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Another Dem Debate Tonight? Another Chance to Go Round and Round on Health Care Mandates

Another Democratic debate tonight? Enough already. Hillary Clinton has been pushing Barack Obama for more and more debates. But these debates have lost their utility. Do we really need to see the pair bicker once more over health care coverage mandates? That's the only major current policy difference that the two have zeroed in on in their face-offs. They argue their points around and around in a circle like quarrelers in a bad marriage. And they're kinda both right.

If you want to achieve universal coverage at the most efficient price point, then you need as big a pool as possible. That's basic economics. So Hillary Clinton correctly notes that mandates are needed--especially to get into this pool those folks who may not need costly health care. Their premiums will help cover the cost of care for others. That's how insurance works: the more, the merrier.

But Obama has a point when he says that it would not be fair to force people to buy insurance they cannot afford and that may not meet their needs. I recently met someone from Massachusetts--where there now is a health insurance mandate--who complained that she and her husband could not afford the insurance they are mandated to purchase. And, she added, they make just enough money to be beyond qualifying for a subsidy. This couple is considering moving out of the state. Maybe they're over-reacting to the situation. But no one should be compelled to purchase substandard but costly coverage. Consequently, it seems fair to say, "Let's see the policy, before we accept the mandate." No doubt about it, Obama got somewhat trapped in all this. He put out a plan with limited mandates (only for parents regarding coverage for their kids) and was then raised (as in poker) by Clinton. At that point, Obama could not admit he had proposed an insufficient plan. He was forced into a corner--defending the absence of a comprehensive mandate in his plan--and this debate was born.

But there's this: if either of these Democrats are elected, he or she will pull together roughly the same band of policy experts and craft a plan with congressional leaders that will likely not match exactly what they are proposing now. They may have to deal with health care reform in increments (depending on the composition and mood of Congress). And mandates may or may not be part of that process at the start. Would Hillary Clinton trade away mandates to get the rest of her plan through Congress? You betcha. (If you truly care about the details of this difference, check out NPR's recent dissection here.)

So can we move on? Probably not. The candidates seem committed to pounding away on this point. In recent days, they have also tussled over NAFTA. Clinton has been endeavoring to back away from the trade accord that is unpopular in Democratic circles (particularly among blue-collar Dems). And while Obama has been reminding people of her past support, the Clinton camp has been trying to dredge up old Obama quotes showing he once had at least a mixed view on NAFTA. But on this front, Clinton, who is in second place, is in the weaker position. It's not to her advantage to do battle over Nafta; her husband worked hard to pass it, after all. She seems to believe that the mandate issue offers her potent ammo. Blasting Obama on this topic hasn't yet paid off. But her campaign advisers must feel that there's no telling what will happen the 168th time she tries.

Comments

The federal government lacks the right to order citizens to do business with private industry. Particularly when that industry is one of unmitigated immoral behavior and a demonstrated hostility towards those who are already members.

The citizens of this country are obligated to buy electricity from 1 private corporation, natural gas from 1 private corporation, cable service from generally 1 corporation, telephone service from 1 corporation and in too many locations around the county only Wal-Mart for shopping.

Imposing a law upon the people of this country may fit neatly into the Pax Americana paradigm globally, but not until the Constitution has been openly declared null and void will the most corrupt government in US history have the right to force people to do business with private industry.

Your near majorette promotion of this ridiculous notion is an indication of your misunderstanding of the point of being an American.

Just my humble opinion, of course.

Posted by: Dusty on 02/26/08 at 9:02 AM Respond

Health care reform scares the crap out of me. Considering that Hillary and Obama are getting LOTS of cash from Wall St and lawyers, what ever comes out of it will serve these sectors and not the American people.

As for another debate, Obama should tell her to eat it. That is unless he sees it as a way to practice for McCain since there is little to no difference between Hillary and McCain anyway.

Posted by: kirkbrew on 02/26/08 at 10:25 AM Respond

It is Hillary Clinton who would be "boxed into a corner" debating the Republican presidential nominee. Already McCain has expressed disdain for mandated health care--forcing people to buy health insurance they may not unable to afford.

Obama, on the other hand, understood the political non-viability of "mandated" health insurance from the beginning.

Posted by: Donna on 02/26/08 at 10:47 AM Respond

"The combined profits for the top ten drug companies in the Fortune 500 ($35.9 billion) were more than the profits of all the other 490 businesses put together ($33.7 billion)," The Truth About Drug Companies, Marcia Angell, M.D.

Having written that--I better watch my tail... Remember Karen Silkwood...!!!

