: Doc at the Radar Station on November 30, 2007 at 9:31 AM | PERMALINK

Wow, now what does this do to Sen. Clinton's vague plans? She will be pressed on how to implement it, and if she doesn't give straightforward answers, the inference will be that it will be like Sen. Edwards'.

Posted by: RollaMO on November 30, 2007 at 9:33 AM | PERMALINK

Thanks to those who have corrected Kevin's "automatically enrolled" error.

And there is also a twist to this - If one does not accept enrolling in medicare when first eligible at 65, then a 10% penalty per each year is added to the monthly fees. So, if one is eligible at 65, but opts out of enrolling, then, if that person enrolls, say at 70, they are hit with a 50 percent per month penalty. Not a one time penalty fee, but a fee increase for each and every month there after.

And Social Security already is a collection agency for back student loans. There was a 73 year old invalid who fought this and took it to the Supremes a few years back and lost nine zip. Terrible idea for a smart trial lawyer to push.

Posted by: bert on November 30, 2007 at 9:40 AM | PERMALINK

The only good thing about this idea is that it gives him something he can compromise on. Is he secretly trying to kill the whole deal?

Posted by: katiebird on November 30, 2007 at 9:44 AM | PERMALINK

"First, do we really want the IRS enforcing healthcare mandates? That's not what the IRS is for"

Hmm, medicare is a tax entry on my weekly check and W2. I'm pretty sure we are using the IRS for healthcare mandates today.

"Why not just do it like Medicare, where the funding mechanism is the existing tax system and everyone is enrolled automatically?"

Posted by: Steve on November 30, 2007 at 9:47 AM | PERMALINK

"First, do we really want the IRS enforcing healthcare mandates? That's not what the IRS is for"

Hmm, medicare is a tax entry on my weekly check and W2. I'm pretty sure we are using the IRS for healthcare mandates today.

"Why not just do it like Medicare, where the funding mechanism is the existing tax system and everyone is enrolled automatically?"

Yes this seems to be the only way it will work (maybe the IRS can keep track though payroll taxes).

Payroll taxes would be collected to fund the lowest cost universal plan. If no insurance is purchased from the "free market" the person would be enrolled int the low cost federal/medi program. If insurance is purchased the insurer would be paid initially from these taxes, with any additional payment coming from the insured.

Posted by: Steve on November 30, 2007 at 9:49 AM | PERMALINK

Excellent post Kevin.

Posted by: Gary Sugar on November 30, 2007 at 9:54 AM | PERMALINK

Kevin states a good, concise case against the Edward's plan. Particularly repellent about the plan is the garnishment scheme, which is political poison. Democrats should drop this stinker as quickly as possible.

Posted by: McCord on November 30, 2007 at 10:06 AM | PERMALINK

There are scores of countries that have health plans like the ones proposed by Edwards and Clinton. As far as I know, all of them require everybody to be insured. Has anybody (besides Ezra Klein) actually thought of finding out how these countries enforce their individual mandates?

Posted by: Stan Jacobs on November 30, 2007 at 10:07 AM | PERMALINK

Yhanks to Steve for injecting a moment of sanity into the debate. The tax system would be used to pay for UHC as single payer so why not use it to fund individual mandates, if one doesn't purchase a private plan? Sounds reasonable to me.

Posted by: RalphB on November 30, 2007 at 10:11 AM | PERMALINK

The absurdity of our political system reminds me of any number of Monty Python skits.

Posted by: Speed on November 30, 2007 at 10:25 AM | PERMALINK

Kevin wrote: "... a Rube Goldberg enforcement program ..."

It's quite amazing the lengths that "sensible liberals" will go to, to keep universal not-for-profit single payer medical insurance under efficient, open, transparent and accountable public administration, ie. "Medicare for all", off the table.

But it is understandable that they do so, given that they are not concerned about the best interests of the American people, but about the interests of the ultra-rich insurance and drug corporations.

Rep. Dennis Kucinich supports universal not-for-profit single payer medical insurance under efficient, open, transparent and accountable public administration, ie. "Medicare for all", which is why moderators of Democratic candidate debates make sure to ask him questions about UFOs.

