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Tilting at Windmills

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February 1, 2008
By: Kevin Drum

OBAMA ON HEALTHCARE....Just when I'm warming up to Obama, his campaign pulls something like this. Yuck.

There's nothing odious or unfair about this mailer. It's perfectly normal hardball politics. But it doesn't help the progressive cause on healthcare one whit. I sure wish Obama could figure out a better way to contrast himself with Hillary.

As a side note, when the subject of healthcare mandates came up last night, I was surprised that Hillary didn't take (yet another) opportunity to suck up to John Edwards by using the argument Edwards himself put forward at the last debate to criticize Obama's voluntary plan. As John Edwards has said, the problem with Senator Obama's argument is you can make exactly the same argument about Social Security. I mean, you think about the analogy. What George Bush says is he wants people to be able to get out of the Social Security system, choose, elect to get out of the Social Security system. Well, that's exactly what Senator Obama's plan allows for healthcare.

I dunno. Maybe the Social Security analogy isn't as good as I think it is. But it sure seemed like a quick, effective argument when Edwards made it.

Kevin Drum 1:12 PM Permalink | Trackbacks | Comments (176)

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I was undecided now leaning strongly for Hillary.

Hillary Clinton from the Democratic Debate on 1/31/2008:


We cannot get to universal health care, which I believe is both a core Democratic value and imperative for our country, if we don't do one of three things. Either you can have a single payer system, or -- which, I know, a lot of people favor, but for many reasons, is difficult to achieve. Or, you can mandate employers. Well, that's also very controversial. Or, you can do what I am proposing, which is to have shared responsibility.

Now, in Barack's plan, he very clearly says he will mandate that parents get health insurance for their children. So it's not that he is against mandatory provisions, it's that he doesn't think it would be politically acceptable to require that for everyone.

I just disagree with that. I think we as Democrats have to be willing to fight for universal health care.

And what I've concluded, when I was looking at this -- because I got the same kind of advice, which was, it's controversial, you'll run into all of this buzz saw, and I said, been there, done that. But if you don't start by saying, you're going to achieve universal health care, you will be nibbled to death.

Posted by: hector diaz on February 1, 2008 at 1:17 PM | PERMALINK

Is this really any worse about Hillary's demagoguery about Obama wanting to raise trillions of dollars of taxes on the middle class by raising the cap on the most regressive of all federal taxes?

Posted by: jbryan on February 1, 2008 at 1:21 PM | PERMALINK

Do you honestly believe that a Democratic Congress -- which will include a very, very powerful senator named Hillary Clinton -- will pass a health care plan without clear universal coverage? I don't. In other words, if Obama is elected and Hillary Clinton remains in the senate then there's really no policy consequence to their differences now.

But I understand the political principle involved here and it's an important one for Obama: don't force people to do things. It may not be a big deal to Democrats, but that sort of thing strikes a cord with independents and disaffected Republicans.

Posted by: Callimaco on February 1, 2008 at 1:22 PM | PERMALINK

I don't think the analogy with Social Security is a good one--too thick in the wonky weeds, and it gets you sidetracked by people who say, "I don't like the government telling me what to do." The idea of mandating that everyone buy health insurance is something that has to be carefully sold as a part of a comprehensive solution that means better and more secure care for everyone.

Posted by: Steve W on February 1, 2008 at 1:23 PM | PERMALINK

In the real world, mandates won't fly. For one thing, they lead to things like Edwards' dopey nanny-state requirement that not only would people have to buy insurance, but they would HAVE TO VISIT THE DOCTOR once a year. Try getting that idea through Congress. Like Medicare, get the principle first -- a national health care scheme in place -- and worry about the details later.

Posted by: Traven on February 1, 2008 at 1:23 PM | PERMALINK

Kevin, individual mandates are simply an awful idea. They blame the victim (Hillary spins and calls it "shared responsibility", but PEOPLE WHO CAN'T AFFORD HEALTH INSURANCE AREN'T RESPONSIBLE FOR THEIR PREDICAMENT!). They avoid taking on the insurance companies, who are responsible for a big layer of costs. They don't work (in Masschusetts, people pay the fines rather than signing up for coverage they can't afford). They don't achieve universal coverage-- we have an individual mandate for auto insurance in California, and plenty of uninsured drivers.
They force people into the crappiest type of coverage. And they forestall us from getting to actual guaranteed health insurance purchased or provided by the government for all Americans.

So there is no "liberal" responsibility to not campaign against individual mandates.

Posted by: Dilan Esper on February 1, 2008 at 1:23 PM | PERMALINK

You know, I'd like to hear once, just once, how it is that Obama is ever going to backtrack on his own attacks on mandates, when it finally becomes obvious to all -- as it is now to economists -- that they are the necessary ingredient to any universal health care plan, given the approach Obama himself has taken.

Does anybody imagine that Obama's own Republican talking points won't be thrown right back in his face? How does he ever get around that obstacle?

Can nobody in the Obama camp do the simple exercise in strategic thinking to realize that the political logic here renders universal health under an Obama Presidency as unachievable?

Or is it that they just don't care?

Posted by: frankly0 on February 1, 2008 at 1:24 PM | PERMALINK

Once again Obama attacks from the right, and once again he tries to spin the major defect of his plan. Rerunning Harry and Louise is an odious smear. Heretofore, most of Obama's attacks have been under the radar and they illustrate his win-at-any-price sense of entitlement.

Posted by: Mike on February 1, 2008 at 1:26 PM | PERMALINK

Is this really any worse about Hillary's demagoguery about Obama wanting to raise trillions of dollars of taxes on the middle class by raising the cap on the most regressive of all federal taxes?

Yes, it is absolutely worse. What Hillary said has no impact on SS as we know it, or any other program.

But Obama's own words will be thrown right back in his face the moment he tries to push for genuinely universal health care.

There's no way of getting around that fact.

I'd like someone to tell me how Obama could fight for mandates when he himself is on record essentially demonizing them

Posted by: frankly0 on February 1, 2008 at 1:27 PM | PERMALINK

I'm sorry, but anyone who's battled with their insurance carrier can understand why it is legit to attack a health care plan that forces people into a financial relationship with insurance companies (with no significant cost controls), and penalizes you if you don't go along.

Posted by: Jrich on February 1, 2008 at 1:27 PM | PERMALINK

Like Medicare, get the principle first -- a national health care scheme in place -- and worry about the details later.

Except for the niggling fact that the "detail" of mandates is the precise thing necessary to make the whole scheme work as universal health care.

So, by all means, go back the helpful technique of covering your eyes and ears and shouting as loud as you can.

Posted by: frankly0 on February 1, 2008 at 1:31 PM | PERMALINK

This whole argument is silly. Whatever comes out of Congress will not be Obama's plan or Hillary's plan, but whatever the Dems, Blue Dog Dems and moderate Republicans can cobble together.

Posted by: Slipsok on February 1, 2008 at 1:31 PM | PERMALINK

Yes, it is absolutely worse. What Hillary said has no impact on SS as we know it, or any other program.

Seriously? You don't think it could have an impact if Democratic senators are shrieking "tax hike! tax hike!" at the drop of a hat? Taxes will need to be raised by the next president regardless of anything else, but especially if we intend to implement any sort of revised healthcare system.

Reflexive anti-tax complaints are a hallmark of Republican obstructionism and they've been disastrous for our economic policies. I'd hate to see that mindset become only further entrenched within the Democratic ideal as well, else it really could be an awful setback for any sort of progressive causes, which was exactly Kevin's criticism.

Posted by: jbryan on February 1, 2008 at 1:33 PM | PERMALINK

"I'd like someone to tell me how Obama could fight for mandates when he himself is on record essentially demonizing them"

Let Senator Hillary Clinton do the fighting for a policy that convincingly "mandates" coverage and let President Obama fight to make sure those mandates don't "punish" those who are mandated.

Obama is not zero-sum game kind of guy. With the right policy I think he'd relent. But he'd have to be able to relent "on principle" -- ie with assurance that people would not be "forced" to buy coverage they can't afford.

Here's the thing: I think having that fight and maintaining that principle would make it easier to pass universal coverage. The debate would not be whether to "mandate" coverage, but how to "mandate" coverage.

Posted by: Callimaco on February 1, 2008 at 1:33 PM | PERMALINK

This whole argument is silly. Whatever comes out of Congress will not be Obama's plan or Hillary's plan, but whatever the Dems, Blue Dog Dems and moderate Republicans can cobble together.

So let me see. What you're saying is that if, say, Obama is President, he's not going to have anything really to do with the actual details of the plan, or advocating for it to the American people, and so can essentially be ignored?

Great reason to vote for him, of course.

Posted by: frankly0 on February 1, 2008 at 1:34 PM | PERMALINK

Yuck is right. Neither of them have great health care plans.

But the SLAP in the face -- A Harry & Louise Ad.... The the symbol of our 1992 HealthCare loss.

I'm already making my 3rd choice (Gore, Edwards ...) How much do I have to compromise?

Posted by: katiebird on February 1, 2008 at 1:36 PM | PERMALINK

Top 10 recipients of healthcare donations in the 2006 election cycle (SOURCE: Open secrets):
1 Santorum, Rick (R-PA) $1,406,183
2 Johnson, Nancy L (R-CT) $1,231,563
3 Clinton, Hillary (D-NY) $1,201,843
4 Kyl, Jon (R-AZ) $1,106,088
5 Talent, James M (R-MO) $916,733
6 Lieberman, Joe (I-CT) $905,910
7 Corker, Bob (R-TN) $801,627
8 DeWine, Mike (R-OH) $740,737
9 Barton, Joe (R-TX) $734,984
10 Hatch, Orrin G (R-UT) $717,182

Posted by: Jrich on February 1, 2008 at 1:37 PM | PERMALINK

jbryan,

Hillary's generic claim that it wouldn't be good to introduce an enormous tax hike is hardly going to be usable against her if she needs to implement specific tax hikes. If anything, it would serve to show that she's not against all tax hikes, but only against dumb tax hikes, to coin a phrase.

But Obama's problem is very specific, and highly damaging.

There's no way to get to universal coverage under Obama's plan without mandates -- ask any competent economist. But Obama himself has demonized mandates.

Checkmate. We lose.

Posted by: frankly0 on February 1, 2008 at 1:38 PM | PERMALINK

Kevin,

Your analogy to Social Security would be correct if the health plans be discussed were single payer (i.e., government-run healthcare as in Canada, the EU, etc). Neither Obama or Hillary, unfortunately, believe that we can do away with the insurance industry at a moment's notice. Alas, they're probably right. So we're still stuck with negotiating with insurance companies for the best price. I'd really like to know what the envisioned cost would be per month. Also, what the subsidy level will be for the unemployed, the poor, the young just getting started out on a job. Obama is saying that it's not a good idea to have a mandate and requisite fines for nonparticipation. I would agree unless the cost/subsidy equation is clearly one that would enable all Americans to purchase health insurance without suffering a great financial burden.

Posted by: nepeta on February 1, 2008 at 1:38 PM | PERMALINK

If Obama later decides mandates are needed he'll have his words thrown back in his face. Scary. Bush was going to cap CO2 emissions...and then decided not to. Bush said a bunch stuff about bridging the partisan divide, uniting the country, compassion, and it helped him get elected. If no mandates is necessary to appeal to general election voters, that's fine by me. I think core democrats over-estimate the popularity moving to government run healthcare in the US. Once people start losing insurance as they lose their jobs they'll be more amenable, but not now. Later, Obama can simply say that the problem has worsened and a more aggressive plan is needed. Rhetoric aside, I have a lot of trouble seeing Clinton as a progressive.

Posted by: Rock on February 1, 2008 at 1:41 PM | PERMALINK

Once people start losing insurance as they lose their jobs they'll be more amenable, but not now. Later, Obama can simply say that the problem has worsened and a more aggressive plan is needed.

And I'm sure that insurance companies and Republicans won't be running ads quoting Obama's own words back at him when that occasion comes.

Why would they do that, after all, even though their economic and political lives might depend on it? He has such charisma!

Posted by: frankly0 on February 1, 2008 at 1:44 PM | PERMALINK

Robert Reich (Sec. of Labor under B. Clinton) had some good thoughts on the two plans:

http://robertreich.blogspot.com/2007/12/why-is-hrc-stooping-so-low.html

Posted by: crazymonk on February 1, 2008 at 1:46 PM | PERMALINK

As John Edwards has said, the problem with Senator Obama's argument is you can make exactly the same argument about Social Security. I mean, you think about the analogy. What George Bush says is he wants people to be able to get out of the Social Security system, choose, elect to get out of the Social Security system. Well, that's exactly what Senator Obama's plan allows for healthcare.

This argument has a lot of appeal on the surface, Kevin, but there are differences between health care and social security.

The fear of people opting out of social security is that they can go a lifetime thinking: "I don't need it" and then discover they do. And the tab for a lifetime of blindness re social security can be huge. Even if a wage-earner "gets religion" in his 40's or 50's, say, it's difficult to impossible to make up for all those years of not paying into it. And who pays for that if the wage-earner hasn't planned at all for his retirement? Tax-payers.

Health care insurance is a different story. A lifetime of going without health insurance and being hit with something requiring treatment will not be significantly more expensive than being hit in your 20's or 30's. Furthermore, once you've discovered the need for insurance, you can buy into a plan. It won't cover you for whatever treatment you need at that moment, and there is the pre-existing condition problem, but you would at least then be covered, and whatever risk you once posed to society is now gone.

