2008 Mandates Matter
posted by on February 5 at 13:13 PM
Paul Krugman, writing on the differences between Hillary’s and Obama’s health care plans in yesterday’s New York Times:
Both plans require that private insurers offer policies to everyone, regardless of medical history. Both also allow people to buy into government-offered insurance instead.And both plans seek to make insurance affordable to lower-income Americans. The Clinton plan is, however, more explicit about affordability, promising to limit insurance costs as a percentage of family income. And it also seems to include more funds for subsidies.
But the big difference is mandates: the Clinton plan requires that everyone have insurance; the Obama plan doesn’t.
[…] Mr. [Jonathan] Gruber of MIT, [a leading health care economist], finds that a plan without mandates, broadly resembling the Obama plan, would cover 23 million of those currently uninsured, at a taxpayer cost of $102 billion per year. An otherwise identical plan with mandates would cover 45 million of the uninsured — essentially everyone — at a taxpayer cost of $124 billion. Over all, the Obama-type plan would cost $4,400 per newly insured person, the Clinton-type plan only $2,700.
That doesn’t look like a trivial difference to me. One plan achieves more or less universal coverage; the other, although it costs more than 80 percent as much, covers only about half of those currently uninsured.
As with any economic analysis, Mr. Gruber’s results are only as good as his model. But they’re consistent with the results of other analyses, such as a 2003 study, commissioned by the Robert Wood Johnson Foundation, that compared health reform plans and found that mandates made a big difference both to success in covering the uninsured and to cost-effectiveness.
And that’s why many health care experts like Mr. Gruber strongly support mandates.
David Brooks makes strong points about the follies of Clinton's 1993 health care plan, particularly how mandates sank the bill.
http://www.nytimes.com/2008/02/05/opinion/05brooks.html?_r=1&hp&oref=slogin
ECB, shouldn't you be at ST's office helping draft a transit plan that will pass at the polls?
Seriously ECB.. that is just semantics.
Both plans would be thoroughly compromised and hashed out in order to win congressional approval, and both plans would not come out without falling somewhere in the middle to gain passage.
*yawn*
has she explained how she plans to enforce the mandate yet? she keeps glossing over it, but it's kind of an important detail. how do you force people to buy something they can't afford?
Reading that Obama's health care plan sucks by the writer who was pushing Edwards for so long is pretty convincing.
@3: That doesn't mean we can't judge their policy designs. Obama's plan is inferior, and his justification for his lack of mandate isn't supported by reality.
I'd still be interested in having someone (who isn't a partisan hack, ideally) poke holes in the following model: A public plan is made available to all who do not get insurance through employers or other sources. When you buy into any plan, including the public plan, you get a tax credit. In this model, you fund insurance if you buy in, and you're still funding insurance (through your higher tax bill) if you don't. Thus everyone pays one way or another.
Why is this somehow destined to failure in a way that the Hillary "mandate" is not? It seems to me that it would serve the same purpose, but be more palatable True, the renounced tax credit for one person might not be as much as the cost of insurance, but I'd expect the fine for not having insurance under Hillary's plan is also likely to be less than the cost of insurance as well - and yes, there will still be people who don't buy insurance, of course.
I just don't see how the accounting would be significantly different.
Is it unfair to label Hillary with the Bush-like characteristic "Manichaean?" Only if you feel that she has a pattern of my-way-or-the-highway absolutism. But I'm not aware of any cases where Hillary does that. Except...
Indeed, HRC's plan is better. The difference is that Obama's plan could actually get some support from Republicans, and therefore have a chance of getting 60 votes in the Senate.
Krugman has Obama Derangement Syndrome if I've ever seen it. Single payer is the ONLY way to achieve universal health care. These half-assed plans--both Clinton's and Obama's--won't do shit unless they make it through Congress. Obama's plan would get a foot in the door without completely alienating people. Clinton's plan is unlikely to pass Congress with the mandates and subsidies she wants, especially if she's elected by a narrow margin.
Health insurance can be a complete rip off, so why should anyone be forced to buy it? If governments are tired of people showing up at the ER then they should provide some free clinics. Forced purchase of insurance does not constitute universal health care.
@2, ECB has no idea what would pass.
Krugman assumes the mandate is efficiently enforced, which we can guess it's not. He just wnats to work in the Hillary White House, that's why he is shilling for her.
@4-you enforce it by raising taxes. If her mandate goes through you can expect to bring home even less of a paycheck to pay for people who may not have needed insurance in the first place. Take a look at Canada. Someone making $60k/yr there gets about 1/2 in take home pay compared to our 2/3.
I keep getting the impression that Krugman is jockeying for a position in Hillary's cabinet.