The most effective, most equitable, and lowest cost solution, which is favored by the majority of Americans in poll after poll, must always be portrayed as a wild-eyed notion of crackpots, because it is unacceptable to the ultra-rich insurance and drug corporations.

And that's the way it is.

Posted by: SecularAnimist on November 30, 2007 at 10:25 AM | PERMALINK

The Medicare payment model works. There is no reason to give any for-profit companies a cut of the health care payment dollar, except to the extent that they are simple administrators. Single payer funded by VAT is a far wiser choice.

Posted by: freelunch on November 30, 2007 at 10:27 AM | PERMALINK

Shorter Kevin Drum and most of the above commenters- No to wage garnishment by the IRS, yes to new income/payroll taxes?

For most Americans who foolishly believe their healthcare is mostly free today from their employer, neither option is going to be a political winner.

However, I do have to give Edwards credit for stepping up to the plate and providing actual details, and what does he get for such honesty? He gets people like you criticizing him for being specific with his plans.

Posted by: Yancey Ward on November 30, 2007 at 10:34 AM | PERMALINK

This seems pretty close to what happens at any college in the U.S. -- you have to furnish proof of insurance to enroll, and if you don't you have to buy insurance through the school. there is no choice in the matter. at most larger schools, you have access to the school clinic often through a student fee. but you are still required to have health insurance.

Posted by: Inaudible Nonsense on November 30, 2007 at 10:40 AM | PERMALINK

The document forgery and the health insurance lobbies must have made some big donations to Edwards' campaign.

Posted by: Brojo on November 30, 2007 at 10:45 AM | PERMALINK

Wow, talk about a reductionist argument about a proposal that actually makes sense.

Here's how the Edwards plan actually works:
When you interact with ANY government agency - paying your taxes through the IRS, going to a public hospital's ER, renewing your license at the DMV, or what have you, you will be asked if you have insurance.

If you don't, you will be enrolled in a plan on the spot. This aspect is absolutely critical for ensuring truly universal health coverage. Without actually going through the process of signing people up who aren't insured, you're not going to get them.

Second, depending on your income and other factors, you can opt into a plan that makes sense for you - including Medicare, Medicaid (if you're an adult in poverty or a family within 250% of poverty), SCHIP (if you've got kids), the new public plan for adults and families above poverty, or a private plan.

Third, these plans are scaled to fit many different family and individual budgets - AND the Edwards plan also provides sliding scale subsidies to help pay for the premiums, based on your income. So the idea that people would be forced into the poorhouse by their new health insurance is inaccurate.

Fourth, for the vast vast majority of people, you're not going to need to garnish their wages or anything like that, for the same reason that most people don't have their wages garnished for failure to pay their taxes. This part is designed so that everyone, including the small minority of ornery people who try to get a free ride, pays their fair share.

Posted by: StevenAttewell on November 30, 2007 at 10:55 AM | PERMALINK

Mandates are horrible unless, as in Germany's national healthcare system, people get vouchers to pay the insurance costs.

Posted by: SocraticGadfly on November 30, 2007 at 11:03 AM | PERMALINK

I can see one argument in favor of Edwards' plan. *If* he is elected after laying out this plan, he has a mandate to go ahead. Whenever someone explains how terrible the plan is, he can come back with "I was elected to do this." What will Hillary's mandate be? Do something that won't upset anyone?

Posted by: EmmaAnne on November 30, 2007 at 11:05 AM | PERMALINK

Kevin is right about the details of the implementation of health care. The details and minutiae need to be tweaked. But it is not the details that matter - it is who has a proven record of taking on powerful corporate interests and winning and the commitment. We need someone who has been proven as fierce as a pitbull in fighting powerful entrenched forces like those opposed to universal healthcare. The only one is Edwards.

Posted by: Chrissy on November 30, 2007 at 11:09 AM | PERMALINK
First, do we really want the IRS enforcing healthcare mandates? That's not what the IRS is for, and Americans are (rightly) suspicious of using the IRS as a quasi-police agency to enforce whatever federal law the current administration feels like using it for.