Put another way, the risk of going without health care is not cumulative -- either to the individual or to society. That is not the case with social security, where the longer you go without social security, the bigger the risk is that you'll eventually be a burden to society.

Finally, the "pre-existing condition" problem is bigger than simply the mandatory vs. voluntary issue and, in any case, can be dealt with separately.

John Edwards came up with a good argument, one that might well be very effective in the court room, particularly if the jury didn't have time to think about it. But his argument is hardly bulletproof, and in fact can be shredded fairly easily with a reasonable amount of thought. And that may be why Hillary didn't say anything about his argument: she knew better.

Figuring this stuff isn't rocket science, Kevin, and if you were honest, you would quit pretending you occasionally lean toward Obama and just admit you're for Hillary.

Posted by: LynnDee on February 1, 2008 at 1:50 PM | PERMALINK

This particular line of attack from Obama hurts the larger cause of achieving universal health care. The point that neither candidate's plan is going to be enacted without major changes is not relevant. The point is, he's actively fighting against a major component of any remotely workable universal health care plan--the principle that every individual will have to participate or it isn't going to work.

There is too much focus on what is and is not going to be palatable to the general public or to conservatives on this issue. What we need to do is rhetorically move the line forward. People need to be made to understand the concept of universal care and be won over to it. When you make arguments like Obama is making, you undermine the entire fight.

Yes, mandates are a stupid way to provide universal care. But Edwards' plan (I don't know anything about forcing people to visit the doctor once a year) showed how mandates can be a bridge to a true single-payer system. But this can only happen if everyone participates. If people opt out then what you have is just a new name for Medicaid and a massive subsidy for the insurance industry.

Also, I find it very funny that the same Obama supporters who scream red-faced about the triangulating Hillary are pleased with how cleverly Obama meets the Republicans halfway on this issue.

Score one for Hillary.

Posted by: Rob Mac on February 1, 2008 at 1:52 PM | PERMALINK

Yep, race-baiting by proxy, "the surge is working," and "tax hikes are teh suck" are perfectly acceptable Clintonite advocacies of Republican talking points.

But how dare Obama criticize healthcare mandates...

I am so sick of primaries.

Posted by: PTS on February 1, 2008 at 1:54 PM | PERMALINK

JRich is absolutely right, about mandates being popular with the insurance companies. It doesn't mean they're bad policy, (I work for an insurance company, and I think they're a good idea) but I am puzzled exactly why having the IRS do my companies marketing for it is a essentially progressive notion. It seems rather like banning people from sleeping on the streets. Combined with other programs, it could be part of a solution to ending homelessness. But it might also be an attempt to look like you're trying to solve the problem, without doing anything about it.

Posted by: Boring Commenter on February 1, 2008 at 1:57 PM | PERMALINK

Obama and his supporters probably agree with the Edwards analogy since the Obama rhetoric on Social Security thus far is almost exactly the same as Bush's; i.e. that the system is IN CRISIS.

To this Edwards supporter, Obama is the real triangulator in this race.

Posted by: howie on February 1, 2008 at 1:57 PM | PERMALINK

nepeta,

Best estimate on cost is $500/person/month--$2000/month for a family of 4.

That's based on current cost of the healthcare system (16% of GDP), and assumes community rating (so everyone pays the same amount regardless of age or health.)

Posted by: SamChevre on February 1, 2008 at 2:00 PM | PERMALINK

Furthermore, once you've discovered the need for insurance, you can buy into a plan.

Do you not get that this is the very reason Obama's plan is failed from the start?

If healthy people simply opt out of the plan, then a greatly disproportionate number of people who go on the plan are there because they are unhealthy. That forces ups premiums, making the plan only less affordable than before.

That's exactly why mandates are enforced, not through some perverse desire to make everybody buy something they don't really want. It's simply forcing both the healthy and the unhealthy to share the burdens of universal coverage. We don't generally allow people without children to opt out of paying for public schools, do we? The burden is rightly shared. So it is with universal health care.

Posted by: frankly0 on February 1, 2008 at 2:01 PM | PERMALINK

I seem to recall the Clinton campaign claiming that Obama was a hypocrite because he said that he wanted single-payer but his plan wasn't single-payer.

No shit. We're not moving straight to a single-payer system in one move.

Folks, if you're going to make a public show about having second thoughts about Obama over something that is this inside baseball, it helps to pay attention to the issue ... preferably from the beginning.

Neither plan is going into law.
.

Posted by: Grand Moff Texan on February 1, 2008 at 2:01 PM | PERMALINK

Also, I find it very funny that the same Obama supporters who scream red-faced about the triangulating Hillary are pleased with how cleverly Obama meets the Republicans halfway on this issue.

Really? I'm not saying that. I'm not sure which I would prefer, actually, but if I had to pick one without any further information, I think I would probably prefer mandates. That's why I'm really pleased with Obama's intention to do this with transparency so we the people can have some input into the process.

So no, all I'm doing here is arguing against those like Kevin who are apparently ready to say: "John Edwards' argument was clever in a way that appeals to me and that has sold me, so that's it."

Posted by: LynnDee on February 1, 2008 at 2:02 PM | PERMALINK

We all lost big when John Edwards left the race.

Posted by: jame on February 1, 2008 at 2:05 PM | PERMALINK

Folks, if you're going to make a public show about having second thoughts about Obama over something that is this inside baseball

Under Obama's plan, it's predicted that 15 million Americans will be without health insurance.

Tell them that that's "inside baseball".

Posted by: frankly0 on February 1, 2008 at 2:05 PM | PERMALINK

Furthermore, once you've discovered the need for insurance, you can buy into a plan.

Do you not get that this is the very reason Obama's plan is failed from the start?

You may be right. But, I suspect that's not immediately discernible from this one provision. I think it would depend on the rest of the program how big a problem this provision might be. As a mother with kids, I can't imagine opting out of health insurance. Like millions of Americans, having health insurance for my family is a huge factor in my decisions about work.

In any case, this is a different issue from the flip argument attempting to analogize social security and health insurance that Kevin seems to have bought into.

Posted by: LynnDee on February 1, 2008 at 2:08 PM | PERMALINK

FranklyO,

I don't think 'healthy' people are the ones who would opt out of the plan. As we've tried to convince our 23-year old daughter, you can always get into a bad car accident. The people who will opt out are those who feel they can't afford it (and admittedly those are probably the ones that need it most).

Posted by: nepeta on February 1, 2008 at 2:09 PM | PERMALINK

Here's a good link for what I mentioned above.

In a video put out on YouTube, the Clinton campaign contrasts portions of the debate - in which Obama says "I never said we should go and try to get single payer" - and a speech Obama gave to the AFL-CIO in 2003 - in which he says, "I happen to be a proponent of single-payer health care coverage."

Sounds fishy, eh? Kinda like Bill Clinton clipping the Obama quote about an AUMF vote.

Here's an unclipped part of Obama's position on the issue:

In a profile of the Senator in the New Yorker this past spring he offered that, "a single-payer system-a government-managed system like Canada's, which disconnects health insurance from employment-'would probably make sense. But we've got all these legacy systems in place, and managing the transition, as well as adjusting the culture to a different system, would be difficult to pull off. So we may need a system that's not so disruptive that people feel like suddenly what they've known for most of their lives is thrown by the wayside.'"

After Clinton pulled that crap, I started leaning Obama.

To the larger issue: yes, Obama keeps using Republican memes. I think that the blogsphere's obsession with that is due to our virtual nature. We think message is all that there is. But using Republican memes
1. steals their thunder
2. exploits something already installed in the public mind
3. piggybacks on someone else's piggybank

Brilliant!

But gaging the man on this is naive. Look who've they've got working for them and what kind of organization they're building. Clinton is obsolete and shacked up with the wrong people.
.

Posted by: Grand Moff Texan on February 1, 2008 at 2:10 PM | PERMALINK

Well, I see the Obama supporters are getting their way, and turning this into a discussion of the relative merits of the plans, and away from the despicable nature of this ad. I mean really, Harry and Louise?

Posted by: ChrisO on February 1, 2008 at 2:12 PM | PERMALINK

Tell them that that's "inside baseball".

Not what I was talking about. Either you knew that, and this is snark, or you didn't, and this is a waste of photons.
.

Posted by: Grand Moff Texan on February 1, 2008 at 2:13 PM | PERMALINK

I mean really, Harry and Louise?

I suspect it's being reminded of being defeated that's driving much of the hand-wringing in the left blogsphere today, at least among the over-30 set.
.

Posted by: Grand Moff Texan on February 1, 2008 at 2:14 PM | PERMALINK

Well, I see the Obama supporters are getting their way, and turning this into a discussion of the relative merits of the plans, and away from the despicable nature of this ad. I mean really, Harry and Louise?

Re-read Kevin's post. He raised a glib argument by John Edwards that goes to the relative merits of the plans.

Not that I object to your talking about the mailer, but the merits of the plans are very much part of this discussion.

Posted by: LynnDee on February 1, 2008 at 2:16 PM | PERMALINK

"JRich is absolutely right, about mandates being popular with the insurance companies. It doesn't mean they're bad policy"

Agreed. And, yes, because Single Payer doesn't seem politically viable, any working solution will have to include insurance cos. MY point, and I think Obama's point on this issue is the affordability issue. That's the striking thing about health care insurance: The cost of plans have skyrocketed. The honest way to ensure that mandated insurance won't break the back of a family of 4 who makes $90K (a little above 400 percent of poverty), is to combine with some sort of rate regulation. NO candidate has endorsed that idea, for obvious political reasons.

As an aside, simply as a political issue, the point is Obama's on this and this argument is a winner among the working poor: "Hillary wants Government to force you into a relationship with insurance cos ... with penalties if you don't"

Let's not forget this is a political campaign, and not a salon where we are sipping tea and discussing the latest New America Foundation report on health care.

Posted by: Jrich on February 1, 2008 at 2:16 PM | PERMALINK

Sam,

Thanks for the cost estimate. $500/mo, $2000 for family of four? I don't know about anyone else, but that sounds incredibly high to me. Btw, to continue with my 22 year-old daughter's situation, we finally decided that the best option, since she isn't given benefits from the company for which she works, to go with hospitalization coverage only. That amounts to $149/3 months coverage and includes out-patient procedures and tests. No way would she spend $500/mo on doctor's visits and drugs nor could she afford $500/mo.

Posted by: nepeta on February 1, 2008 at 2:17 PM | PERMALINK

Grand Moff Texan,

If it's not mandates that you consider to be "inside baseball" -- the exact feature the lack of which will leave out 15 million people under Obama's plan -- then what are you talking about?

Posted by: frankly0 on February 1, 2008 at 2:19 PM | PERMALINK

Put another way, the risk of going without health care is not cumulative -

LynnDee, I disagree with this statement of yours. People generally tend to accumulate health problems as they move along in life. If those problems can be addressed early on, the mortality risk decreases, the cost of treatment is less.

Take cholesterol or LDL/HDL levels. If you see them start to rise you can address the problem by changing your diet. If you don't and continue to eat as before you can have a massive heart attack, or stroke, etc.

While I know it is impossible to force people to go and see a doctor. It sure would be nice if we could get people to believe that going for an annual check up is good for them.

Posted by: optical weenie on February 1, 2008 at 2:19 PM | PERMALINK

Stop playing the race card Kevin. If you don't approve of Obama's health care, you are racist to the core...

Posted by: Hank Essay on February 1, 2008 at 2:19 PM | PERMALINK

If it's not mandates that you consider to be "inside baseball" -- the exact feature the lack of which will leave out 15 million people under Obama's plan -- then what are you talking about?

Um, the subject of the post?

Thought it was obvious. It (and most of the comments) have to do with why this is bad strategy. The rest of us understand that Obama's plan isn't going to go straight into law, so it's either childish or dishonest to keep waving 15 million hypothetical people around. And I really don't care which it is.
.

Posted by: Grand Moff Texan on February 1, 2008 at 2:23 PM | PERMALINK

The "mandate" argument was never sound and will soon be relegated to the dustbin, mark my words.

Posted by: Jimm on February 1, 2008 at 2:28 PM | PERMALINK

If Obama discredits HillaryCare, and reminders of "Harry and Louise" will do that, then it will be difficult for Hillary to project Obama as inexperienced on the issue (which she does every chance she gets).

Posted by: Ugly Moe on February 1, 2008 at 2:31 PM | PERMALINK

If this is all about political courage, then Clinton needs to spell out just how these mandates will be enforced. She had the opportunity last night and didn't.

I'd also be interested to hear some evidence of the folks who get sick and go the emergency room and get care for free. Are they talking about folks that skip out on the bill? If that's the case, aren't you going to have that problem in a mandatory system? Or do you refuse coverage when the uninsured (but apply to pay) show up for coverage until they pay the penalty plus the back premiums?

Posted by: Keith on February 1, 2008 at 2:33 PM | PERMALINK

The rest of us understand that Obama's plan isn't going to go straight into law, so it's either childish or dishonest to keep waving 15 million hypothetical people around.

So what are you really claiming? That Obama will play no important role in advocating for health care by using the bully pulpit?

What you don't seem to get is that given any of the proposals on the table, it is an essential economic element that mandates be included to achieve universal health care. No matter how they mix and match things in Congress, that essential economic fact does not go away. It's precisely because of that essential role that mandates were included in Edwards' and then Hillary's plan. It was not some perverse desire to punish the American people that led them down this path.

And the lack of mandates certainly plays a major role in the reason Obama's plan misses covering 15 million people.