Yes, mandates do matter. The Republicans are already running against them, and their small-government campaign plank will resurrect itself in time to oppose.
so do hillicrats always propose an uncompromising position that wont be voted in and thusly never deliver a slight bit of their agenda?
Could annie and ECB please each do a post outlining the pros of their candidate's health care plan and negatives of their opponent's?
Well, I'd like to see him working in a Clinton White House too....
But I'm with Annie. Single payer all the way; that's the only way you really cut out the bureaucracy -- the current "free enterprise" bureaucracy vastly outstrips any government one. But we're not getting single-payer.
The problem with a "just good enough to pass" plan is, of course, that after a few years of Clinton's or Obama's plan stinking up the joint (in the face of scorched-earth Republican opposition, nay, sabotage all the way), it'll get killed. And we'll be back where we are now.
The only thing that's going to rescue the US economy is severing the bullshit link between employers and health coverage. A lot of HR staff would get laid off as a result, but the overall benefits would be strong.
I do like Clinton's plan better, though.
Hillary's plan is better but it will never pass Congress. Obama's could.
@7
unless you give actual numbers your plan is meaningless. I'd be pleased to poke holes in it, but you don't describe what it is with enough specificity.
"A public plan is made available to all who do not get insurance through employers or other sources."
OK.
" When you buy into any plan, including the public plan, you get a tax credit."
How much??????
"In this model, you fund insurance if you buy in,"
Noted
"and you're still funding insurance (through your higher tax bill) if you don't."
NO WRONG BZZZZT.
If you forego a tiny $100 tax credit (I believe that was the figure you gave earlier) instead of paying $300 a month for 10 years......you are not really funding health care except in a teensy, tiny way. And if you don't file a tax return you are not funding it.
"Thus everyone pays one way or another."
No, not really. Some trivially contribute, some meaningfully contribute, and some don't pay in at all.
The enforcement mechanism w/ mandates is in the first instance withholding like social security and secondarily fines and penalties and such.
Please tell us what is the tax break ?
If it's large enough to mattter in reality it is a penalty imposed (on some people, not all) via the tax system. If it's smaller than that you're not paying your share.
Mandates are a waste of time.
Neither Clinton nor Obama are willing to do what is necessary, and put this nation on a First World status with Nationalized Health Care.
Easiest way? Just adopt Canada's system wholesale, then you don't get people gaming the system by using one system or the other.
Result: costs HALF as much out the gate, easy to train, and the trainers speak English already and are nearby.
mandates are gay.
Now you see the OBamaton slash and burn old style divisive politics of the past at work again.
First Krugman spends about a year promoting John Edwards. All the liberals loved that.
Now he's out and Krugman says the exact same things about mandates being right, nonmandates being wrong, wrong, wrong.
So, instead of dealing with the substance the Obamatons attack him personally.
Disgusting.
And @10: you have no idea what will get thru Congress under either candidate. To say only single payer works and to say the only way to get there is actually a nonmandate plan does not make sense either.
Again, instead of dealing with the substance _- Krugman showing that the nonmadate plan doesn't work -- you evade it by re-casting it as the stepping stone to something Obama has said he's not even for (single payer, ie elimination of insurance companies)!
What artful, dodging logic.
Pe4rsonally I'd prefer it if either one would just be for single payer and duke it out. That would be real change. But Obama is not for real change he's for ....nothing much more than Romney, on health care.
Like the eminent James Brown said, "It's a Man's World", and I think it would give each little girl of any race in this country more hope and courage in their own lives to see a Woman become the President of America. I don't hate Obama, but I'm leaning towards Hillary, Erica. For reasons such as this post's topic -> I've been working/paying taxes since I was 15 & I WANT SOME HEALTH CARE ALREADY!
As Krugman (who was more of a fan of Edwards' proposal) points out, Hillary Clinton's plan covers more people and is projected to be cheaper per person.
Personally, I'm unwilling to declare what will or won't pass in Congress on account of I have no fucking clue about that.
But *beginning* with covering the most people for the least money is a strong negotiating point. I've rarely in business, if ever, led off negotiations by weakening my position in favor of what my opposition wants before we even get to the table.
how can clinton's plan cover more and cost less? isn't that impossible?
Well, let's face it, any specifics on these plans aren't of much significance. After all, if HRC (somehow, against all odds) gets elected president, the plan she passes will bear little resemblance to what she's pushing today anyway after the endless tweaks. I just don't see how this plan is inherently infeasible, that's all.
Indeed. (And ignore the $100 figure; it was arbitrary. I'm not actually making policy here, just sketching it.) But, like I said, there's an equivalent problem under the mandate. There will be people who try to dodge the law - what will you do with them? Fine them? How much? Will it be as much as insurance? You're unlikely to get much out of many of them, even assuming enforcement is intense.