There's some validity to this. OTOH, reducing the number of separate government contacts involved has value, too.

Second, a Rube Goldberg enforcement program like does nothing except highlight the absurdity of individual mandate healthcare plans in the first place.

"Rube Goldberg"? Its straightforward, you have your choice of plans. If you fail to choose, a default choice is made for you, and you are required to pay for it. If you fail to pay, the cost is collected from you.

Third, this is a political loser.

Um, "third"? How so? Neither of the first two objections were policy objections, they were political objections.

Sometimes you can offer too much detail in a campaign, and this is one of those times.

The problem is not too much detail, the problem is that the plan isn't well crafted. You acheive the much the same effect without the undesirable political points you point to and more simply by having a default plan in which people are automatically enrolled until or unless they choose an alternative, and collecting the cost of the basic plan as a payroll deduction for regular employees. The problem isn't that people know what the details of the plan are, the problem is what the details are.

Posted by: cmdicely on November 30, 2007 at 11:13 AM | PERMALINK

StevenAttenwell,

OK, since you think Edwards plan is so defensible, how about dealing with the sort of situation I described.

You have a job with an average income, and are living from paycheck to paycheck. One day you lose that job, and you stay unemployed for a full year.

Where is the money going to come from to pay for health insurance, "sliding scale" or not? What happens if you can't afford to pay for it? Even if you are "automatically enrolled", you are incurring debt, and to the federal government. In the end, that debt must be paid off, in addition to any further penalties you would incur, and the IRS is going to enforce it.

Explain to us all how that ends well.

Posted by: frankly0 on November 30, 2007 at 11:16 AM | PERMALINK

frankly0, good point. It also begs the question about homeless people. Would they get taken care of, or will the ER just be a revolving door until they are dead?

Posted by: Doc at the Radar Station on November 30, 2007 at 11:21 AM | PERMALINK

Kevin,

Currently the Social Security Administration deducts Medicare premiums from old folks SS checks. If you lose your Medicare card you have to go to your local Social Security office to get a replacement.

My dad's VA benefits don't cover 100% of the cost of the services he requires so his SS check is also dunned before direct deposit to his account on behalf of the VA. The SSA writes us letters to tell us they're doing this but if we have a problem with it we have to call a VA office in Wichita KS I think it is.

So we already have one agency doing the work of another in a "Rube Goldberg" set up that nobody seems to mind a hell of a lot.

Posted by: markg8 on November 30, 2007 at 11:29 AM | PERMALINK

lord mike asked what happens in MA if you don't sign up for health insurance.

Living in MA, I think if you don't sign up, you lose your personal deduction on your income taxes.

In some way disagreeing with Kevin (see Ezra Klein's succinct Don't F*** with What People Already Have political motto) this could be an alternative plan to the garnish wages problem depending on what the price of the baseline insurance coverage is - if eliminating income tax deduction X (individual deduction) covers the cost, that would be the most elegant way to do it, with the presumption that the people for whom that would be no cost (wage earners so low they don't pay income tax) would be the same folks who receive the subsidized coverage anyway.

Posted by: random on November 30, 2007 at 11:33 AM | PERMALINK

This plan is, of course, stupid, and I'm guessing the motivation is to emulate the "mandatory auto insurance" programs that seem to be fairly successful.

However, the difference there is that if you don't want or can't afford auto insurance, you can opt out of it by not driving. Not so with medical insurance. You can't opt out of being a human with health needs.

Posted by: Steve Simitzis on November 30, 2007 at 11:37 AM | PERMALINK

"You have a job with an average income, and are living from paycheck to paycheck. One day you lose that job, and you stay unemployed for a full year."

My guess: anyone who is unemployed is covered by the credit. Also anyone who makes under s certain amount. But if this is so Edwards needs to emphasize it quick.