Either Obama himself has got to become a fifth wheel when this whole debate comes up or he is going to have to go to the American people and advocate for that critical feature when finally it must be implemented.

The notion that we can just pretend that this whole issue is just going to go away if we don't think about it and plan for it is groundless. It essentially comes down to denying basic facts of economics.

Posted by: frankly0 on February 1, 2008 at 2:33 PM | PERMALINK

As long as we're trafficking in specious analogies, I think the mandate plan is actually more like Bush's Social Security pipe dream. To wit, you're required to give your money to a private company -- of your choice! -- to get a service that government is perfectly capable of providing. Except that mandates are worse, since there's nothing staking the amount of money you have to pay to the amount you have to earn. Subsidies? Plenty of people will still fall through the cracks. Mandates are an illusion of universal health care. Maybe they're only meant to be a stepping stone, but I'd rather not dabble in implementing bad policy that's supposed to be a bridge to good policy.

Posted by: neil on February 1, 2008 at 2:34 PM | PERMALINK

if you don't start by saying, you're going to achieve universal health care, you will be nibbled to death.

Correction: If you do start by saying you're going to achieve universal health care, you've earned some powerful enemies from the very beginning. Those enemies succeeded in keeping the status quo around until now. Do we want to wait another 15 years? I sure don't.

Posted by: neil on February 1, 2008 at 2:35 PM | PERMALINK

LynnDee, I disagree with this statement of yours. People generally tend to accumulate health problems as they move along in life. If those problems can be addressed early on, the mortality risk decreases, the cost of treatment is less.

That's actually a good point. I did think of it but decided not to raise it and further cloud things, unless I got a response. And I will add to your comment the observation that, excluding unforeseen accidents for the moment, the risk of catastrophic illness does increase with age.

But, my point -- even if qualified by yours -- is still valid. It is possible to go without health insurance for some period time, even a long period of time, and then buy health insurance and not be penalized in terms of the health care then available to you and even in terms of your own health. You're rolling the dice, of course, because, as has been pointed out, you could be in an accident any time. Or, as you point out, you could end up allowing a progressive illness to, well, progress.

Social security simply doesn't work that way, catastrophe or no catastrophe, progressive illness or not. You can't opt out through your 20's and 30's and suddenly decide to get with the program and not pay a big penalty. That makes the potential burden to society greater, possibly much greater.

None of this is to argue for opting out of health insurance or even for the opportunity to opt out.

I'm simply saying the analogy with social security is ultimately specious.

Posted by: LynnDee on February 1, 2008 at 2:37 PM | PERMALINK

"the progressive cause on healthcare" insurance is a single payer, not-for-profit publicly funded system of health insurance.

The Obama, Clinton, and Edward's plans all accept their senses of the political reality that a progressive plan is not feasible, and none are willing to fight the good fight.

If "There's nothing odious or unfair about this mailer" then why get lathered up about it.

The mailer is entirely factual but omits mention of the subsides and limits on premium, as a percentage of income, included in the Clinton proposal. Despite such, my bet is that there would still be those uninsured under Clinton's plan, as mandates are unenforcible.

The fact is that the Clinton and Obama plans differ only on the margin. I iam puzzled by those, such as Krugman, Klein, and Drum who work up such a lather over the matter.

Posted by: Chris Brown on February 1, 2008 at 2:40 PM | PERMALINK

Social security doesn't cover everybody so how is it an argument for making healthcare cover everybody?

Posted by: James B. Shearer on February 1, 2008 at 2:40 PM | PERMALINK

Anybody see the statement released by the clinicians and health policy experts today:
http://www.samefacts.com/archives/health_care_/2008/02/universal_coverage_individual_mandates_etc.php

The important part:
"Regardless of our feelings on this issue, what is clear from the evidence is that mandates alone, without strong incentives to comply and harsh punishments for violation, will have little impact on the number of uninsured Americans.1 Indeed, as the Massachusetts experience illustrates, non-compliance with mandates is a large problem, absent harsh sanctions. There is simply no factual basis for the assertion that an individual mandate, by itself, would result in coverage for 15 million more Americans than would robust efforts to make health care more affordable and accessible."

Posted by: Mike P on February 1, 2008 at 2:42 PM | PERMALINK

One more thing: the Hillary/JohnEdwards approach relies on market economics - the theory being that if everyone has to buy insurance, the cost per plan will come down.

I get that in theory, but where is it in their plans that says the insurance companies can't raise the cost of the plans for no other reason than they want to? It's interesting to note that while there are penalities for consumers who don't buy in, there are no penalities for insurance companies who increase costs more than, say, the cost of living.

In other words, these plans put A LOT of faith in insurers, mostly public companies, to not behave as bad actors. Watching the subprime crisis shake out, does that strike anyone else as naive?

Posted by: Jrich on February 1, 2008 at 2:44 PM | PERMALINK

frankly0:

You're assuming there's going to be one policy, one agency, like a Homeland Security of healthare, rolling things up into a monolith, being debated as the bill is crafted.

I've already quoted Obama to show he knows better. Money quote:

But we've got all these legacy systems in place, and managing the transition, as well as adjusting the culture to a different system, would be difficult to pull off. So we may need a system that's not so disruptive that people feel like suddenly what they've known for most of their lives is thrown by the wayside.'"

So saying "the Obama plan does X" as if that's going to be the state of affairs in this country ignores what the man is actually saying.
.

Posted by: Grand Moff Texan on February 1, 2008 at 2:48 PM | PERMALINK

Look, there's a genuine policy difference here, and if universal health care is your main issue you should probably support Hillary Clinton. As an Obama supporter I respect that.

You might even be pleased that we are having a debate about different kinds of health care plans i.e. a discussion with a wee bit of substance and a general premise that there will be some forward movement on this front after the election.

I don't see why this is so hard or why people get so upset.

Posted by: Colin on February 1, 2008 at 2:49 PM | PERMALINK

LynnDee,
I do like your point about why it is important to contribute to social security early and it certainly hits home.
And I can see your argument about the thing called health insurance if one considers it like we consider home insurance.

Posted by: optical weenie on February 1, 2008 at 2:53 PM | PERMALINK
....I don't think 'healthy' people are the ones who would opt out of the plan.....nepeta at 2:09 PM
Actually, yes that is precisely the case. When people self-select, those who don't feel the need won't spend the money. However, that increases the rates because the theory of insurance is that all pay for some. The young and healthy have less need than the older, but if they were able to opt out, their low use doesn't contribute to the rate structure. That is called adverse selection.

...Insurance companies use the term "adverse selection" to describe the tendency for only those who will benefit from insurance to buy it. Specifically when talking about health insurance, unhealthy people are more likely to purchase health insurance because they anticipate large medical bills. On the other side, people who consider themselves to be reasonably healthy may decide that medical insurance is an unnecessary expense; if they see the doctor once a year and it costs $250, that's much better than making monthly insurance payments of $400 (example figures)....

To make the rates less burdensome for all (because the young can also need the system), a policy called risk equalization is used. This is why in socialized insurance plans like those being proposed must have mandates in order to work. If they don't, they won't.


Posted by: Mike on February 1, 2008 at 2:58 PM | PERMALINK

Regardless of our feelings on this issue, what is clear from the evidence is that mandates alone, without strong incentives to comply and harsh punishments for violation, will have little impact on the number of uninsured Americans.1 Indeed, as the Massachusetts experience illustrates, non-compliance with mandates is a large problem, absent harsh sanctions. There is simply no factual basis for the assertion that an individual mandate, by itself, would result in coverage for 15 million more Americans than would robust efforts to make health care more affordable and accessible.

Yes, the idea is that a mandate needs something to make it enforceable, otherwise it fails. And that's exactly what Obama opposes in his ads: any method to enforce it.

And of course "robust efforts to make health care more affordable and accessible" are the way to make those methods, whatever they may be, as painless as possible.

Why this argument might be one favoring Obama is beyond me.

Posted by: frankly0 on February 1, 2008 at 3:04 PM | PERMALINK
And the lack of mandates certainly plays a major role in the reason Obama's plan misses covering 15 million people.

Either Obama himself has got to become a fifth wheel when this whole debate comes up or he is going to have to go to the American people and advocate for that critical feature when finally it must be implemented.

The notion that we can just pretend that this whole issue is just going to go away if we don't think about it and plan for it is groundless. It essentially comes down to denying basic facts of economics.

Wrong. This has always been a bad argument, one that has never even seemed credible enough to seriously (in terms of time) dispute. There is room for disagreement, there are no "basic facts of economics" that argue one way or the other (since there are always dueling "basic facts of economics"), people really do want health insurance who can afford it, and there are ways to make that more doable and realistic without mandating that everyone must have health insurance.

It just makes me chuckle sometimes that the real argument here is whether to go single-payer, not whether to require mandates like automobile insurance, where liability to others and property is the central concern (i.e. not concerns of people seeking their own medical care).

Posted by: Jimm on February 1, 2008 at 3:05 PM | PERMALINK

Hillary Clinton is part of the reason why we have the SCHIP program. I get so tired of people focusing on a failure she shares with Truman, Nixon, and several other presidents and neglecting her successes. Michael Moore implied that she sold out to the lobbyists, but she went right on working toward what was achievable under the circumstances. That is why I will vote for her -- if she can't get what she wants and what is best, she'll go after whatever she can get and it will be better than what we have now.

Posted by: Mary on February 1, 2008 at 3:06 PM | PERMALINK

Look, there's a genuine policy difference here, and if universal health care is your main issue you should probably support Hillary Clinton. As an Obama supporter I respect that.

Actually I think the goal with both plans is universal health care.

Also, both plans leave something unanswered. With Hillary's plan, the question is: What do you do with the people who can't afford it? Yes, she plans to bring the cost as low as possible, but unless it's "0" there will be some number who can't afford it. And the higher the price, the more people there will be who can't afford it. This is not a slam at her plan, just something that would need to be worked out.

Similarly, with Obama's plan, you would have the people who can't afford it as well as those who, as he says, might "game" the system. This might sound like, Oh he's got more problems to worry about, therefore Hillary's plan is better, but I don't know that you can conclude that. It's clear, though, that provisions would need to be made for both contingencies.

Bottom line is: Whichever plan is eventually adopted -- and keeping in mind that that plan may not resemble either of the proposed plans closely enough to say: It's Hillary's! Or: It's Barack's! -- the devil will be in the details.

Posted by: LynnDee on February 1, 2008 at 3:10 PM | PERMALINK

Jimm,

Rather than just blandly asserting that, sure, there are just so many other ways to handle the problem of guaranteeing universal health care, why don't you point to a case example of a proposed program where every good economist grants that it will do the trick, but it does NOT involve mandates, and does not have some other obviously fatal flaw from a political point of view?

And then maybe you can explain to us all how it is that none of our three Democratic candidates plunked down for this plan. How strange that they didn't immediately reach for the political Nirvana you imagine is so easy to come up with.

Posted by: frankly0 on February 1, 2008 at 3:11 PM | PERMALINK

Oh, give me a break. This ad is so dull it makes my eyes shut. Talk about the Clintons saying anything to get an edge. Sheesh, this so has nothing to do with the original Harry/Louise ad in '94 that it boggles the frickin imagination how someone could even think it was an attack ad. Hey, Clinton boyz & guhls - you'd better come up with something better than this load of hockeypucks. This website is obviously in the bag for Clinton. Last time I visit here!

Posted by: Jrichards Tennessee on February 1, 2008 at 3:16 PM | PERMALINK

This idea that the mailer has something to do with "Harry and Louise" is as phony as the "snub."

Posted by: coyote on February 1, 2008 at 3:21 PM | PERMALINK

why don't you point to a case example of a proposed program where every good economist grants that it will do the trick, but it does NOT involve mandates, and does not have some other obviously fatal flaw from a political point of view?

Why don't you go first, and show me that every good economist insists on mandates and muddled solutions over simple single-payer?

As for single-payer, I'm not suggesting anyone should advocate it, but it is the obvious alternative, not the pseudo-solutions crafted to please special interests, who seem to have too much hold on our government since all 3 candidates, as you mention, have gutless health care reform proposals.

In the end, if we're going to go with gutless and overly complex health care reform proposals, I don't see having or not having mandates as an especially burning issue, whether argued on this merit or on its own merits (i.e. even accepting that these health care reform proposals were not gutless and disastrously complex, there is still no burning need to have mandates and force this to be like automobile insurance, which has totally different concerns/issues).

Posted by: Jimm on February 1, 2008 at 3:22 PM | PERMALINK

This idea that the mailer has something to do with "Harry and Louise" is as phony as the "snub."

Looks like we got the latest Obama talking point here. I wonder if they distribute them by text messaging nowadays instead of fax.

Posted by: frankly0 on February 1, 2008 at 3:24 PM | PERMALINK

As for those who want to "game" this system, going to an emergency room for basic health care, especially in an environment where that is less common and probably more hectored (on site), is not likely going to be a winning proposition.

Make health insurance affordable, and even I'll buy it, or I'll pay the price.

Posted by: Jimm on February 1, 2008 at 3:25 PM | PERMALINK

frankly0: No, it's original to me. But coming from you, I take that as praise.

Posted by: coyote on February 1, 2008 at 3:30 PM | PERMALINK

Why don't you go first, and show me that every good economist insists on mandates and muddled solutions over simple single-payer?

Look, I won't say I understand why none of the three candidates would go for single-payer. To me, that should be both possible in this political moment and highly desirable.

