Jon Cohn’s TNR piece Mandate Overboard goes (in somewhat grueling detail) into a defense his estimate that a mandateless universal insurance plan will leave a substantial number uninsured. I’ll say it more simply.
Voluntary universal health insurance is a Harvard economist’s fantasy.
Obama’s campaign, meanwhile, is attacking Paul Krugman by showing that he said nice things about the Obama health plan before dissing it. But what Krugman’s been dissing is Obama coming out and attacking the mandates in Clinton and Edwards’ plan. Most of us thought that Obama was being late and careless when he introduced his plan (not to mention chose his adviser). Only when he started beating up Clinton on mandates did Krugman go after him.
Given that the majority of Democrats prefer single payer anyway I have no idea why Obama thinks this is good politics in the primaries (see the CODA). Although as I said in my Spot-on piece on Friday I think that he has no intention of introducing real health care reform in 2009 if he actually wins.
But then you get a Harvard economist saying this about mandates: “A better approach is to do everything possible to make it affordable and available. When it is, almost everyone will have it.”
I think by “it” he’s referring to health insurance and this is the same Harvard economist who thinks our current health care system provides “reasonable value”.
I am eagerly awaiting Cutler’s explanation of how he reconciles the “reasonable value” we are allegedly currently getting from the health care system with the presumably massive reduction in prices/costs of health care that’s going to be needed to make insurance “affordable”. I guess we’ll just be getting excellent value then!
CODA: By the way if you doubt that Democrats favor single payer then consider these two questions from the recent Gallup Poll:
"Do you think it’s the government’s responsibility to make sure that everyone in the United States has adequate health care, or don’t you think so?"
84% of Democrats say yes. compared to 54% of independents and only 32% of Republicans
"Which of the following approaches for providing health care in the United States would you prefer: replacing the current health care system with a new government run health care system, or maintaining the current system based mostly on private health insurance.”
41% say replace, 48% maintain.
This one isn’t broken down by party, but if you do the rough math it’s pretty damn clear that a sizable majority of Democrats prefer single payer, and apparently Stan Greenberg estimates that it’s the choice of 70% of primary voters. But as it doesn’t seem to impact their vote, I think that it’s not as important an issue as all that when compared to getting the Republicans out of the White House. Hence voting for war hero John Kerry and now the newly centrist Hillary Clinton and Barrack Obama.
Were it not for government-run health insurance, Dick Cheney would be dead now, given his history. Once you get past the cognitive dissonance on that one, the answer becomes clear.
What makes you think John “Reminiscent of Genghis Khan” Kerry was a war hero? If the Democrats want to win the White House, then nominate a Candidate the country, not the base, will get behind. So far, I don’t see today’s Scoop Jackson or Hubert Humphrey running, let alone JFK or Harry Truman. As far as a government run healthcare system, we already have one – it’s called the VA. Didn’t I see Walter Reed in the news this year. And has anyone had the displeasure of trying to get a passport this year? National Healthcare reform, in whatever shape it takes, needs to be the result of reasoned review, with input from all groups (including Doctors – right HRC?)I agree that the current system is ill … but we need to insure that the treatment isn’t worse than the disease. OK. I’m done.
“I believe most VOTERS don’t care about the uninsured because they already have health insurance.”
True, but they havn’t been educated about the cost to their own insurance with the uninsured getting a free ride. Maybe that should be on their paycheck as well. Everyone wants the government off their backs until they need government to bail them out – even
Repuglicans. How many real estate agents want a government bailout of the housing situation (crisis?), given they fight tooth and nail to keep that same government out of their lives most of the time.
“What they care about is having to pay more of a very high health care bill themselves (because most employers have pushed up cost sharing).”
People also don’t realize that being under insured is the same as being unisured just at a higher price point. They like to think they have health insurance because it is easier to hide their head in the sand than look at reality. But unless all premium payers get sick and need the “system”, the money movers will have the advantage of public perception and faith in free markets – if there are any left.
I don’t think Obama will get far in the South/red states, who are still fighting the civil war and forced desegregation. Ophra’s entrance into his campaign will get more red neck non-voters to register even though they would benefit the most from universal care. Don’t underestimate the ability of hate to defying logic and undercut your own self preservation.
Mathew, no-one knows for sure whether Obama is simply pulling his punches by not advocating an individual mandate. Individual mandates piss off his largely youthful constituency, who would pay the largest relative price of an individual mandate. (If Obama is actually nominated, it will be because he mobilizes a largely dormant youth vote).
But the reality is that public support for “comprehensive” health reform is a lot softer than your polling data suggests. I believe most VOTERS don’t care about the uninsured because they already have health insurance. What they care about is having to pay more of a very high health care bill themselves (because most employers have pushed up cost sharing). None of the candidates have proposed anything that would address this issue, nor have they actually attacked the industry itself (including, remarkably, the guy who made his millions suing hospitals!).
However hallowed “single payer” may be to the Democratic base, broad public distrust of government makes it a political non-starter. Greenberg’s own polling data this spring round that, by a 57% to 28% margin, voters believed that government prevented people from getting ahead vs. helped people get ahead. A stunning and bipartisan 83% believed that if the government found additional revenues (e.g. thru tax increases), the money would be wasted! You can blame Democratic Presidential candidates for being realists in this political climate, rather than ideological zealots, if you wish. But reducing the number of uninsured in the United States by, say, 25-30 million, would be a huge victory. We ain’t Canada.