Posted by: EmmaAnne on November 30, 2007 at 11:42 AM | PERMALINK

Kevin asks:
"If you're really this serious about getting every man, woman, and child in the country enrolled, why go through all this? Why not just do it like Medicare, where the funding mechanism is the existing tax system and everyone is enrolled automatically? "

This, http://farm3.static.flickr.com/2349/2075337951_ed6b57ec40.jpg, is the answer. Those in favor of expanding Medicare-Medicade to cover everybody through taxation -- 26%. It's that word "taxes" that drives them off, I think. Maybe the poll's lousy, but it should give one pause, and I agree with Kevin that this is the best and cheapest way to go.

Posted by: David in NY on November 30, 2007 at 11:42 AM | PERMALINK

My guess: anyone who is unemployed is covered by the credit.

I'd be astonished but immensely pleased if this were true.

Posted by: frankly0 on November 30, 2007 at 11:46 AM | PERMALINK

And I must give Yancey Ward credit for explaining the results of the poll above (only 26% in favor of universal care paid by tax, 76% in favor of forcing all employers to provide health ins., gov. to cover rest). That is "most Americans ... foolishly believe their healthcare is mostly free today from their employer."

Posted by: David in NY on November 30, 2007 at 11:48 AM | PERMALINK

FOURTH: Lots of folks, especially many of those who would not want to sign up for such health care, DON'T FILE TAX RETURNS. I have a strong feeling that many tax protestors, especially the militia sorts (not that there is anything wrong with being a militia sort), are not gonna want to sign up for such health care, and as they do not file tax returns this idea would not help resolve a large part of the 'problem.'

Posted by: bubba on November 30, 2007 at 11:52 AM | PERMALINK

My guess: anyone who is unemployed is covered by the credit.

I'd be astonished but immensely pleased if this were true.
Posted by: frankly0 on November 30, 2007 at 11:46 AM
--------------

There is a current health care tax credit (refundable subsidy) for people that are on unemployment insurance. It pays 65% of your COBRA or other private plan premium. I've been unemployed for 3 months and will be taking advantage of it when my severance benefits run out in another month.

Posted by: Doc at the Radar Station on November 30, 2007 at 11:58 AM | PERMALINK

I think this is a hell of a lot better idea than taking millions of $ in campaign cash from Pharmadeutical & Insurance Companies.

In no way does it limit individual freedom. If you have and or want your own policy with your insurer of choice than do so and the IRS/Gov won't force you to do anything.

Best thing about the idea is using an existing agency that checks up on finances and extending it slightly rather than creating a whole new agency. Also, no more going to the emergency room without insurance because an employer won't provide it -> increases costs for insured -> gives employers excuse for eliminating other employees insurance covergage -> increased profits for corps with less benefits for workers.

Perhaps many of you would rather vote for someone that avoids specific details regarding implementation or triangulates in enough ways to make all of her 'pay for access' supporting lobbyists happy?... (aka Hillary the Great)

Posted by: Brian on November 30, 2007 at 11:58 AM | PERMALINK

Why not just do it like Medicare, where the funding mechanism is the existing tax system and everyone is enrolled automatically? It amounts to the same thing and it's cheaper, easier, and less intrusive.

With all the comment this post has generated I am sure someone else made the obvious point here that under current political realities any call to "tax" anybody on anything is like handing the Republicans a club to beat you over the head. Kevin's solution will be viable as soon as someone can convince Grover Norquist and the entire Club for Growth to go set up shop in a nice safe neighborhood in Baghdad, outside the Green Zone.

Posted by: majun on November 30, 2007 at 12:01 PM | PERMALINK

Forget that poll. I guarantee that Americans like the IRS coming after them for not buying their own healthcare, even less than they like new taxes.

When you just say "new taxes" in a poll, it leaves the amount up to the respondant's imagination.

Posted by: glasnost on November 30, 2007 at 12:02 PM | PERMALINK

DID ANY one READ Krugmans Piece!
There would NOT be any interest or penalties or fines imposed.
The parties would only be signed up.
MY God
Its true about progressives We are too smart for our own good, (Somersby is right about you Kevin)we are only good for fighting among ourselves (and more ofter then not using MSM and RNC spin to do it).
"I'am a progressive and a Libertarian !" are you kidding me!
We deserve what we get!