But this much is certain to me: there's no hope at this juncture for single payer in one bold step. Even if it's in an abstract way politically possible, it's simply impossible that there will be anyone who will be able to champion that effort at this stage. The only ones who might have been able to do so would be the candidates themselves, who can take their plans as part of their mandate when elected. No one else than a President has the clout to push for an even more aggressive measure than those already proposed.

I simply take the infeasibility of single payer as a fait accompli at this time, given what our candidates have themselves proposed. I can't imagine Congress itself proposing something even riskier from a political point of view, because they are, let's just say, not big risk takers.

Short of single payer, I have never heard of a plan that has a path to get to universal coverage that does not incorporate mandates. Certainly none of our candidates has proposed such a plan, and I've got to believe that all the alternatives they considered exhibited only more grievous faults than the ones with mandates.

Posted by: frankly0 on February 1, 2008 at 3:33 PM | PERMALINK

I don't see why this is so hard or why people get so upset.

Um, because the last several years have sucked?

Having been in ideological combat for a very long time, now that we're about to be in power our means of confrontation haven't ratcheted down. Everyone's phasers are still set on 'kill.'

Ideological combat leads to ideological rigor. That's a very stupid place to be.
.

Posted by: Grand Moff Texan on February 1, 2008 at 3:38 PM | PERMALINK

Kevin -

The difference between healthcare and social security is that we already have social security and we don't already have universal healthcare.

To get from zero to something, it often helps if you give people the chance to opt-out.

Posted by: Peter Bautista on February 1, 2008 at 3:51 PM | PERMALINK

We already have universal coverage.

Anyone can go to an emergency room or "ready care unit" (or whatever you call those things) and get health care. If you break your leg, you will not be walking around with the bone sticking out for the rest of your life, you will get that bone set.

The primary problems we're dealing with today are cost and lack of preventive health care. These are the issues that the half-azz health care reform proposals we hear about today are addressing, and mandates is not an especially crucial element, nor is mental mistakes like likening health care insurance to automobile insurance (social security is not the apt likeness, either for actual or ideal reasons).

You deal with cost by making more affordable, and you deal with preventive health care by again making more affordable so people actually have doctors (and you also have to emphasize some many other things/changes I won't bother going into now).

The automobile insurance model is entirely different, dealing with liability and property, and social security is even more different, for so many myriad reasons there is no point in even talking about it.

Posted by: Jimm on February 1, 2008 at 3:58 PM | PERMALINK

From Krugman:

The Obama campaign sends out an ugly mailer. Sorry, but this is just destructive — like the Obama plan, the Clinton plan offers subsidies to lower-income families. And BO himself has conceded that he might have to penalize people who don’t buy insurance until they need care. So this is just poisoning the well for health care reform. The politics of hope, indeed.
Update: Ezra Klein adds a screenshot of the original Harry and Louise ad — they’ve obviously deliberately copied it. Just to remind everyone, Harry and Louise were the center of the vile smear campaign the insurance lobby waged against health care reform in 1993 — and this time a Democratic candidate is doing the smearing for them.
Ezra also points us to an Urban Institute study that shows that yes, mandates are essential. The key passage:
Voluntary measures would tend to enroll disproportionate numbers of individuals with higher cost health problems, creating high premiums and instability in the insurance pools in which they are enrolled.
I know that Obama supporters want to hear no evil, but this is really, really bad.
One must bear in mind, of course, that since Krugman started evaluating Obama he has apparently become deranged with Obama hatred and his otherwise superb reasoning faculties have entirely deserted him.

Posted by: frankly0 on February 1, 2008 at 3:58 PM | PERMALINK

Unless of course we considered single-payer, then health insurance would be more aptly likened to social security.

Posted by: Jimm on February 1, 2008 at 4:00 PM | PERMALINK

Krugman is not "all economists", and all economists make "choices", and it's people with health problems that need insurance most obviously, why should relatively young, healthy individuals have to pay for that care?

Posted by: Jimm on February 1, 2008 at 4:03 PM | PERMALINK

The more you explore this issue, when actually taking into consideration single-payer, the less sense Krugman makes, especially economically.

I don't know why the guy has a hair up his azz, but as an economist who has bought into a certain political "reality", he does noone justice by splitting those hairs up his azz and declaring them the only popular weave of the next era.

Posted by: Jimm on February 1, 2008 at 4:07 PM | PERMALINK

why should relatively young, healthy individuals have to pay for that care? Jimm

Because relatively young, healthy individuals eventually age and become sickly feeble senior citizens. Unless of course their hearts blew up at a young age because they had high cholesterol levels but never bothered to get an annual check up because they thought they were invincible.

Jimm - universal health care is a progressive policy. That means all for one and one for all.
Not I'm only gonna take what benefits just me.

Posted by: optical weenie on February 1, 2008 at 4:33 PM | PERMALINK

franklynO, how much are the Hillary people paying you to spend all day writing on the comments section of this blog?

Posted by: Traven on February 1, 2008 at 5:02 PM | PERMALINK

I'm so disappointed that single-payer seems to have flown out the window. Stupid for-profit insurance companies, the bane of healthcare. Does anybody have a solution?

Posted by: nepeta on February 1, 2008 at 5:06 PM | PERMALINK

I thought Kevin had posted comments from policy wonks that suggested starting single-payer, and at the same time allowing people to stay with their employment benefit plans or buying private insurance. So there would be three options. If the single-payer plan was very good, then people would be tempted to opt out of employment benefits to which they contribute an increasing amount, and opt for the single payer plan. Obviously single-payer requires a tax hike (a progressive one), but isn't it worth it in the long run?

Posted by: nepeta on February 1, 2008 at 5:14 PM | PERMALINK

Nepeta,
Inkblot has the solution. Free health care for all. Free Nibblies for all. Free pet pods for all. And of course. Free cat nip for all.

Posted by: optical weenie on February 1, 2008 at 5:16 PM | PERMALINK

As people have said upthread, it doesn't seem to me that forcing people to pay insurance companies for health benefits, when those same companies, I assume, will still be reaping a profit, is anywhere close to a liberal healthcare plan.

Posted by: nepeta on February 1, 2008 at 5:18 PM | PERMALINK

optical weenie,

I'll write-in Inkblot for Prez! Btw, do you know what my name means??? A riddle...

Posted by: nepeta on February 1, 2008 at 5:21 PM | PERMALINK

Nepeta is latin for Catmint. I have several plants in my yard. Cleopatra the Empress of the Universe likes to sit on one in particular.

Posted by: optical weenie on February 1, 2008 at 5:29 PM | PERMALINK
this so has nothing to do with the original Harry/Louise ad in '94....Jrichards Tennessee at 3:16 PM
It just happens to mimic the entire style and message. Yeah, right.
This idea that the mailer has something to do with "Harry and Louise" is as phony as the "snub." coyote at 3:21 PM
Keep the faith, O 'bamabot, keep the faith!
We already have universal coverage. Anyone can go to an emergency room ....Jimm at 3:58 PM
And some have died waiting. Seriously, those services as well as free medical clinic are overwhelmed and the wait for treatment is long.
...since Krugman started evaluating Obama he has apparently become deranged with Obama hatred.....frankly0 at 3:58 PM
Isn't that the fate of everyone who is underwhelmed by the Euphonious balonious?
....The more you explore this issue, when actually taking into consideration single-payer....Jimm at 4:07 PM
It's called reality. They entrenched power of the corporate medial interest groups is too strong. It was too strong in 1947, it's stronger today. Perhaps if we had government election financing so that capitalists could not buy and own the government, things might be different. That would be probably harder to establish than socialized insurance. Remember, the only way we have Medicare Part D is because it subsidizes pharaceutical companies. The government is still subsidizing Advantage Care Medicare even though it's more expensive than straight Medicare. Posted by: Mike on February 1, 2008 at 5:29 PM | PERMALINK

franklynO, how much are the Hillary people paying you to spend all day writing on the comments section of this blog?

As much as your own comments are worth.

Posted by: frankly0 on February 1, 2008 at 5:38 PM | PERMALINK

optical weenie,

Congratulations! And here I thought I would at least make you google. I love catmint. I have a few different species in my garden and my cats love to lie in it and nibble on it too.

Posted by: nepeta on February 1, 2008 at 5:39 PM | PERMALINK

You. Have. GOT. To. Be. Freaking. KIDDING!

An ad that apes the Harry and Louise ad is being attacked and compared to the dirtiest of dirty politics -- and this web site is trying to both not say it's dirty politics but then attack it as if it IS? Talk about talking out of both sides of your mouth!

By the way, whatever policy issues could have been illustrated, or whatever "dirty pool" could have been charged against Obama, has been completely obliterated by the Clinton campaign's official reaction (from Americablog - note the third paragraph):

"The Clinton campaign convened a conference call with health policy experts to denounce Obama's new mailer (.pdf), which attacks Clintons plan for "forcing" Americans to sign up for insurance, and which features a couple at a kitchen table that recalls, for some, the famous insurance-industry financed "Harry and Louise" ads against the original Clinton plan.

""I am personally outraged at the picture used in this mailing," said Len Nichols of the New America foundation, a leading supporter of mandatory insurance, who called it a "Harry and Louise evocation."

""It is as outrageous as having Nazis march through Skokie, Illinois," Nichols said. "I just find it disgusting that this kind of imagery is being used to attack the only way to get to universal coverage."

"Clinton advisor Neera Tanden called the mailer "politically dangerous.""

Link to original quote:

http://www.americablog.com/2008/02/clinton-campaign-call-obama-ad-evokes.html


What's more damaging: a witty use of an ad, or comparing that use to Nazis?

Posted by: EdgewaterJoe on February 1, 2008 at 5:40 PM | PERMALINK

nepeta: it doesn't seem to me that forcing people to pay insurance companies for health benefits, when those same companies, I assume, will still be reaping a profit, is anywhere close to a liberal healthcare plan

Germany and Japan have UHC systems where private insurers play a large roll, and Germany is widely considered to have one of the best systems.

However, the devil is in the details. IIRC the German insurers are not-for-profit and are closely regulated. That's certainly not the case here, and, under our "finest government money can buy" system, it never will be.

Face it: the root of the problem is the bribery we call campaign finance. Without publicly financed campaigns (ala the People's Republic of Arizona) real improvement hasn't got a chance. Yet this issue gets almost no attention.

As for Obama, his Harry and Louise ad has pushed me over the edge. I've never been a fan of Hillary, and before this said that it was just a meaningless contest between Republican-Lites. No more - Obama looses the "Lite" qualifier. I hope that Hillary rips him a new one over this (not that I think she will).

What's appealing about Obama other than the fact that he gives pretty speeches? I think he's an image candidate, just as Reagan was an image president. By that I mean someone who projects an appealing image, but whose actions contradict it.

Whatever happens this will be another "hold your nose" election, where you fight the stench of voting for someone whose only qualification is that they're not quite as bad as the opposition. With Hillary I'll hold my nose, but with Obama I'll need a gas mask.

Truman is dead - any chance we can draft Feingold?

Posted by: alex on February 1, 2008 at 5:44 PM | PERMALINK

EdgewaterJoe,
You need to tell the whole story, where the Clinton campaign distanced itself from the Nichols remark.

Posted by: optical weenie on February 1, 2008 at 5:44 PM | PERMALINK

Edwards was our last, best, hope on Health Care.

Whether it's Hillary or Obama, we will ALL be the Health Insurance Industry's BITCHES for another 9 years, at least.

My plan?

Don't get sick.
Don't care about anyone who gets sick.

Posted by: osama_been_forgotten on February 1, 2008 at 5:52 PM | PERMALINK

If you've never been in a situation WHERE YOU HAVE ABSOLUTELY NO POSITIVE CASH-FLOW COMING INTO YOUR HOUSEHOLD, then I guess you can't relate to people who are terrified of mandated insurance.

"Subsidies" pheh. How would those work? How much paperwork? What are the requirements? What's the appeal process should I be unfairly denied? How long after I pay the premiums until I receive the "subsidy"? How much less than the out-of-pocket will the subsidy be? If I'm somebody who has been laid-off and my spouse is sick and my unemployment benefits have run out - where the hell do I get the money to cover the difference?

As somebody who has been there, and knows people in that circumstance right now, I can relate to Obama's incrementalist approach, and appreciate it.

Proponents of mandates have done little or nothing to assuage these concerns, and Obama's campaign is right to remind the voters of this.

He's not trying to sabotage universal coverage, and you can't look at the man's background and seriously believe that's where he's coming from. He's protecting the interests of the people he cares about. Damn good for him. You don't agree with his approach, fine. But stop with the "GOP-Lite" bullshit, their are real progressives out there with real concerns about mandates, and Obama is one of them.

Posted by: Brautigan on February 1, 2008 at 6:08 PM | PERMALINK

Once people start losing insurance as they lose their jobs they'll be more amenable, but not now. Later, Obama can simply say that the problem has worsened and a more aggressive plan is needed.

What is needed is that Americans must understand the truth: They're losing their jobs because their employers can no longer afford the healthcare costs. Salary's becoming a relatively trivial component, of the cost of compensating a professional. The healthcare component is increasing at an astounding rate, and the service is declining, leading to less healthy (both physically, and financially) employees; so what's the point of group healthcare plans again? Oh, that's right - to SUCK ever other sector of our economy dry, until it crumbles and blows away like dust.

Posted by: osama_been_forgotten on February 1, 2008 at 6:09 PM | PERMALINK

Mike: Perhaps if we had government election financing so that capitalists could not buy and own the government, things might be different.

