February 24, 2009
'UNIVERSAL' HEALTH CARE.... Back during the Democratic presidential primaries, one of the few areas of major disagreement between Barack Obama and Hillary Clinton was healthcare mandates. Clinton said individual mandates were key to achieving universal coverage. Obama, in the least attractive part of his campaign platform, disagreed. It was pretty obvious throughout the debate that Clinton was right, and that Obama would have to switch if elected.
And sure enough, that may be poised to happen.
After speaking with administration officials, Ezra Klein reports this afternoon that the administration's budget will remain deliberately vague, directing Congress to make coverage "universal."
The budget -- and I was cautioned that the wording "is changing hourly" -- will direct Congress to "aim for universality." That is a bolder goal than simple affordability, which can be achieved, at least in theory, through subsidies. Universality means everyone has coverage, not just the ability to access it. And that requires a mechanism to ensure that they have it.
Administration officials have been very clear on what the inclusion of "universality" is meant to communicate to Congress. As one senior member of the health team said to me, "it will cover everybody. And I don't see how you cover everybody without an individual mandate." [...]
The administration is bringing itself into alignment with senators like Max Baucus. Though they're not proposing an individual mandate in the budget, they are asking Congress to fulfill an objective that they expect will result in Congress proposing an individual mandate. And despite the controversy over the individual mandate in the campaign, they will support it. That, after all, is how you cover everybody.
Does this count as a flip-flop over the policy details? Probably, but it's nevertheless an improvement that makes the broader goal more likely. I was always under the impression that Obama got boxed in on opposing mandates for political purposes, and never quite believed his own campaign rhetoric anyway.
The president also probably figures the mechanism lets him off the hook, at least a little -- he's not proposing universal coverage through individual mandates; he's letting Congress do it and merely going along.
As this moves forward, though, expect congressional Republicans to use every criticism Obama uttered during the Democratic primaries to undermine the initiative.
—Steve Benen 3:40 PM
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However, Obama has always said that he will be flexible and listen to good ideas. So, I see no reason why he can't blow off the GOP charges by maintaining his position as flexible and working for what is good and right.
Grab the CEO from Pfizer and have him bring up how it will help U.S. Businesses big and small to be more competitive globally and it shouldseal the deal tom a human perspective and a business perspective (since the GOP's can't quite think on a human scale).
Ask the Big Three if they'd like to get out from under the health benefit costs of employees and retirees.
Posted by: GreyGuy on February 24, 2009 at 3:49 PM | PERMALINK
Adequate Health Care coverage for most (or even all) and not just a few seems to be the lynch pin in so much of what we are talking about here.
Posted by: Health Care is at the "Heart" on February 24, 2009 at 3:53 PM | PERMALINK
What mandate?
It gets paid for by everyone's taxes and the availability is there.
I fully expect Governors Sanford and Jindal to decline coverage for South Carolina and Louisiana, thus saving us billions. Thanks, guys.
Posted by: toowearyforoutrage on February 24, 2009 at 3:54 PM | PERMALINK
Actually, an insurance mandate scares me and I liked Obama for not insisting on it. I'm afraid the cost may be too high and if we are forced to pay it then we might have to give up something else... like high speed internet service to stay inside our budget.
Posted by: sjct on February 24, 2009 at 3:57 PM | PERMALINK
It is almost too much to hope that universal health care, without involvement of insurance companies, will actually become a reality. This should make it easier to get US companies to stop outsourcing jobs overseas, because employee costs will be lessened. Remembering the prediction that national medical coverage will presage dominance of the Democratic party for decades, expect the Repugnants to fight this harder than they fought the recovery bill.
Posted by: capalistpig on February 24, 2009 at 3:58 PM | PERMALINK
Fortunately, any ReThugs criticism will just sound more and more juvenile.
Let them hold their breath until they become blue in the face. Please.
Maybe Jindal and Sanford can turn down universal health care, too.
Posted by: Cal Gal on February 24, 2009 at 3:59 PM | PERMALINK
I'd rather have a flip-flopper who takes in new information and changes his/her mind than the "strong and resolute" idiocy we've had for 8 years. W always believed the same thing on Friday that he believed on Monday, no matter what happened on Tuesday, Wednesday or Thursday.
Posted by: Mnemosyne on February 24, 2009 at 4:00 PM | PERMALINK
How is it that the other civilized nations are able to offer universal coverage to their citizens, without suffering fiscal implosion?
Maybe it has something to do with their defense budgets, or lack thereof. . .
