Paul Krugman has been very harsh on Barack Obama on healthcare mandates. I am not going to rehash the arguments fully here. This is a personal piece on how they work. Health care mandates are a "way" of covering universally all the people in our system. Certainly, a lofty goal. Clinton and Edwards have attacked Obama because his plan does not universally cover everyone. Fair criticism in my opinion, but the substance of his argument gets lost I think. Mandates are essentially a pay-off to insurance companies. It is a public - private partnership to have everyone covered and the money goes to who else - insurance companies. Now mandates are better than nothing certainly, but what Obama argues for is lowering health care costs to make it easier on all of us and that when health care costs are lowered those left behind will be able to buy health insurance.My brother is a single dad with three children. He does not make much money, somewhere in the range of $30,000 per year. He pays child support for 2 children and has custody of one. He was unemployed for a while and his youngest child was covered under SCHIP and he was also covered by the Massachusetts plan. He acquired employment, just enough to pay his bills. Massachusetts summarily cut him and his child off the plan. He lobbied for an exemption for his child and received one, now his child is covered. But, because he now makes too much money ($30,000 for a household of four), he no longer qualifies for the health insurance from the state. He is left to get that insurance from his job at a price of over $200 per pay period (approximately) which he cannot afford. He is in fact, now uninsured and a fine of $500 will be levied against him because he does not have insurance, i.e. the mandate.
Does this sound fair? Krugman argues that the mandate is not the problem & that the Clinton and Edwards plans (unlike Massachusetts) have subsidies to low-income families that will alleviate this problem. Though, I must say he leaves out how that occurs (his criticism of Obama) and how this enables lower income families to afford coverage. For example, why does Massachusetts not do this?
I think the criticism of Obama's plan is a policy debate as he has said and we can discuss that, but criticizing him for not wanting health care for all is really a misnomer and unfair because as is evident above there are problems with mandates, serious problems.
As someone who had a near fatal car accident with no health insurance, I know that tragedy lurks around the corner for all of us without health insurance or what really matters - free and affordable health care. When we are, at the same time, trying to please corporations while providing health care we will inevitably run into trouble. When the priority shifts so that everyone is covered no matter what the circumstance or job, is as large a priority as keeping corporations happy, then we will have a plan that works for all of us.
Mandates are not the end all to be all that we have been told they are by Krugman, by Clinton and by Edwards. On this point I am squarely in the Obama camp.
1 comment:
Mandates are a massive giveaway to one of the most contemptible industries around.
That said, all three of our candidates have mediocre health plans. The goal is there. The means are not.
While obviously single payer is the only real solution, there must be an intermediate step. Mandates are not it. We should have an expanded medicare, competing with private insurers. Individuals should be incentivized to go into the Medicare plan. it should also be subsidized, while the privates are taxed. That way, we can use the "market" to gradually move to a single payer system.
As this expanded medicare system grows, it will have more and more bargaining power with hospitals and drug companies. Eventually, when a large majority of people are covered federally, we can expand it to all people. Voila, Single Payer.
This is basically what Canada did. Took them 15 years to transition.
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