Thanks for mentioning that. Sometimes I feel like a voice in the wilderness. I wish I could say that I have great insight, but I'm more like the kid who said that the emperor was naked.

optical weenie: EdgewaterJoe, You need to tell the whole story

Save you breath (electrons?, photons?). Here's the Obamabot approach in a nutshell:

1. He speechifies so prettily that you should ignore what he actually says or does.

2. What he says is meaningless - a tool to appeal to the heathens. Much as early Christian missionaries tolerated their converts continued use of certain pagan symbols and rituals so that they were more likely to accept Christ, we believe that words and actions are just a veneer. We know, as an article of faith, that he's a stealth liberal, progressive or other good thing.

3. You're either with us or your against us.

4. Hope, change, change, hope. Lather, rinse, repeat.

osama_been_forgotten: Don't get sick.

Under the current or future regime, where you have a choice between crony economics or more blatant crony economics, that's about the only practical advice. Please provide details.

Forget Harry Truman, even Adam Smith is rolling over in his grave (look at the economic system he was criticizing and you'll see what I mean).

Posted by: alex on February 1, 2008 at 6:11 PM | PERMALINK

The pivotal issue in last night's CA debate wasn't health care. It was Iraq.

Barack Obama was against the war from the start. Hillary Clinton can't say that, nor has she ever apologized for her vote to authorize war. That's the issue that will turn red states blue in November. Bringing a swift resolution to the war in Iraq -- that's the issue that will unite a coalition of Democrats, Independents, and disgruntled Republicans in November. (Though it's interesting to note that the Hillary Clinton campaign has tried to create buzz on the health care issue in the days leading to every primary thus far.)

To turn a phrase, "It's the war, stupid."

Posted by: Edith on February 1, 2008 at 6:23 PM | PERMALINK

The very poorest of us already have coverage thru Medicare, so their premiums are not an issue. The richest of us can afford to pay whatever it costs. It's the vast middle of us who pay more and more for less and less care, or lose it entirely and can't get new insurance. We need to get to universal single payer (Medicare for all) and Obama is fighting AGAINST a step along the way, ensuring we'll never get there with him as President nor will we even get closer to single-payer. It's bad policy, ensures no progress and more strain on our already overburdened and underfunded public hospital system, and repeats GOP talking points (again, from him).

It really is appalling--he couldn't hurt us all more on this issue if he tried.

Posted by: amberglow on February 1, 2008 at 6:44 PM | PERMALINK

Obama may be right on day 1 about Iraq, but Clinton is right on day 1 about healthcare. That clinches it for me. Harry and Louise Redux just cost Obama a campaign contribution. For shame!

Posted by: Sharon on February 1, 2008 at 7:05 PM | PERMALINK

Scrutinize Obama's "Harry and Louise" ad just a little bit here. We've got a married couple in their 40's. The house looks pretty decent-quite a bit *LARGER* than the original "Harry and Louise" ad. I'd guess that both of them are employed and they certainly don't look like factory workers-more like middle-managers or technical professionals. They just don't seem to fit the picture I have in my mind of people that don't ALREADY have insurance from an employer and are fussing about how to find money for their premiums.

Uh, when you hit 40-45, usually some significant medical attention has been required, and if you've got insurance available from your employer wouldn't you be electing to pay your 20% of the premium every month? That's what's wrong with this picture here. I think Obama is sending a subliminal message here about those extra TAXES this middle-income educated working couple would have to pay under Hillary's plan to make her plan more "affordable".

Posted by: Doc at the Radar Station on February 1, 2008 at 7:20 PM | PERMALINK

And I can see your argument about the thing called health insurance if one considers it like we consider home insurance.

That's a good analogy. To extend it a bit further, social security is more like buying a house in the sense that, by paying into it, you build up equity. If you don't pay into it, you are nowhere close to having a house at the end of 30 years.

Medical health insurance, OTOH, is more like buying insurance on that house. Assuming nothing goes wrong, you're never more than one payment away from being insured. Big risk, though. No doubt about that.

Posted by: LynnDee on February 1, 2008 at 7:22 PM | PERMALINK

There is another name for a government mandated cost item. It's called a tax.

Mr. Drum is correct that mandated insurance would be no different than SS. In order to do it we would need to add a new payroll tax for workers. And it would probably be in the same range as the FICA tax, 15% total taxation.

Of course this would be primarily just a wealth transfer from workers to insurance carriers.

And if you don't think the Republicans will make this very same point but with much more frightening imagery, you haven't been paying attention for the past 20 years.

Posted by: flyerhawk on February 1, 2008 at 7:23 PM | PERMALINK

That clinches it for me. Harry and Louise Redux just cost Obama a campaign contribution. For shame!

Hmm. I'm always skeptical when someone says: "My checkbook was open and I was this close to writing a check! And for big bucks too!"

Yeah. Right. :)

Posted by: LynnDee on February 1, 2008 at 7:40 PM | PERMALINK

I was undecided now leaning strongly for Hillary.

Truth to tell, I'm skeptical about this too. Did you know nothing about their health care plans before last night? Is that why you were undecided? It's not like this stuff was just declassified.

Note to me: Take your sarcastic self out to the kitchen and fix dinner!

Posted by: LynnDee on February 1, 2008 at 7:43 PM | PERMALINK

To turn a phrase, "It's the war, stupid."

Posted by: Edith

Amen. Comparing their health care insurance plans is like picking pepper out of fly shit. How much health care insurance would one trillion dollars buy?

Read Krugman. Chicken shit HRC let John Edwards take the lead.

Posted by: Econobuzz on February 1, 2008 at 8:06 PM | PERMALINK

LynnDee, you don't know me from Adam. I routinely contribute to campaigns. I've contributed to Clinton, to Edward, to Dodd, and I just signed a pledge to contribute to Obama. I also contribute to worthy blogs. When ActBlue makes a good recommendation, I contribute to candidates they recommend. It's part of being a good Democrat. So take your snide shit and shove it, punk.

Posted by: Sharon on February 1, 2008 at 8:08 PM | PERMALINK

I'm kind of tired of hearing every single political ad EVER that features a married couple talking called "Harry and Louise" and somehow demonized as the lowest of low political tricks. Would you think this ad is just so absolutely horrible if it had the same message but didn't have a middle-aged couple sitting around a table on the front? Disagree with the substance if you will, but using a middle-aged couple to make the pitch isn't inherently worse or make it somehow evil. I know, I know, you claim it will remind folks of 1994. But, seriously, how many non-political junkies really remember an ad from 14 years ago? And how many ad campaigns (political and otherwise) really on married couples talking to make their pitch? About a zillion.

Posted by: micah on February 1, 2008 at 8:10 PM | PERMALINK

There's nothing odious...about this..."

Then what's the difference between this and odious?

Posted by: Sharon on February 1, 2008 at 8:13 PM | PERMALINK

micah: Disagree with the substance if you will, but using a middle-aged couple to make the pitch isn't inherently worse or make it somehow evil.

I'm sure it's just a coincidence that it's practically a carbon copy of the infamous Harry and Louise ad. While we're at it, I'm sure that Reagan chose to start his presidential campaign in Philadelphia, Mississippi just because it was a nice little town.

Just because the symbolism isn't apparent to everyone, doesn't mean it's not there, and doesn't mean that it wasn't put there on purpose. Depending on your message, "obscure" symbolism may be the most effective kind. It goes over most people's heads but appeals (or repels) those that are particularly concerned about an issue.

This one screams "Obama's not serious about UHC".

I know, I know, you claim it will remind folks of 1994. But, seriously, how many non-political junkies really remember an ad from 14 years ago?

The people who prepared and approved this ad are political junkies of the first order - it's how they earn a living. They knew what message they were sending.

Posted by: alex on February 1, 2008 at 8:27 PM | PERMALINK

Sharon,

Odious would be something that misrepresents what Clinton said. Did they ad claim something that wasn't true?

Gee a middle aged couple together making decisions. How would anyone identify with that other than because they remember a commercial from 15 years ago?

Honestly comparing a mailer with a still of a married couple to a TV ad with an entire dialogue? Here's a hint folks, it wasn't the images that scared people.

Posted by: flyerhawk on February 1, 2008 at 8:28 PM | PERMALINK

LynnDee, you don't know me from Adam. I routinely contribute to campaigns. I've contributed to Clinton, to Edward, to Dodd, and I just signed a pledge to contribute to Obama. I also contribute to worthy blogs. When ActBlue makes a good recommendation, I contribute to candidates they recommend. It's part of being a good Democrat. So take your snide shit and shove it, punk.

You're right. I don't know you. And I started that post several times and scrapped it for that very reason. But ultimately your "I was this close to contributing" just irked me enough that I posted it.

That said, my post was pretty tame stuff (IMO, of course), while you apparently, judging from your post, are sitting on a mountain of rage about something.

I apologize for setting you off.

Posted by: LynnDee on February 1, 2008 at 8:31 PM | PERMALINK

how many ad campaigns (political and otherwise) really [sic] on married couples talking to make their pitch

Oh please, this is as disingenuous as Huckabee claiming the looming cross in the background of his mailer was just a window. I worked in the ad business for 20 years and I know from experience these people know exactly what they're doing.

The question is: Did Obama? It's possible he didn't. I'll give him the benefit of the doubt. If he recognizes how offensive this image is to millions and millions of Americans who saw their desperate hopes for healthcare reform dashed in the 90's, he should disavow Harry and Louise II at once. I hope he will.

Posted by: Sharon on February 1, 2008 at 8:32 PM | PERMALINK

'As somebody who has been there, and knows people in that circumstance right now, I can relate to Obama's incrementalist approach, and appreciate it.'

Brautigan, DAMN RIGHT! I wish this weren't such a public forum. I'd love to tell my sob story.

Posted by: nepeta on February 1, 2008 at 8:42 PM | PERMALINK

Interesting how, when the fur was flying over the issue of race last week, not just a few commenters -- here, in particular -- remarked to the effect that politics ain't beanbag & what the Clintons & their surrogates were doing was nothing compared to what the Republicans would do to Obama in a general election. Funny how folks rediscover outrage when it's their candidate on the receiving end of something.

Posted by: junebug on February 1, 2008 at 8:43 PM | PERMALINK

LynnDee, technically you didn't apologize, but I accept you comment as such. I really hate the kind of cynicism that makes some people think it's cute to impugn the character of others. That's soooooo Maureen Dowd and soooooo unfunny. That's what sets me off. I'm old and I'm grouchy, and when someone calls me a liar, I'm going to invite them to kiss my ass.

Posted by: Sharon on February 1, 2008 at 8:45 PM | PERMALINK

Obama folks, please stop saying that Hillary's plan forces you to buy unaffordable private insurance.

First, she has aggressive subsidies, and a cap on what fraction of your salary you can be required to spend on health care. She says her subsidies are at least as aggressive as Obama's. If that's the case, then everyone should be able to afford it, just as Obama.

Second, and more importantly, she will set up a public plan based on Medicare. So you can always buy into that plan, and not one from a rapacious private insurer.

My guess is that that public plan will have a big competitive advantage, as it won't be burdened with administrative costs and only has to break even, not run a profit for shareholders. Ideally, this would cause private companies to get better as well, or quit altogether.

The argument that Congress will mangle any proposal is also wrong to me. Congress will not come up with a plan that is a bigger political risk than the president's plan. If Obama doesn't propose UHC, it's not going to happen. Congress will only make it weaker.

As for the upstream argument that you can't go for the whole thing all at once: Social Security came about all at once. If it started piecemeal, it would never have survived. It's popular because it's universal, not the other way around. To see the opposite case, look at welfare. It's unpopular because it only benefits the poor.

And I still don't see how Obama deals with adverse selection.

Posted by: Steve on February 1, 2008 at 8:48 PM | PERMALINK

LynnDee, technically you didn't apologize, but I accept you comment as such. I really hate the kind of cynicism that makes some people think it's cute to impugn the character of others. That's soooooo Maureen Dowd and soooooo unfunny. That's what sets me off. I'm old and I'm grouchy, and when someone calls me a liar, I'm going to invite them to kiss my ass.

Actually, reading through your other recent posts here -- in which, BTW, you indulge in plenty of Maureen Dowdyish snarkiness of your own -- I see that, rather than being particularly set off by anything, you're actually sort of a rogue elephant on the rampage.

Is it because you're old and grouchy, as you say? Is it because it's driving you to distraction to see Obama's star in ascendancy when you've decided he's on the wrong side of voluntary vs. mandatory health care?

Who the hell knows.

BTW, I don't know how old you are, but I'm a boomer myself, so I ain't no spring chicken.

Posted by: LynnDee on February 1, 2008 at 8:56 PM | PERMALINK

Steve,

Here are a couple brief passages from Hillary's website on her healthcare plan.

It puts the consumer in the driver's seat by offering more choices and lowering costs. If you're one of the tens of million Americans without coverage or if you don't like the coverage you have, you will have a choice of plans to pick from and that coverage will be affordable. Of course, if you like the plan you have, you can keep it.

How is adverse selection avoided if a large number of people opt for keeping their employment sponsored plan, which is undoubtably less than $500/mo.

"Insurance companies won't be able to deny you coverage or drop you because their computer model says you're not worth it. They will have to offer and renew coverage to anyone who applies and pays their premium. And like other things that you buy, they will have to compete for your business based on quality and price. Families will have the security of knowing that if they become ill or lose their jobs, they won't lose their coverage."