How very scary...--nowadays it takes these people an entire year to get off the pot..., and get the appropriate anti-flu serums out the door...

"Over the past two decades the pharmaceutical industry has moved very far from its original purpose of discovering and producing useful new drugs. Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself," M. Angell, M.D.

"Innovations that may lower fees or streamline delivery of services cannot be tolerated by a system whose fundamental purpose is to uphold and increase its member's incomes and its political power," How Medical Boards nationalized Health Care, Henry Jones.

"Simply stated, many insurance companies and hospital management groups are after profits, with conflict of interest being trying to provide quality health care to patients and at the same time trying to save money. For profit businesses will attempt to optimize their profits, and this puts at risk the ethics of medicine, which have always predluded sorting patients according to profitability," Understanding Our Current Healthcare System, Poyai Wu.

Thanks to boy George W. and his Fed. ban on Stem Cell Research, the following states have funded identical programs: CA, CT, FL, IA, ID, IL, MA, MD, NJ, NM, OH, VA, WA and WI...

Nowadays one hears a lot about how National Security dictates this and that--we should be Nationalizing the Drug and Medical Industries...

Who Killed The Electric Car--isn't the same "pressure" found with Nationalized Medicine; hasn't this happened with Britain's and Canada's Nationalized Medicine...

Same vein here: "Since George Bush became President in 2001, the top five oil companies in the United States have recorded profits of $464 billion through the first quarter of 2007 ...," Skyrocketing Gasoline Prices and Record Oil Company Profits: No Coincidence, Public Citizen (Nader).

"The Aug. 14, 2003 blackout in the northeastern United States was not an isolated event. Slow response times of mechanical switches, lack of automated analysis of problems, and an inability to see the whole grid in real time are contributing to a noticable increase in failures of the present electric grid. The problems that have caused the recent spate of blackouts will propagate cascading failures of the grid more and more frequently, unless we create a more intelligent grid control system. This is a vital national security interest. If the present trends continue, a blackout enveloping half the continent is not out of the question," smart grids and the American Way, R. Anderson and A. Boulanger.

Just as bogus Candidate Bush was all about cutting the CO2 emissions from power companies--the worst offenders (GOOD ONE!!!!), isn't the same true with Candidate Hillary and her Nationalized Health platform... In fact, her bogus plan stupidly reads, "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."

First she says the insurers will be forced to offer everyone coverage, but then she does a 180 degree turn and says that their going to be flat out competing to offer us the best price...

She's way over my head here!!!!

Isn't that like where Hon. Green said, "The District's (Washington, DC) system for investigating complaints about police officers has been so ineffective that it helped cause the behavior it was designed to punish."

Posted by: Michael L. Wagner on 02/26/08 at 11:21 AM Respond

A national health care plan with a mandate on it is probably shooting its self and the candidate that proposed it in the foot. Its that whole stigma that conservatives have created and exploited about "big government" and "socialized medicine" coming after people while health care companies are ripping Americans off ten times worse than people in countries with actual socialized medicine. Mandates might have to a national insurance plan if people aren't being covered, or a single payer system could evolve, but the kind of massive changes that Obama is proposing would have to lay the ground work before that could happen. Mandating health insurance seems a bit similar to mandating car insurance for drivers, but in either case those who can't afford it may try to get around it so it isn't as if Hillary's plan is fool proof on that front either, so her plan looses on both total coverage and public acceptability on top of the fact that her proposed plan for health care change was "Xeroxed" from the Edwards plan.

Posted by: Michael Z on 02/26/08 at 12:00 PM Respond

make that "might have to be in a" and you'll know what I mean.

Posted by: Michael Z on 02/26/08 at 12:03 PM Respond

Will Illegal Immigrants be mandated to buy health insurance, or will government buy it for them?

Posted by: Isopluvial on 02/26/08 at 1:45 PM Respond

You know, where I live there's a rather nice bus system, and it costs $1.50 a ride. Now, if the city MANDATED that everyone ride the bus, we could probably get that down to $0.40, since each bus would be packed full with people rather than 2/3 empty. Is it logical to say that those people who can afford cars are unfairly "costing" the bus-riders money? Should we all have to ride the buses together in the name of "fairness"?

By the way, I think a major problem with this debate is that we seem to be confounding health INSURANCE with health CARE.

And stop blaming pharmaceutical companies: only about $0.07 out of each dollar spent on health care is for the actual medications. People tend to think drugs cost more than they do because that's usually the only full bill they see.

Posted by: Jason on 02/26/08 at 9:21 PM Respond

Health care in the USA is bad

Posted by: Frank on 02/28/08 at 9:06 AM Respond