Posted by: michael on November 30, 2007 at 12:21 PM | PERMALINK

Paul Krugman and Ezra Klein both called it a terrific idea.

Posted by: framecop on November 30, 2007 at 12:21 PM | PERMALINK

Edwards plan and Hillary's plan are basically identical. The only difference is that Hillary's plan will ultimately do all of these same things, she just isn't willing to admit it. Instead, when asked how she intends to enforce her mandate, she refuses to answer the question.

Both of these plans are terrible starting points for negotiations.

And frame... It's pretty clear that Drum is the sort of person who supports Clinton. That means that honesty isn't something that important to him.

Posted by: soullite on November 30, 2007 at 12:25 PM | PERMALINK

Where is the money going to come from to pay for health insurance, "sliding scale" or not? What happens if you can't afford to pay for it?

Tax credits.

The newly covered individual would not only have access to health benefits but would also be responsible for making monthly payments with the help of a tax credit.
Posted by: Edo on November 30, 2007 at 12:36 PM | PERMALINK

The Edwards concept is a good one. You're all wrong.

That is all.

Posted by: brooksfoe on November 30, 2007 at 12:36 PM | PERMALINK
You have a job with an average income, and are living from paycheck to paycheck. One day you lose that job, and you stay unemployed for a full year.

Where is the money going to come from to pay for health insurance, "sliding scale" or not?

From the tax credit which is calibrated to pay for the cost of the basic plan for someone eligible for the full credit. (Of course, if you stay unemployed for a full year, you may well be eligible for Medicaid, in which case you are outside of the mandate entirely, but still have healthcare coverage.)

Posted by: cmdicely on November 30, 2007 at 12:48 PM | PERMALINK

The newly covered individual would not only have access to health benefits but would also be responsible for making monthly payments with the help of a tax credit.

Maybe this would work. Of course, a very real problem is that the formulas to determine need are usually quite unrealistic for many middle class people who suddenly suffer a great loss in income.

The devil is in the details of course.

But here's the ideal solution: you pay a portion of your income when you are employed, and you don't when you're not. In either case, you are covered. That means that when you most need to reduce your expenses, namely when not employed, you are not burdened with putting up still further monies beyond all your other expenses.

At very best, the Edwards solution only approximates this. And, in my view, it is good only to the extent that it comes exceedingly close to that optimum solution.

But if it truly comes close to that solution, the question is why not go straight to Medicare for All?

Posted by: frankly0 on November 30, 2007 at 12:50 PM | PERMALINK

You know, I don't agree that this was a losing gambit. Edwards is behind, he has to take chances. And his plan got him a very favorable mention from a very prominent, Democrat-leaning commentator.

He needs that. I'm sure they consider that a big score. Plans like this are important because you tell the electorate something about who you are, and how you would like to do things.

Posted by: Doctor Jay on November 30, 2007 at 1:03 PM | PERMALINK

I have no problem with this plan at all. It will force the few folks who fail to get it into the system and it will force them to pay their share. It lets everyone keep what they've got now if they want it. Reporting and enforcing through the administrative infrastructure that's already in place at the IRS is an efficient and economical solution to get everyone paying at least a minimum amount for health insurance.

At first I didn't think I liked the idea of mandates because I thought they'd be hard to enforce. Now that Edwards has described how it will work, I think it's a good idea. I also give Edwards credit for answering the tough question. Unlike Obama and Clinton, he's stated clearly how his plan will work.

Posted by: NealB on November 30, 2007 at 1:07 PM | PERMALINK

I am very sick of the Kevin Drums of this world who continually worry more about how Republicans are going to react than what is good policy.

The trusted experts, Ezra and Krugman, both love this idea. That should be enough for Progressives to run with, but as usual Kevin is more concerned with how this will look to the other side.

It's no wonder we keep losing Presidential elections.

Posted by: Mike in SLO on November 30, 2007 at 1:08 PM | PERMALINK

But here's the ideal solution: you pay a portion of your income when you are employed, and you don't when you're not.

So, wealthy people whose income is derived from capital rather than labor are covered for free?