Here she is talking about insurance companies. I don't believe she has a public plan at all. Both Clinton and Obama's plans are essentially the same, both plan to fund their plans by repealing Bush tax cuts, and neither offer a 'public' government-managed plan. Their only difference is on the mandate issue.

Posted by: nepeta on February 1, 2008 at 9:18 PM | PERMALINK

Steve: As for the upstream argument that you can't go for the whole thing all at once: Social Security came about all at once. If it started piecemeal, it would never have survived.

Damn straight. Obama's "incrementalist" approach is another way of saying "don't do shit".

Happy Anniversary! 60 years since Truman campaigned on UHC (Congress stopped it). The "moderate", "incrementalist" approach has gotten us exactly nowhere, and Obama's promising more of the same. But wait, we're still in the campaign promise phase. If he's compromising now, what will happen when it gets down to real politics?

Change, hope, hope, change ...

It's popular because it's universal, not the other way around. To see the opposite case, look at welfare. It's unpopular because it only benefits the poor.

FDR understood that. So much for the theory that Obama is another FDR.

And I still don't see how Obama deals with adverse selection.

Hope, change, change, hope ...

I never thought that I'd prefer Hillary to any other Dem, but Obama has changed my mind. Hey, Chelsea in 2016?

Posted by: alex on February 1, 2008 at 9:23 PM | PERMALINK

Obama folks, please stop saying that Hillary's plan forces you to buy unaffordable private insurance. - Steve

Steve, you are quite correct, but both candidates offer plans that allow you to buy into a public plan, not just Hillary's. The REAL issue here is whether you want to support Hillary's plan that mandates that everyone pays in, but also results in higher taxes to make it more affordable for lower incomes -OR- Obama's plan that will have lower taxes and no mandate, but still allow an opt-in to a public plan for self-employed and others who *can afford* to pay.

Hillary's plan is ironically more attractive for the working poor, while Obama's is more attractive for the "already insured" and self-employed who would pay a full premium for a public plan. Obama is trying to woo upper middle-class voters at the expense of the working poor IMO in the guise of choice issues. BUT, Hillary's plan begs the question about the costs of enforcement of mandates, the cost of additional taxes, a more complex bureaucracy that in the end guarantees private insurers more business. I'm not convinced by either one's plan-three days to go until I go into the voting booth. I would like more clarity here and less smoke and mirrors.

Posted by: Doc at the Radar Station on February 1, 2008 at 9:42 PM | PERMALINK

nepeta: How is adverse selection avoided if a large number of people opt for keeping their employment sponsored plan

That's exactly how you avoid adverse selection. If people like the plan, they keep it - regardless of whether they loose their job, change jobs, or retire.

Further, her plan incorporates another idea from our German friends - penalize health insurance companies that have, on average, an excessively healthy set of customers.

Here she is talking about insurance companies.

Just like she did in the 1990's, and just like the Germans and the Japanese do. Managed right, it works very well.

Their only difference is on the mandate issue.

In other words, their only difference is on one of the most important points. Without mandatory coverage, you don't have real risk sharing. It would be like telling people that they can be covered by buying car insurance after they have an accident.

I'm not, and never have been, a big Hillary fan. Right now she's just the lesser evil. And yes, both Obama and Hillary are only talking about UHC because Edwards pushed them into it. But at least she's talking about it. Obama's saying "first, we compromise", which means that eventually, you do nothing.

Posted by: alex on February 1, 2008 at 9:49 PM | PERMALINK

This whole debate about mandates is a waste of time. Congress will create the plan with or with out mandates (which may be added later if needed)
The question that voters should be focused on is who is better qualified to lead congress on this and many other important issues. I think Obama is the more capable, persuasive leader. He has a stronger record of passing legislation as a senator.

Posted by: noexpert on February 1, 2008 at 9:53 PM | PERMALINK

you're actually sort of a rogue elephant on the rampage

LOL...cough...hack...wheeze...stop it...I wet my pants! That was the best line in this whole thread LynnDee! I accept that description with pleasure.

Posted by: Sharon on February 1, 2008 at 9:54 PM | PERMALINK

Imagine a future in which families are mandated to buy a health plan with a $10,000 deductible (the cheapest legal option?) -- okay; they obeyed the law -- but now they end in the emergency room MORE OFTEN because they have even LESS money left for family doctor visits.

Medicare for all ought to be the easiest program in the world to sell: Medicare is the plan most folks happily look forward to relying on when they are older and perhaps much more in need of even critical care -- why in the world should they hesitate to rely on it now while they are young and usually healthy?

Posted by: Denis Drew on February 1, 2008 at 10:01 PM | PERMALINK

Alex,

I admit I'm not a policy wonk on this stuff, so maybe you can help me. Under Obama's 'no mandate' plan something like 15 million people would not be covered. Out of a population of about 300 million, how does that 15 million adversely affect the cost/benefit algorithm? Seems sort of small to me. 285 million seem like a sufficient number to spread risk over the group.

Are you saying that if one opts to stay with their employment healthcare plans that the employer would be charged $500/mo/person by all insurance companies to make those plans of equal cost? How does this compare to what employers pay now?

The other option is to sign up with an insurance company for $500/mo/person on a private basis and your coverage options will vary from company to company?

I just don't understand this at all.

Posted by: nepeta on February 1, 2008 at 10:05 PM | PERMALINK

Oh, wait. You don't sign up for 'private' insurance, you sign up for 'public' insurance which costs $500/mo from any insurance company with the same coverage. My husband and I (currently unemployed) are paying $500/mo now for both of us under New York's 'Healthy New York' program, which benefits low-wage income earners with no healthcare benefits. $500/mo/person would be twice as much for us. What would NY decide to do if Hillary's plan were adopted?

Posted by: nepeta on February 1, 2008 at 10:14 PM | PERMALINK

Damn straight. Obama's "incrementalist" approach is another way of saying "don't do shit".

Where did anyone get the idea that Obama is an incrementalist? Clearly, incrementalism is the very hoped-for result of Clinton triangulation!

She -- along with an unfortunate number of other Democratic Senators in 2002 -- triangulated us right into a disastrous war in Iraq!

Down with incrementalism! Up with transformation!

Vote Obama!

Posted by: LynnDee on February 1, 2008 at 10:19 PM | PERMALINK

nepeta: Under Obama's 'no mandate' plan something like 15 million people would not be covered. Out of a population of about 300 million, how does that 15 million adversely affect the cost/benefit algorithm? Seems sort of small to me.

If you actually had "only" 15M uncovered, you might be right. What I suspect though is that the number will be much higher and increase as more employers get out of the health insurance business.

Note that the latter will be easier if people can buy reasonably priced insurance by themselves. It's also something I don't blame them for. I don't see why my employer should buy my medical insurance any more than they buy my food. Of course, the big question is who will get the money employers now pay towards premium. But if a company put that money into your paycheck and told you to buy your own insurance, I think that would be reasonable (don't laugh - that's close to my current situation).

285 million seem like a sufficient number to spread risk over the group

The real question isn't how many people (hey, 1M would be plenty) but how the pool is selected. If currently healthy people opt out to save a few bucks it will affect the composition of that pool. And if said people suddenly have a big accident or some unforeseen major health problem, then they'll be let into the pool even though they didn't pay their "dues" when everything seemed rosy.

I really think that Obama's lack of a mandate is saying that he's not serious, and/or that he's not willing to face the trade offs and difficulties of enacting a UHC system. While UHC would be great, like everything else it won't be without its drawbacks or be universally loved. Trying to be everything to everybody might sound good, but in reality it means that you're nothing to anybody.

Posted by: alex on February 1, 2008 at 10:48 PM | PERMALINK

Clinton right on healthcare. Obama right on Iraq. I had a candidate...Edwards...and watched as the press "disappeared" him. I wish had the clarity and, in some cases, apparent clairvoyance of so many of you. I'm glad I don't have to vote Tuesday. Digby summed up the conflict for me and many others:

Democrats may very well win the election. And they may have a large working majority. Hopefully they will get some good things done for the country. But if they do not run on and then act on these constitutional abuses, they will be used again the next time a Republican is in office (if not sooner) and we will have to fight this battle all over again, having lost a tremendous amount of territory in the meantime. What we will have lost in terms of morality and decency is uncountable.

This stuff should not be brushed aside. And my biggest worry is that neither Clinton, due to the structural and institutional loathing for her in the political establishment, or Obama, who is running as a uniter not a fighter and will have little political capital for "looking backwards," will make this a priority.

Posted by: Sharon on February 1, 2008 at 10:50 PM | PERMALINK

Napeta, you always ask the best questions. It's really helpful.

Posted by: Sharon on February 1, 2008 at 10:51 PM | PERMALINK

nepeta: Oh, wait. You don't sign up for 'private' insurance, you sign up for 'public' insurance which costs $500/mo from any insurance company with the same coverage. My husband and I (currently unemployed) are paying $500/mo now for both of us under New York's 'Healthy New York' program, which benefits low-wage income earners with no healthcare benefits. $500/mo/person would be twice as much for us. What would NY decide to do if Hillary's plan were adopted?

Where are you getting those numbers from, seriously? Do you know that Hillary's plan, with the tax credits, would cost you more than you pay now?

BTW, I'm happy that we live in a state that's civilized enough to offer something like that.

Posted by: alex on February 1, 2008 at 11:05 PM | PERMALINK

BTW, LynnDee, not for "big bucks"...$50...chump change. And I'd like to add, I like Obama, but I was appalled by the mailer. It's possible he'll disavow it. He should. He doesn't have my $50...not yet anyway (though I'm sure he's frantic for it because, after all, I am a Master of the Universe)...but he will most definitely have my vote if I get a chance to cast one for him. But he needs to get right with healthcare.

Posted by: Sharon on February 2, 2008 at 12:21 AM | PERMALINK

Alex,

I got the numbers from a poster upthread:

"est estimate on cost is $500/person/month--$2000/month for a family of 4.

That's based on current cost of the healthcare system (16% of GDP), and assumes community rating (so everyone pays the same amount regardless of age or health.)" - Sam Chevre

It would have been nice if either Obama or Clinton had thrown out some ballpark figures on cost. I mentioned upthread that my daughter, age 23, has a part-time job, no benefits. She subscribes to a hospitalization only plan (BC/BS) for only $48/mo. This includes outpatient procedures and tests as well as all hospital charges if she should be hospitalized. It doesn't pay for surgeon fees. This is affordable for her, $500/mo would not be possible.

Beyond cost, though, I'd much prefer a universal single-payer plan, funded by a progressive tax. I used to be in the group that a progressive tax would probably begin to hit, and really I wouldn't have minded paying it at all. As Obama points out, this is a moral issue, not just an economic one. And I tend to wonder: how much will be spent on subsidies to make it possible for the people who make under $45,000/yr (average family income) yet are above the poverty level to easily afford the cost? It's not going to be a small amount. If it's not a sufficient amount to make the cost affordable, then mandates will only be cruel.

I have the very sneaky suspicion that this is all about the insurance industry. I'll do as you suggest, though, and check out the German healthcare system.


Posted by: nepeta on February 2, 2008 at 1:22 AM | PERMALINK

Sharon,

Thanks. You just have to be willing to look like an idiot. (grin)

Posted by: nepeta on February 2, 2008 at 1:24 AM | PERMALINK

This is all so ridiculous, and this is why we will screw up this election if we aren't careful. I have great respect for Hillary Clinton, but I am supporting Obama because of the appeal he has among rural voters in red and purple states. We have to start thinking bigger than we have in the past when it comes to the electoral map. We can carry every city over 500,000 but we can't win a state where the rural population is greater than the urban population. Obama knows this and he knows that mandates are a deal breaker in rural America. I live in a rural state where people are fiercely independent and simply recoil at the idea of the government forcing them to do something. There is a reason Obama got the endorcements of those red state govs. and senators. He has a good chance of delivering enough rural voters in midwestern and western states to turn some blue in November. And if anyone here is naive enough to think that Democrats in the heartland like Claire McCaskill are going to vote for mandates and jeopardize their own political futures then you don't know much about politics. They will throw Hillary under the bus. We have a chance to do something about healthcare because the country is ready. But we have to be careful. The Reps. are smart. They know the old "socialized medicine" meme has grown pretty tired, but we're going to give them a new boogeyman - mandates- and they will club us to death with it. But if ideological purity is more important than winning elections and getting something done, then so be it. We are starting to sound like those right wing kooks on talk radio.

Posted by: samc on February 2, 2008 at 1:48 AM | PERMALINK

nepeta: I got the numbers from a poster upthread: "est estimate on cost is $500/person/month -- $2000/month for a family of 4. That's based on current cost of the healthcare system (16% of GDP), and assumes community rating (so everyone pays the same amount regardless of age or health.)" - Sam Chevre

That estimate ignores the fact that the government already pays about 1/2 of the total cost of health care in this country, so the incremental cost should be about 1/2 of that.

It also ignores the possibility of saving money through a better system. Germany spends about 10.5%/GDP on health care, and by many measures has better care than we do. Certainly the coverage is more reliable. No Germans go without because they're unemployed, or face bankruptcy because of it. Slip on some sauerkraut and you're covered.

Lastly it overlooks the fact that people who get coverage through their employer usually get at least some part of it paid through their employer, so the additional out-of-pocket cost to most people should be no more than now.

Beyond cost, though, I'd much prefer a universal single-payer plan, funded by a progressive tax.

I agree. Yes, I know, that's downright Canadian of me. Why do I suddenly feel like playing hockey?

Unfortunately nobody who's likely to get elected has the guts to even propose it.