Posted by: DAY on February 24, 2009 at 4:03 PM | PERMALINK
I don't like the mandate. If insurance companies want to offer me a plan that makes sense for me, they can already offer it. Until then, I'll self insure. I've had insurance before, and not once has an insurance company ever paid a dime for my medical care. To me, insurance means paying 100% of your medical costs in addition to paying your premiums. I fail to see the appeal of it. Now, I can compromise, but the insurance companies have to compromise as well. As long as they consider all of my medical needs to be pre-existing conditions, insurance is just a scam. The question is whether this plan will offer medical coverage, or just medical insurance premiums. If I'm not going to get coverage, why should a pay a premium? My worry is that the "compromise" is that we'll give up a ban on pre-existing conditions in give them a mandate requirement in return.
Posted by: fostert on February 24, 2009 at 4:16 PM | PERMALINK
Americans need universal access to health care, not a universal requirement to buy insurance from insurance companies. We need a single-payer system, period. As has been noted elesewhere, health care access is on par with fire and police protection and should be recognized as such.
Posted by: ghillie on February 24, 2009 at 4:31 PM | PERMALINK
The government should set prices. That is how they do it in Japan. (check out Frontline's documentary on universal hc)
A doctor visit is $80 no matter where/when/or who. don't like what you got for $80 -- everyone is free to change -- no resrictions.
Same goes for xrays and lab tests. As a hospital worker -- you have no idea how badly you are being ripped off by charges for lab tests and procedures !!!
Let an elected government review board set prices for most things and have them reexamine it every 2 years.
Posted by: coral on February 24, 2009 at 4:33 PM | PERMALINK
You've got it backwards: from where I sit, as exactly the sort of healthy 20-something mandates are intended to drive into the money-loving arms of private insurance carriers, Clinton's insistence on mandates was the very first thing that made me question my support for her, and the lack of mandates in Obama's plan was one of the first major reasons I switched my support. Her crude attacks on Obama for his "failure" to legislate a giant new profit center for one of the industries that donated the most money to her sealed the deal.
Expect my representatives and senators to oppose mandates.
Posted by: 21st century Yuppie on February 24, 2009 at 4:52 PM | PERMALINK
"A doctor visit is $80 no matter where/when/or who."
That may not work out so well. Last time I had insurance, I went in for an ear infection. I asked how much it would cost if I just paid cash, and they said $280. My insurance company said they'd charge me $60 for an office visit, so I decided to use the insurance. Trouble is, I got billed for five office visits for a total of $300. And the infection didn't go away. Turns out, all I needed was a $6 tube of steroid cream, which I got on a routine check-up (for which I paid cash).
Posted by: fostert on February 24, 2009 at 4:59 PM | PERMALINK
They still don't get it. Whether they allow subsidies to make sure everyone can get health care ins. (in time the expense will be too great to continue) or not it is doomed to failure until we get rid of the private ins. companies whose bottom line is profiteering from our health care. Only by eliminating the profit motivation will we have an affordable national health care program.
No matter how they figure it 'now' there will appear hundreds of lobbyists to get congress to keep changing legislation to increase their profit margin and their CEO's pay and stockholder's share.
All Americans can be the stockholders if we extend medicare for everyone, and medicaid will be the subsidy for the poor.
Only a single payer, NOT FOR PROFIT, national health care ins program will get us the results we crave and need. It will free up corporations and small businesses expenses...it will be cost efficient, and controllable by we the people.
The Kucinich plan was perfect...so why keep ignoring it.
Posted by: bjobotts on February 24, 2009 at 5:13 PM | PERMALINK
How to pay...ending the Reagan tax cuts on capital gains and those making over $3.2 million a year(they don't pay increased taxes on the first $3.2mil) will net the treasury over $500 BILLION in the first 2yrs alone.
Are you starting to get the picture of where all the money goes that used to be used to rebuild infrastructure and balance the budget??? The estate tax on the 400 wealthiest families in America...$600 billion.
Posted by: bjobotts on February 24, 2009 at 5:24 PM | PERMALINK
And I don't see how you cover everybody without an individual mandate. -- an anonymous, but senior (naturally), member of Obama's health team.
A physical presence at the doctor's office won't do?
If you have to buy your *insurance* (mandate), either individually or via your employer, then it's no way universal healthcare. We'll still have a quagmire of differing "plans", one offering to cover this condition, another covering that condition, for this amount, that amount...
Posted by: exlibra on February 24, 2009 at 8:44 PM | PERMALINK
...a quagmire of differing "plans", one offering ...
Hey now, your not allowing the Insurance companies, care providers, drug manufacturers etc. room to obfuscate. That is _so_ unAmerican. ;-)
Posted by: Kevin on February 24, 2009 at 10:17 PM | PERMALINK