Butrflynet wrote:http://www.huffingtonpost.com/harold-pollack/universal-coverage-and-t_b_84386.html
Click the link to see who the 80 signers are.
"Universal Coverage and the Presidential Candidates' Health Care Proposals"
Posted January 31, 2008 | 10:29 PM (EST)
Harold Pollack
Jonathan Cohn responds - expresses respect for the signatories - but has some nitpicking and factchecking to do as well. Plus - there's that flyer Thomas already posted.
Quote:Harry and Louise -- They're Back!
A quick follow-up on last night's debate over health care reform -- and then a new development.
1. A substantial group of 80 intellectuals have signed a letter arguing that the mandate debate is overblown and that "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." And while not everybody on the list qualifies as a heatlh care scholars -- I'd love to see Harvard Law Professor Laurence Tribe on the Supreme Court, but when did he start studying insurance mandates? -- it includes a lot of people I know and respect, including Henry Aaron from Brookings, Stuart Altman at Brandeis, and Ted Marmor at Yale. I'm also a fan of the University of Chicago's Harold Pollack, who posted the letter at Huffington Post -- where you can read it.
Read what they have to say; take it seriously. Since I've certialy had my say on this, and then some, I'll give only a very brief response.
Last night, I concluded my item by saying "about the policy question asked during the debate -- whether this mandates make a difference -- the overwhelming consensus among experts is that they do." This was overstated. What I should have written was that it's the overwhelming consensus among economists who model these propoals -- i.e., people who have worked closely with the actual available data on this and projected the impact of various policy levers. (Whether or not you put faith in that judgment, it's worth mentioning that, when it's time to actually pass legislation, everybody will have to go by the estimates of the Congressional Budget Office. And CBO will use a similar model for making its estimates.)
I'll also point out that, as proof of their point, the letter-signers reference a paper by Sherry Glied, a Columbia University economist. It's the right place to look for answers -- she's very well-respected and has looked at this issue closely. I know, because I consulted that paper, too. And then, to go more deeply on this issue, I contacted Glied herself. I wrote about that in one of my original articles, which you can read here.
(For more on this specific dispute, see another Huffington Post entry -- this one by Gene Sperling of the Congressional Budget Office.)
The letter also makes a broader point: That the similarities between Clinton and Obama -- and the relative difference between them and the Republicans -- are far more impotant than the mandate dispute. I agree. As I've written many times, I think Obama's support for health care reform is genuine and that, overall, his plan is still very good. And there are aspects of this mandate issue, particularly the political elements of it, that are open to genuine debate. On the other hand, I continue to think that Clinton (and John Edwards before her) have been bolder, at least on paper, when it comes to health care.
Of course, that doens't mean I like the way Obama and his campaign have sold his plan lately. Which brings me to this...
2. Like Ezra Klein, my inbox this morning contained all sorts of mail from folks about this new Obama mailer on mandates.
And Ezra says pretty much everything I would say about it. It's one thing for Obama to defend his position, which (I believe) he genuinely prefers to Clinton's. And in the heat of the campaign, it's hard to avoid saying things that might ultimately come back to hurt your opponent if he or she becomes the nominee. So I'm happy to cut some slack there, particularly since he's been on the receiving end of all sorts of campaign trash lately.
But a presidential candidate who believes in a reform has to avoid making statements that could undermine that reform down the road. And that's precisely what Obama has done here. Even he has admitted, in some instances, that a mandate might be necessary in order to get everybody into a universal health care system. (And he already has one for kids.) But this mailer -- with all of its unmistakble echoes of Harry and Louise -- makes that task much harder.
--Jonathan Cohn
OBAMA'S "HARRY AND LOUISE" AD.