I used to be in the group that a progressive tax would probably begin to hit, and really I wouldn't have minded paying it at all.

I'm lucky enough to still be in that group, and I wouldn't object. My only caveat it that I want people who make more than me to pay at least the same tax rate towards it. I hope your economic situation improves.

As Obama points out, this is a moral issue, not just an economic one.

Yes, it's a moral issue, but it's also a matter of self interest to anyone who lacks millions. I know perfectly well that my economic situation could change tomorrow, largely as a matter of luck. If that happens I want my family covered - that would be real insurance.

And I tend to wonder: how much will be spent on subsidies to make it possible for the people who make under $45,000/yr (average family income) yet are above the poverty level to easily afford the cost? It's not going to be a small amount. If it's not a sufficient amount to make the cost affordable, then mandates will only be cruel.

True, but without the mandates people will just opt out, and there won't be the necessary political pressure to keep the subsidies high enough to make it genuinely affordable for those folks.

I have the very sneaky suspicion that this is all about the insurance industry.

How cynical. As if the millions of dollars in bribes (oops, I mean campaign contributions) they make have any effect on our fine upstanding representatives.

As I said upthread, the real problem is campaign finance. It's supposed to be one person, one vote, not one (million) dollars, one vote.

How about Feingold for president?

Posted by: alex on February 2, 2008 at 1:53 AM | PERMALINK

samc: They know the old "socialized medicine" meme has grown pretty tired, but we're going to give them a new boogeyman - mandates- and they will club us to death with it.

Just like the Dems - slow and behind the times. I understand why mandates scare people. So give them single payer and the mandate scare goes away.

We are starting to sound like those right wing kooks on talk radio.

Hardly, we're talking policy, not ideology. Rush, et al, wouldn't know policy if it fell on their drug addled heads.

Posted by: alex on February 2, 2008 at 1:59 AM | PERMALINK

samc: "... I am supporting Obama because of the appeal he has among rural voters in red and purple states."

I'm supporting Mrs. Clinton, because I've concluded that Barack Obama is all meringue and no filling. Further, I'm finding it rather difficult to envision his candidacy as transformational when he's supported by the likes of Edward Kennedy, John Kerry, and Tom Daschle.

But yeah, if Obama's the nominee, I'll gladly walk my precinct for him in the fall. I will not vote GOP under any circumstances.

Posted by: Donald from Hawaii on February 2, 2008 at 2:13 AM | PERMALINK

If a better qualified woman is passed over because a black male would be ground-breaking it signals to women (who are 50% of the population compared to 12% who are African American) that no matter what their qualifications women must stand in line behind men (no matter what their qualifications). I will vote for Nader before I'll vote for Obama under those circumstances.

Wow, mary, interesting that you think identity politics is "dumb" when you reflexively situate this primacy race in terms of: identity politics! You'll vote for Nader before you vote for Obama?! That's all I need to know about your commitment to the progressive agenda.

And mind you, I cast a symbolic vote for Nader in 2000 in a blue state. (Before Pat et al. pile on me for this, no I would not have voted for Nader had I lived in a swing state. Indeed the Naderites I knew living in swing states ultimately voted for Gore. Please let's not start.)

This has been a very informative thread. Thank you to all the savvy posters above. I've followed Krugman's tirades against Obama and do appreciate the weakness of a non-mandated plan. But..I've taken the view all along that that any post-election plan will be a different creature from the campaign rhetoric plan and that Obama is right that "the culture" can't absorb too seismic a shift. I also sympathize with families who can not fork out around $500 a month for health insurance. We would certainly fall into that category, if we were not insured (crappily) through an employer. Still, perhaps I've become too complacent on the issue.

By the way, I hate the mailer.

Posted by: Lucy on February 2, 2008 at 9:49 AM | PERMALINK

If a better qualified woman is passed over because a black male would be ground-breaking it signals to women (who are 50% of the population compared to 12% who are African American) that no matter what their qualifications women must stand in line behind men (no matter what their qualifications). I will vote for Nader before I'll vote for Obama under those circumstances.

Wow. So the only thing that really matters to you is that she is a woman. Such candor is rarely seen.

Posted by: flyerhawk on February 2, 2008 at 11:02 AM | PERMALINK

If a better qualified woman is passed over because a black male would be ground-breaking it signals to women (who are 50% of the population compared to 12% who are African American) that no matter what their qualifications women must stand in line behind men (no matter what their qualifications). I will vote for Nader before I'll vote for Obama under those circumstances.

Wow. So the only thing that really matters to you is that she is a woman. Such candor is rarely seen.

Well, what's implicit in that first position is that the speaker thinks Obama isn't qualified. And what I would say in return is that he's more than qualified and -- what I like about Obama -- far more visionary. Where Clinton's position is up for grabs once she discovers another position is more politically popular, Obama will lead.

Compromise is of course necessary to get legislation passed, but I don't get the sense with Clinton that there are solid principles she will not compromise. With Obama there are, and he does not lose sight of them. He looks further down the road than the next vote. Clinton, it seems to me, does not.

And, if anything can, that is what will get us out of gridlock and entrenched positions, business as usual, in Washington.

Posted by: LynnDee on February 2, 2008 at 11:15 AM | PERMALINK

My understanding is that, from day one, both Clinton and Edwards may clear that sufficient subsidies would be provided to the poor and unemployed so that they could be covered.

I don't blame people for asking how this would be accomplished, but I really see no reason to doubt that it would be feasible. Neither Clinton, Edwards, or Obama have been foolish enough to spell out every detail of their health care plans.

The arguments I see against mandatory participation do not ring true for these reasons. People keep arguing the unarguable, e.g., young healthy people would not be less inclined to participate without mandatory participation.

Come on, some facts are well established. Of course young healty people would be less inclined to participate. Some facts are well established.

Posted by: little ole jim on February 2, 2008 at 11:26 AM | PERMALINK

Some facts are well established

Lacks foundation.

Posted by: LynnDee on February 2, 2008 at 11:52 AM | PERMALINK

My understanding is that, from day one, both Clinton and Edwards may clear that sufficient subsidies would be provided to the poor and unemployed so that they could be covered.

And Sen. Obama has said people would be prevented from gaming the system. Why isn't that also your understanding from day one?

Posted by: l on February 2, 2008 at 11:55 AM | PERMALINK
So give them single payer and the mandate scare goes away…..alex at 1:59 AM
It would be good to see that done by extending Medicare to accept lower age limits the way S-Chip as an extension of it to children. You see what happened in this era of "compassionate" government: extensions filibustered, Medicare to be cut $200 billion. It's a pity that Obama's vaunted togetherness and bipartisanship haven't moved the hard-hearted one iota.
….. That's all I need to know about your commitment to the progressive agenda…Lucy at 9:49 A
Where is Obama's commitment to a progressive agenda? Thus far, he has triangulated from the right and attacked from the right. There is nothing about the man that show anything other than a commitment to his ambition. The notion that he's progressive is a wide-eyed assumption of his children of Hamelin followers.

You hyperventilate that Krugman's criticisms are tirades, but, unlike your beliefs, they are based on Obama's stated positions.

The mailer the Team Obama sent out is indicative of him and his campaign. As long and the media remain anti-Clinton, it will work until he becomes the nominee.

Posted by: Mike on February 2, 2008 at 11:58 AM | PERMALINK

Where did anyone get the idea that Obama is an incrementalist?

I'm afraid I'm the one to characterize his plan as "incrementalist." I did so because I think it's fairly obvious that Obama sees this as an incremental step towards single-payer, by providing government-provided (Medicaid) insurance as a competitive option, and having more and more people "opt" for the (gasp) "socialist" health care.

Posted by: Brautigan on February 2, 2008 at 12:00 PM | PERMALINK

Of course young healthy people would be less inclined to participate.

little ole jim, I agree. In my late 20s and early 30s my previous employer offered an excellent health care plan that would have required me to pay a whopping $7-10 week and still I elected not to participate. Why? Wasn't sick, never had an operation or health problem and I was saving every penny for a down payment on a house. The gamble *seemed* worth it at the time. It happened to work out because I didn't have anything substantive happen to me until I was 38 and I started electing coverage when I was 34 (after I bought my house-didn't want a health crisis to take my house away!). Priorities change. I think a partial compromise with mandates might be to apply a payroll tax to the *employee* who elects no coverage instead of chasing people down after the fact.

Posted by: Doc at the Radar Station on February 2, 2008 at 12:14 PM | PERMALINK

BTW, If anybody hasn't read both of their plans yet here are links to both (as pdf documents):

http://www.barackobama.com/issues/pdf/HealthCareFullPlan.pdf
http://www.hillaryclinton.com/feature/healthcareplan/americanhealthchoicesplan.pdf

One interesting difference between their two plans that hasn't been mentioned here (that I can recall anyway) is that Obama mentions his "public" plan as fashioned after the Federal employees private plan, but Hillary offers the Federal employee's private plane AND a public plan "similar to Medicare".

Posted by: Doc at the Radar Station on February 2, 2008 at 12:43 PM | PERMALINK

Ooops. "Plan" not "plane"!

Posted by: Doc at the Radar Station on February 2, 2008 at 12:44 PM | PERMALINK

Where is Obama's commitment to a progressive agenda? There is nothing about the man that show anything other than a commitment to his ambition. Etc., etc.

His books, his record, his speeches, and his actions testify to his progressive credentials.

It's always funny when an irony-deaf Hillary supporter fumes about triangulation. If you sign on with Obama, you sign on to his avowed willingness to work with the opposition and compromise on points while getting his overall agenda passed. His record in the Illinois legislature is a good indication that there is substance behind the rhetoric.

Meanwhile, Obama is a politician and during the campaign and as president will do things that disappoint me. What do you expect? Still, on the big picture my support for Obama is unwavering. I think Obama can deliver on his claim to grow the Democratic party and create a working majority so we can start getting our stuff through Congress. I figure if I'm wrong, at worst Obama would be more like Hillary Clinton. So why not go with the guy who brings a lot of new voters into the process by giving them hope at what seems like a hopeless moment in our history.

Posted by: Lucy on February 2, 2008 at 1:00 PM | PERMALINK

I see some commenters immediately disputed my contention that young healty people would be less inclined to participate in a health care system that lacks mandatory participation.

See following links:

http://blogs.tnr.com/tnr/blogs/the_plank/archive/2007/12/03/so-about-that-15-million-figure-you-ve-been-hearing.aspx

http://www.urban.org/publications/411603.html

http://content.healthaffairs.org/cgi/content/full/21/6/195

I think you will be hard pressed to find health care experts who disagree.

I think you will be hard pressed to find existing health care systems that have not shown this to be true.

And Sen. Obama has said people would be prevented from gaming the system. Why isn't that also your understanding from day one?

I don't care who says it (I like BO just fine), the facts to not support this statement. If young healthy people opt not to participate in disproportionate numbers, which they are free to do under the Obama plan, how in the world can you stop them from gaming the system? He has not answered this question. For those who opt to not participate, are you going to permanantly deny them participation in the future? Are you going to charge them a big entrance fee if they later change their minds? What?

Posted by: little ole jim on February 2, 2008 at 1:22 PM | PERMALINK
His books, his record, his speeches, and his actions testify to his progressive credentials….my support for Obama is unwavering….. Lucy at 1:00 PM
Actually, his history of triangulating from the right, from using RNC talking points, or echoing Harry and Louise, his remarks that Republicans were the party of ideas and that Reagan was an important transitional figure, and his disingenuous health care spin that he won't cover every American all show his lack of commitment to a progressive agenda. A progressive would not under any circumstance decline coverage to all using the poor as an excuse. After all, the poorest are provided coverage by Medicaid. A real progressive would find a way to expand that to the lower middle class.

His inability to explain adequately his Rezko connection when he attempts merely to minimize it shows that his capability to withstand Republican attacks is non-existent. His complete inability to explain his high school peccadilloes prove he's not in reality if he thinks that will not become a target of smears.

There is nothing 'hopeless' about this moment in history and empty rhetoric of hope is not the answer for Americans at this time. Retuning to constitutional government is not a matter of hope, it's a matter of will and action. Spare us the pabulum.

I realize that your support is unwavering: you have been acting like one of his operatives from the gitgo. At least you parked your potty mouth this time.

Posted by: Mike on February 2, 2008 at 3:52 PM | PERMALINK

Speaking of Krugman and Obama and healthcare, Krugman reports on a paper from a highly respected health care economist who is not aligned with any campaign.

Bottom line? A health care plan without mandates may expect to get 23 million currently uninsured people covered. A health care with mandates may expect to get 45 million currently uninsured people covered.

That is, the difference between mandates and no mandates is that 22 million more people would be covered under the plan with mandates.

Who might care about 22 million people? Not, I guess, Obama or his supporters.

Such fine, proud progressives!

Posted by: frankly0 on February 2, 2008 at 4:02 PM | PERMALINK

Some folks need to understand that the arbitrary $500 a month that a poster threw out earlier was not a quote, or an estimate, or a consensus... It was a figure he made up on the spot.

Posted by: Steve on February 2, 2008 at 5:46 PM | PERMALINK

Massachusetts sounds like a mess and look at those mandated COSTS!!!