Posted by: cmdicely on November 30, 2007 at 1:16 PM | PERMALINK

So, wealthy people whose income is derived from capital rather than labor are covered for free?

I imagine that they would be handled just as they are with Medicare. If they have an income, and presumably they do, they pay out of that income.

Personally, I could care less whether some of the wealthy somehow "cheat" and get coverage.

I'm interested in the rest of us. It's the rest of us who have a big problem with health insurance.

Posted by: frankly0 on November 30, 2007 at 1:25 PM | PERMALINK

Living in MA, I think if you don't sign up, you lose your personal deduction on your income taxes

This is ridiculously miniscule. The personal deduction in MA is on the order of US$2K per year per taxpayer. The laat time I paid BCBS for a single policy, it was four times as high for virtually no reimbursement. And at an approximate 5% income tax rate (it's level, no progressivity) the personal deduction amounts to something on the order of US$100/year.

Klein is a nut if he believes that Edward's proposal to use the IRS to enforce a mandate such as this. Nobody trusts the IRS anyway and giving them more power would be a non-starter.

Posted by: raj on November 30, 2007 at 1:26 PM | PERMALINK

raj,
I was writing off the cuff.
http://www.hcfama.org/act/mahealthreformlaw.asp
In MA, this *first* year the penalty is loss of the exemption which I think will be ~$200 but the site above says ~2000. Subsequent years, the penalty is 1/2 the premium cost.
Sure, individual coverage for BCBS may have been really high, but was that the lowest cost policy?

Posted by: random on November 30, 2007 at 1:51 PM | PERMALINK

Fear of being called a "socialist", prevents us from doing the right thing? How cowardly. I am comfortable with my own views of right and wrong, and could care less about a label thrown at me by a greedy, selfish fascist (read: Republican).

A major problem with this is that a bureaucracy notorious for losing paperwork will now be charging you for insurance you are already paying for. Good luck getting that one straightened out.

Posted by: John on November 30, 2007 at 2:14 PM | PERMALINK

Stupidest fucking idea ever.

Here's my plan:
Let's MANDATE that all Insurance company executives get strung up in the streets.

Posted by: osama_been_forgotten on November 30, 2007 at 2:25 PM | PERMALINK

Tax credits are a stupid, indirect, bureaucratic idea. (See 1993.)

Only a voucher system, as in Germany's national health care plan, where people get a direct government payment, and a payment high enough to pay 100 percent of the cost of at least a bare-bones plan, is a legitimate way of having an individual mandate national health care plan.

I don't give a flying fuck if Edwards (and Obama and Clinton) are talking about "some subsidies."

That's not enough.

We'll get something that won't even be national health care lite.

Posted by: SocraticGadfly on November 30, 2007 at 3:43 PM | PERMALINK

Edwards is behind, he has to take chances.

I cannot figure out why a candidate like Edwards is not out leading the anti-war protests. Had Edwards become the national leader of the anti-war movement immediately after the 2004 campaign ended, he might be the front running candidate today. I could be wrong. Edwards may think he would have been marginalized and demonized by the establishment moneymen, politicos and media, and that he did not have to lead such a controversial movement to win the nomination, but I think he miscalculated. His healthcare plan is lame, as is his antiwar stance, for someone who claims to the most progressive of all the candidates.

Posted by: Brojo on November 30, 2007 at 4:54 PM | PERMALINK

Mike in SLO said:
I am very sick of the Kevin Drums of this world who continually worry more about how Republicans are going to react than what is good policy.

John said:
Fear of being called a "socialist", prevents us from doing the right thing? How cowardly. I am comfortable with my own views of right and wrong, and could care less about a label thrown at me by a greedy, selfish fascist (read: Republican).

It's not a question of having thin skin, worrying about what the Republicans will think, or not wanting to be called "socialist". The problem is, will the proposed policies give the Republicans ammunition to scare the people away from the Democratic candidate in 2008? You cannot implement "what is good policy" or "the right thing" unless you can get elected. This what's being debated here -- not the merits of the policies in a political vacuum. Unfortunately, some proposals (and their details) lend themselves more easily to Republican distortions and scaremongering than others.