Alternatively, of course, you could opt for harsher incentives and send people to jail for noncompliance - if you like committing political suicide.
Same thing will be true of the HRC mandate. The real question would be the proportions. Well, that and whether the plan could find ever general public approval, which I question.
#24: You really shouldn't make a decision based on gender or race. ...Also, you will probably pay higher taxes or be fined to pay for a mandated health care plan.
What are both plans promising in terms of copays and deductibles? If neither plan offers copay-free/deductible-free to people who can afford neither, both plans are meaningless. If poor and lower middle class people can't afford to pay $25 per visit plus deductibles up to $1000 per year, then they can't go to the doctor whether they're insured or not. Under Hillary's plan however, they'll be forced to pay x number of dollars per month for the privilege of not getting health care.
I think I meant: if neither plan guarantees no copays or deductibles...
@26 - actually, it does do that (takes off Obama hat). By forcing all young people to be covered, who are mostly healthy, it reduces the cost for older (sicker) people. And by including everyone in mandated coverage, it makes sure healthy people (like say me who is rarely sick ever) to pay for all the continually sick people out there.
Basically, it's a tax on the young and the healthy.
Which is how Canada keeps costs down, too.
well, then, it would have to cost more on some level. saying it costs less is just pushing the numbers around.
Both of these plans are doomed to fail and bankrupt the system unless there is a companion plan for controlling the rising cost of medical care.
It's actually very discouraging that there is this much public focus on improving the nation's healthcare system and it is completely focused on the wrong thing.
Wait a minute, you guys are actually saying that Hillary is too idealistic, too hopeful, too visionary? What the hell happened to the audacity of hope? "In the unlikely story that is America, there has never been anything false about hope." Remember that? Can we no longer hope that the U.S. will get on par with fucking Cuba when it comes to health care?
i do, however, like the idea of everyone being covered, and everyone paying. but like many have said here, it has to be done right (in a way that can pass, and in a way that can succeed), otherwise it may actually turn out to be harmful to our national health.
This is way more than semantics. Hillary is proposing to build a city-wide monorail; Obama is offering us the SLUT.
In a perfect world, we'd just expand Medicare downward in age, pulling in younger and healthier people, until it finally covered everyone who wanted it. It would actually BUTTRESS Medicare: as the pool of insured people gets younger and healthier, the cheaper it gets per person.
That's why you have to have mandates. Admit it: most uninsured twenty-somethings on Capitol Hill are not going to voluntarily sign up for the new government insurance program because they feel invulnerable. Then, when they turn 40 and decrepit (or maybe have an expensive injury on their skateboards), they'll want to join the system. That doesn't work. If you want to be covered when you're sick, you have to contribute when you're well.
Hillary learned her lessons in 94. She knows what she's doing.
"Mandates" matter when you get ELECTED with one.
Who's more likely to get elected with a larger margin?
Is Hillary "49% Nationwide Negatives" Clinton really gonna have longer coat-tails than Obama and help the Dems get large enough majorities in Congress to push through a new agenda and "create change"?
We have to think about the morning after Inauguration.
Why is anyone talking about the specifics of plans that don't actually exist and have zero chance of making it through Congress?
If Obama or Clinton promised to build a freeway to Jupiter, would you believe that too?
well, whose freeway plan will cost less and move more vehicles? will there be HOV lanes?
I think what I'm hearing w.r.t. health care is that when the Obama supporters talk about "hope" and "change", they mean Democrats and Republicans talking nicer to each other! And having more hope for the future!
Not, you know, bills and policies and stuff. That's for wonks and nerds. And probably won't ever happen anyhow.
STOP!!!!
Please read the SOURCE material " a plan that RESEMBLES Obama's..." our MIT EXPERT is NOT reviewing Clinton or Obama's plans but "plans that resemble Clinton's...."
ECB I am REALLY disappointed in you-you have been displaying a great deal of candor and passion for your candidate-but the care with which you have de-contextualized this quote from the NY Times OP-ED page is misleading in the extreme.
Passion, sure, but when has ECB ever, ever shown candor?
I gotta be the lone voice here: Nationalize healthcare and watch progress and improvements in medicine grind to halt. Canada's and Britain's systems are so great that people routinely come to America to get private care. I'm all for people who actually can't afford it to be able to get subsidized healthcare - and I'd pay some taxes for that. But economically comfortable journalists who want a nationalized system just so they can spend more money on clothes and lattes instead of saving for a rainy healthcare-day should keep their hands of my paycheck.
Latte liberals? Seriously? That's all you've got?
Somebody get this kid a calendar. Recycled tropes from 1993 are not going to set anybody on fire.
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