I was going to write a post about the health care exchange in last night's debate, noting that Hillary Clinton is basically arguing against Barack Obama's mandate from the wrong direction. The problem isn't that it leaves people out, but that it effectively closes off his ability to regulate the insurance industry, and opens up a flaw that could bring down his whole proposal. But before I do that, my inbox is full of e-mails this morning alerting me to his new mailer on health care. Here's what it looks like:
When I say that Obama is demagoguing universal health care, this sort of campaign literature is what I'm talking about. For contrast -- or more accurately, to see how little contrast there really is -- here's what the Harry and Louise ads looked like:
The Obama campaign kept their hairstyles and barely even changed their clothing [..]. What's worse is that the argument they're making is applicable to any kind of universal health care arrangement, including the arrangements Obama himself will eventually have to adopt.
An "automatic sign-up," a la Medicare, would still force Americans into health care they may not want to pay for, or may feel overburdened by. Some seniors feel overburdened by Medicare's cost-sharing now. Meanwhile, Obama not only has a mandate for kids in his own health care plan -- what if the parents can't pay, one might ask? -- but he said, in last night's debate, "If people are gaming the system, there are ways we can address that. By, for example, making them pay some of the back premiums for not having gotten it in the first place." That, of course, is exactly what a mandate does. Gaming the system, in this context, means not purchasing health care. And Obama is now threatening to force them to pay back premiums. That's a harsher penalty than anything Clinton has proposed.
Meanwhile, here's how Clinton should have explained the problem in Obama's plan: A central tenet of his proposal is that " No insurance companies will be allowed to discriminate because of a previous bout with cancer or some other pre-existing illness." You literally cannot have that rule without some mechanism forcing everyone to buy in, as the healthy will stay out. So one of two things will happen during the legislative process: Either a mandate will be added, or the prohibition against preexisting will be dropped, or limited to Obama's National Health Insurance Exchange. What will happen in that case is that the Exchange will largely become the domain of the public insurer, which will be a catch-all for the ill and unhealthy. Meanwhile, most insurers will operate outside the Exchange -- you don't have to buy insurance within the Exchange, it's just an option -- and use the existence of the Exchange to enhance their ability to skim the healthy and young and fob off the sick and old. A mandate is not how you cover everyone, it's how you force insurers to cover everyone, and discriminate against no one. And even if you don't have a mandate in your plan, to argue against universal mechanisms because they force people to buy insurance is supremely damaging to the long-term goal, which Obama professes support for, of some system in which everyone is, and has to be, covered.
Obama is, of course, right that affordability is an issue, and needs to be in place before a mandate. But what a mandate does is, additionally, force you to think about affordability. The Clinton campaign does that, with a plan that limits total expenditures to a percentage of income. Not a dollar amount, a percentage. If you make very little, your total expenditure, by law, can't be very much. Obama's plan has a more traditional subsidy mechanism that simply goes on a sliding scale by income, and given how much money goes towards his reinsurance plan, he's actually got less in there for subsidies than Clinton. So while he's warning that she'll make you pay even if you can't afford it, she's actually got the right affordability mechanisms in there -- she keeps it to a small percentage of income. By pretending her plan lacks those and is just a mandate, he's misrepresenting its fundamental premise, in much the way the Clinton campaign misrepresented his arguments on Social Security taxes.
In the end, his plan is not universal, does not attempt to be, and is probably less generous in its affordability provisions than Clinton's. And even so, I wouldn't really care, as it's still a pretty good plan, except that he's decided to respond to the inadequacies of his own policy by fear-mongering against not only better policy, but the type of policy he's probably going to have to eventually adopt. It's very, very short-sighted.
Posted by Ezra Klein on February 1, 2008 1:21 AM
By the way, that Clinton mining deal article is now on the NYT site and is currently the 4th most mailed article.
http://www.nytimes.com/2008/01/31/us/politics/31donor.html
sozobe wrote:By the way, that Clinton mining deal article is now on the NYT site and is currently the 4th most mailed article.
http://www.nytimes.com/2008/01/31/us/politics/31donor.html
But is what he done, illegal or a smart business move! He's OUT of office, yet you people stillscrutinize everything he does, while the country goes to hell in a handbasket from the secrecy, hypocrisy, theft, spying on citizens, and spending tax dollars on an illegal war, of which Bush hasn't attended 1 funeral and doesn't give a schitt, about our troops. Remember the Walter Reed Scandal! You're a bunch of nitpicking hypocrites!