Posted by: JS on November 30, 2007 at 5:24 PM | PERMALINK

Gadfly, can you explain the German system in a bit more detail? Who gets the vouchers? Everybody? And how is income taxed?

Posted by: JS on November 30, 2007 at 5:26 PM | PERMALINK

America, meet your Marxist makers! The wattage in this room is brilliant. Yes, let's go on pretending Europe has a better system than ours, even if it's only in theory. So much better than reality.

Posted by: Rob on November 30, 2007 at 7:08 PM | PERMALINK

Yes, let's go on pretending Europe has a better system than ours, even if it's only in theory.

Most of Europe has better systems than ours in practice, whatever you might say about ours in theory. Equal or better outcomes by most measures, lower overall costs per capita and per GDP. Pay less, get more. Better. See?

Posted by: cmdicely on November 30, 2007 at 7:14 PM | PERMALINK

We're talking ourselves into a real pickle.

1) We have to build the plan on private insurance companies, because anything else won't fly politically.

2) Any plan based on private insurance companies WON'T WORK. It will be Medicare Part D all over again.

Something's got to give here. If we really do want to reduce costs and include everyone, we have to go with single payer.

Posted by: denise on November 30, 2007 at 7:14 PM | PERMALINK

We want to implement a national comprehensive health care plan and we might have to implement a way to make sure everyone is covered and pays for it. Oh my god. If you want to see how a strong, progessive, and committed candidate will handle himself in the coming campaign take a look at Edwards at the DNC at the following:
http://www.democrats.org/a/2007/11/john_edwards.php

Posted by: popudem on November 30, 2007 at 7:22 PM | PERMALINK

The idea that the people of this country are so opposed to taxes that they automatically oppose any increase in Medicare taxes to pay for a national health system is, frankly, ludicrous.
I have no doubt that there are polls asking the question: "Would you favor paying higher taxes for a national health system?" and gettng the answer "No!". That, however, is only part of the question that needs to be asked. Are there any polls asking the the above question prefaced by this question: "You do realize that a national health system paid for by increased (Medicare?) taxes would mean your not having to pay ANY additional health insurance premiums?"
Wonder what the results would be then?
Simplest method is increasing Medicare coverage, piecemeal if necessary, until everyone is covered. A 1-5% surcharge on unearned-income would cover those who aren't wage earners.
Of course there is the possibility that these ridiculously convoluted and intrusive plans are simply red herrings, designed to lull the opposition into a false sense of security...?

Posted by: Doug on November 30, 2007 at 7:37 PM | PERMALINK

Actually in the polls Americans say all the right things. For example:

[Sep 2007] Q: Which do you think would be better for the country: having one health insurance program covering all Americans that would be administered by the government and paid for by taxpayers, or keeping the current system where many people get their insurance from private employers and some have no insurance?

One program for all: 55%
Current System: 29%
Combination: 3%
Neither: 4%
Unsure: 9%

But this is when the question is posed rationally. In an election, the Republicans manage to distort issues and scare people and the results are often different from what the polls suggest they should be.

Posted by: JS on November 30, 2007 at 8:01 PM | PERMALINK

I suggest an individual voucher system.

Each American, man woman and child would get a voucher for, say $3,000 as appropriate, to purchase basic health care. This voucher can be cashed by any private insurance company that the individual decided to purchase this basic insurance from, by billing the government.

The insurance company would be required to offer a standard policy to all. If the individual chooses not to join one of the private policies, then they are covered by "Medicare plus". Note: Any insurance company could, of course offer more coverage at additional price if they wished.

The coverage and rates would be such that the voucher would cover the basic and catastrophic care, plus a 6% profit.

Thus individuals would be free to choose any insurance they desired, but if they did not choose, they would be covered and their "premium" would effectively pay Medicare plus for the coverage.

Posted by: Mike Liveright on November 30, 2007 at 8:05 PM | PERMALINK

And in may 2007 (CNN Poll):

Q: Do you think the government should provide a national health insurance program for all Americans, even if this would require higher taxes?