"Having already relaxed requirements on the insurance giants who stand to gain tens of millions in additional profits under the plan, now we learn that the obligations on employers have been effectively eliminated in Massachusetts.First, the Massachusetts legislature agreed, after intensive corporate lobbying, to gut the shared responsibility for businesses with over 10 employers who don't currently provide health benefits for employees to a paltry "fair share" fee of $295 per employee per year.Even that token amount was too high for then-Gov. Mitt Romney who wanted his corporate donors to pay nothing, but whose veto of that provision was overridden.Then, the state made it ridiculously easy for employers to evade that meager cost. All they have to do is cover one of four employees, or offer to pay a third of their employees' premium costs, no matter how bad the plans, to be exempted from the fee. And, the employer trade groups which lobbied against the fee quickly offered counseling for employers on how to avoid paying any fees.Now, the Boston Globe reports that the state is not even bothering to collect those pitiful fees. The penalties were supposed to bring in $95 million this fiscal year and $76 million next year to help pay a portion of the public cost of the plan. Instead the state plans to collect nothing this year from employers and only $24 million next year.That's quite a contrast with the heavy handed yoke on middle income Massachusetts residents and families who are forced to buy expensive health insurance policies or face escalating punishment.The cheapest plan for residents of eastern Massachusetts, the main population centers, is $2,100 a year for someone in their mid-30s. For individuals over 55, that same plan costs over $4,100 a year. That's with bare bones benefits, more comprehensive plans cost more.Add to that out-of-pocket annual deductibles of $2,000 per individual and $4,000 per family before the insurance company begins to pay for most patient services. And, if you want to choose a doctor or other provider who is not on the insurer's network list, the cost also increases.Further, the premium fees are for the first year only. The second year, they are expected to go way up, since the law has no cost controls on rising premiums."

Massachusetts Healthcare Scam

Posted by: nepeta on February 2, 2008 at 6:34 PM | PERMALINK

A good argument in favor of Obama's plan by Jonathan Alter in Newsweek, Dec. 17, 2007:

Why Krugman Is Wrong; Why Obama's Approach to Healthcare Isn't Naive

Posted by: nepeta on February 2, 2008 at 6:52 PM | PERMALINK

Never mind. I misread the plan costs as $2100/mo and $4100/mo instead of yearly costs.
So monthly cost would be $175/mo for someone in their mid-30's and $341/mo for 55 and over.

Posted by: nepeta on February 2, 2008 at 7:05 PM | PERMALINK

I don't care who says it (I like BO just fine), the facts to not support this statement. If young healthy people opt not to participate in disproportionate numbers, which they are free to do under the Obama plan, how in the world can you stop them from gaming the system?

How, you say? By building provisions into the plan that would prevent them from doing so. Obviously those provisions would have to be carefully thought out, but clearly that can be done. After all, how are we going to keep track of people if buying into health care is made mandatory? How do we keep track of whether people pay their taxes?

Whether health insurance is mandatory, or voluntary with provisions in place to prevent gaming the system, there will need to be a bureaucracy set up to keep track of people and monitor their insurance status. Anyone who thinks monitoring them for mandatory care is possible can't reasonably argue (IMO) that monitoring them to ensure they aren't gaming the system isn't possible.

Of course, with such a provision in place, Obama's plan moves that much closer to Hillary's. And if Hillary is going to find a way not to penalize those who can't afford health insurance under a mandatory system, then her plan moves that much closer to Obama's.

Posted by: LynnDee on February 2, 2008 at 8:29 PM | PERMALINK

Whether Obama or Hillary gets the nomination, the important facet of either of their respective plans is the accessibility of citizens to a PUBLIC plan (even if they have to pay a full premium). John McCain or any of the other Republicans offer NO such possibility. I view Obama's or HRC's health plan details as something that is likely to change, but the choice of a public plan is integral to either of their plans -especially for the self-employed who don't have the advantage of belonging to a large group that is expected to be charged the same and treated the same (Claim denials anyone?). What is really at stake (and being tested) here is this: Can a new or expanded existing federal bureaucracy able to compete effectively with private health insurance? Let's see the proof. I think it can, and quibbling over who can get under the tent at the beginning is missing the point.

Posted by: Doc at the Radar Station on February 2, 2008 at 9:14 PM | PERMALINK

Doc Radar, Yes. And the goal of both plans is universal health care.

Posted by: LynnDee on February 2, 2008 at 9:29 PM | PERMALINK

I see Mike has put all his favorite memes into one neat little spin package at at 3:52. We've all been around and around the block with "triangulating from the right", "right-wing talking points", "Reagan", "Rezko", blah blah blah. What difference does it make? I've never seen Mike make the slightest concession on any point whatsoever. No wonder he doesn't like Obama.

Toss the slightest bait and an alarmed Mike scurries in with his Obama-Vac, shooting off a fussilade of invective, channeling Paul Krugman, and shaking his fist at the legions of apostates who fail to grasp the true religion. Grimly he tracks down enemies to his binary planet of absolutes, where the rhetoric of hope and "will and action" must be mutually exclusive, where youthful peccadilloes must be extinguished, where dirty words are soooo unladylike, and where Mike is Right and Obama is Wrong!!

It really becomes tedious.

Posted by: Lucy on February 2, 2008 at 10:28 PM | PERMALINK

Social Security came about all at once.

Actually, that's not true. A lot of people were excluded from Social Security when it was first enacted, and it took several amendments to expand coverage.

Posted by: Quinn on February 3, 2008 at 12:37 AM | PERMALINK

LynnDee: You are throwing up a strawman. Nobody has suggested you cannot "monitor" who has signed up and who has not.

My point blank question is for you to give me some examples of how you would keep people from gaming the system. I threw out a couple of example that I don't think would work. I am trying to imagine other examples.

Full participation is a widely accepted method for holding cost down while insuring everybody. It has worked elsewhere and it makes logical sense.

Say I am 21 years old. I opt not to participate and thus save money. I reach age 34, realize I have some potential health problems, and apply to join the system. Is that ok with you? If not, how will you stop me? And how will you have kept cost down in the meantime if there are significant numbers of people like me?

Posted by: little ole jim on February 3, 2008 at 9:11 AM | PERMALINK

Lucy: "the culture" can't absorb too seismic a shift

Lucy, that got me asking myself when and under what circumstances will a culture accept a seismic shift? We certainly have absorbed a seismic shift in the last 7 years. (1) The Supreme Court determines the outcome of elections. (2) Anything the unitary executive does is legal by definition. (3) Our treaties are quaint and our laws apply in ad hoc fashion as the unitary executive sees fit. (4) Impeachment is off the table even in the face of conspicuous flouting of law. I could go on and on, but you catch my drift. How/why did the culture absorb this seismic shift? We've seen nothing like the 60s and 70s when the culture fought back hard to turn back a similar shift. Does the shock doctrine explain it? Does incrementalism explain it?

Posted by: Sharon on February 3, 2008 at 9:41 AM | PERMALINK

quibbling over who can get under the tent at the beginning is missing the point

Doc, I think you're right.

Posted by: Sharon on February 3, 2008 at 9:57 AM | PERMALINK

My point blank question is for you to give me some examples of how you would keep people from gaming the system. I threw out a couple of example that I don't think would work. I am trying to imagine other examples.

Well, this would be why I said:

Of course, with such a provision in place, Obama's plan moves that much closer to Hillary's. And if Hillary is going to find a way not to penalize those who can't afford health insurance under a mandatory system, then her plan moves that much closer to Obama's.

That is: Any provision that required culling out those who might be gaming the system -- i.e., those who could afford health care but weren't buying into a plan -- and requiring that those people pay (for example) a fee into a fund for emergency care and/or catastrophic care would move Obama's plan toward Hillary's.

Similarly, any provision in her plan that provided relief to those who didn't buy into a plan because they couldn't afford to buy in would move her plan toward his.

You're thinking way too rigidly, little ole jim. And at this point, it hardly seems necessary except, possibly, for campaigning purposes.

Posted by: LynnDee on February 3, 2008 at 12:05 PM | PERMALINK

Say I am 21 years old. I opt not to participate and thus save money. I reach age 34, realize I have some potential health problems, and apply to join the system. Is that ok with you? If not, how will you stop me? And how will you have kept cost down in the meantime if there are significant numbers of people like me?

As I said -- and this is worth repeating, which is why I'm doing it -- by (for example) requiring you pay into a fund for emergency care and/or catastrophic care. And that's just an obvious choice that springs to mind. Call it a penalty if you like. A penalty for those who, intentionally or not, would game the system.

The devil is in the details, little ole jim. And since we haven't even begun to thrash out the details of a program, you're getting way ahead of yourself.

Posted by: LynnDee on February 3, 2008 at 12:09 PM | PERMALINK

Sharon,

There's a difference between the issue of health care, which people care about because it affects them directly and profoundly, and the imperial presidency, for example, or the Bush administration's purposeful undermining of government institutions, which are a lot more abstract. Katrina did expose the hackery and incompetence of the administration, but I don't think the public perceived it as part of the systematic erosion of government that is fundamental to Bush's ideology. Eventually people get the uneasy sense that "the country is moving in the wrong direction", but they don't tend to be conversant with the gory details of why that is so.

When you get off the blogs and talk to some of the vast majority of Americans who are not obsessed with politics, you begin to appreciate Obama's strategy. Health care reform is not going to happen without a Democratic president and a solid Democratic majority in Congress, and it will be a fight. So I see this issue through the lens of: who can get us there? Who has the best shot of beating McCain, and who has the longest coattails? First things first.

The early chess moves by red state governers and state officials were a very clear signal that a Hillary headliner is considered a problem downticket.

That was my point in bringing up the progressive agenda; it was not to provoke a false consciousness circle jerk. Vote for Nader over Obama, as mary threatened to do out of pique over perceived sexism, and you are voting against the cause of progressive politics. Pretty obvious, really.

Posted by: Lucy on February 3, 2008 at 12:13 PM | PERMALINK
It really becomes tedious. Lucy at 10:28 PM
What is most tiresome is your endless disingenuous pandering of Obama talking points to the exclusion of the reality of his campaign and record; but, hey, that is what campaign surrogates do.

Here are some numbers on the cost effect of mandates
Reduction In number of insured
Without mandate 23 Million
With 45 million

Cost of Newly insured
Without $4400
With $2700

Total cost
Without $102 billion
With $124 billion

One of the unmentioned reasons for not providing universal coverage is the resistance of those who are satisfied with their insurance coverage. They fear that universal coverage will add so many new people to the system that it will be overwhelmed and consequently, their coverage will worsen, either by overcrowding or by more limited availability of service.

…..Vote for Nader over Obama….and you are voting against the cause of progressive politics.....Lucy at 12:13 PM

The claim that Obama is a political progressive can not be maintained with in the face of all the evidence that he is not. Here is one more example, a bill that he brags about, his nuclear legislation which was actually a cave to nuclear industry

When residents in Illinois voiced outrage two years ago upon learning that the Exelon Corporation had not disclosed radioactive leaks at one of its nuclear plants, the state’s freshman senator, Barack Obama, took up their cause.
Mr. Obama scolded Exelon and federal regulators for inaction and introduced a bill to require all plant owners to notify state and local authorities immediately of even small leaks. He has boasted of it on the campaign trail, telling a crowd in Iowa in December that it was “the only nuclear legislation that I’ve passed.”
“I just did that last year,” he said, to murmurs of approval.
A close look at the path his legislation took tells a very different story. While he initially fought to advance his bill, even holding up a presidential nomination to try to force a hearing on it, Mr. Obama eventually rewrote it to reflect changes sought by Senate Republicans, Exelon and nuclear regulators. The new bill removed language mandating prompt reporting and simply offered guidance to regulators, whom it charged with addressing the issue of unreported leaks…..

The man does have a problem with mandates and his bipartisanship is the same as Bush bipartisanship: do it their way.

Posted by: Mike on February 3, 2008 at 2:25 PM | PERMALINK

Lucy at 12:13 PM

I read your thoughtful comment and found it convincing until you said, "you are voting against the cause of progressive politics." How is that so? I supported Edwards until he withdrew. I don't see how a vote for Clinton would be a "vote against the cause of progressive politics." If you have explained that in your comments I don't see it. I admit I might not have the comprehension skills it might require.

Posted by: Sharon on February 3, 2008 at 2:47 PM | PERMALINK

Duh...I see my comprehension skills are poor indeed. Missed the comma. You did not say that I am voting "against the cause of progressive politics" but that someone who would vote for Nader out of pique would be voting against the cause. I agree. Sorry for the confusion.

Posted by: Sharon on February 3, 2008 at 2:53 PM | PERMALINK

LynnDee: Yeah, the devil is ofen in the details, but you are not familar with the details.

Both Edwards and Clinton put forth plans that include subsidies for poor people who cannot afford to buy in. "Moving" toward Obama's plan will not be necessary.

Furthermore, if you require people to pay into an emergency fund, you are mandating. Obama is the one who needs to revise his plan.

Posted by: little ole jim on February 3, 2008 at 11:32 PM | PERMALINK

Little Ole Jim: "Obama is the one who needs to revise his plan."

Well and succintly put and correct. Obama et al need to park their egos and take Krugman's wise counsel, pronto, regarding both healthcare and social security.

Posted by: Sharon on February 4, 2008 at 8:38 AM | PERMALINK

And here's economist Dean Baker saying the same thing I said -- but with credibility! Facts! Analysis! That is, the devil is in the details and there's more than one way to get to universal health care. Thus, he disagrees with Paul Krugman that it's gotta be a mandate.

http://prospect.org/csnc/blogs/beat_the_press_archive?month=02&year=2008&base_name=krugman_wrong_on_obama_and_man

Posted by: LynnDee on February 4, 2008 at 4:05 PM | PERMALINK




 

 

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