Yes: 64%
No: 35%
Unsure: 2%

No major candidate dares suggest this, however.

Posted by: JS on November 30, 2007 at 8:07 PM | PERMALINK

in an ideal world, we would have universal coverage via altruistic healthcare providers and insurance companies and/or an efficient universal single payer scheme. In the real world, we have to accept that "we" cannot cover everyone without turning into a socialist state and culture. And we have to accept that we can only force people to make an economic choice if the choice is a fair one. We can force people to pay child care because there is agreement that neglecting children is bad. But can we force someone to buy insurance from a private company when there is no agreement that that private company is acting in the public interest and doing everything it can to keep costs down?

This reminds me of the debate over whether city governments should have the ability to use eminent domain to revive economically depressed neighborhoods. Sounds good until you realize that the primary beneficiaries are land developers who drink at a profit from the public trough.

The real disappointment I have in Hillary is that she can't seem to break out of the old way of thinking, of the old labels, networks and associations. I had hoped Edwards would be fresh, but he's not. His rhetoric is starting to sound old and tired because the assumptions behind those phrases are based on philosophies and ideas that are from two centuries ago.

Obama is interesting. Yes, he's short on specifics, but he also doesn't seem to be running on a platform consisting of a set of policies. Rather, he's running on a way of doing things. If he can convince voters that changing the approach to making policy in Washington is as important as changing the policies, then he has a real shot at winning. And if he can follow through, it will be a remarkable presidency.

BTW, various outlets in NH and Iowa have good in-depth one-on-one interviews with the major candidates, during which the candidates have as much time as they want to explain themselves. It's a striking advancement in our politics that is enabled by the internet, and let's you get a real sense of how a candidate thinks and behaves in small-group settings.

I'm curious why more political bloggers are not linking to them.

Posted by: huh? on November 30, 2007 at 9:11 PM | PERMALINK

"StevenAttenwell,

OK, since you think Edwards plan is so defensible, how about dealing with the sort of situation I described.

You have a job with an average income, and are living from paycheck to paycheck. One day you lose that job, and you stay unemployed for a full year.

Where is the money going to come from to pay for health insurance, "sliding scale" or not? What happens if you can't afford to pay for it? Even if you are "automatically enrolled", you are incurring debt, and to the federal government. In the end, that debt must be paid off, in addition to any further penalties you would incur, and the IRS is going to enforce it.

Explain to us all how that ends well."
-------------------------------------------

Hey, happy to answer your question.

While you're employed, you would be paying a premium for health care that would be subsidized by a refundable tax credit, which would bring your costs down. If you can't afford to pay any of it, then you qualify for Medicaid, or if you have kids, SCHIP.

If you become unemployed, and stay unemployed, as people have said, first you would be able to be covered under COBRA, and then you would be covered under Medicaid. So no debt would be incurred at all.

And just to respond to someone else's issue: you would be signed up whenever you come into contact with the government, be it the library, hospital, polling place, school, etc. Even people who don't file tax returns come into contact with the government at some point, and will get signed up.

Posted by: StevenAttewell on November 30, 2007 at 9:20 PM | PERMALINK

Is it the 'worst plan ever, except for all the rest'?

By Kevin's account we shouldn't have Democracy either, cause it's confusing and people have to pay taxes and stuff.

This is what's called Leadership. Compare his plan to others and then come back and say you've changed your mind and now you're going to vote for Edwards.

John Edwards -- Real Leadership for America!

Posted by: MarkH on November 30, 2007 at 9:46 PM | PERMALINK

All of the Dem candidates probably see single payer UHC as the ideal. I wouldn't be surprised that most of the R candidates feel the same way in their heart of hearts. The real questions are: 1) Do we push triangulated compromises now with private insurance to get something that can hopefully morph into a better system down the road or 2) Go for a decent single-payer UHC NOW because people are ready for it to be a banner issue. Wouldn't it be nice (cue Beach Boys) if the Dems could feel enough confidence to reach out to Republicans and get them to see the light on this one?

Posted by: Doc at the Radar Station on November 30, 2007 at 11:31 PM | PERMALINK




 

 

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