“I want to make change but I’ve already made change. I’m not just running on a promise of change — I’m running on 35 years of change.”
—Hilary Clinton at tonight’s debate.
Update: It’s interesting to read the transcript. Edwards did the best, I think; if the press were willing to admit he existed he might do better. The end of the debate ended up being focused on economic issues, and that’s an area where Edwards really speaks with more passion and conviction than the other candidates. No idea if that would translate into more policy success, though.
Obama did next-best. Hilary came in third; I think her willingness to be driven by what the polls say (“mention the word “change” every sentence!”) was a little lame. Richardson came off as grumpy (“what’s wrong with experience?,” he complained).
Obama annoyed me with his discussion of health care.
We do have a philosophical difference. John and yourself believe that if we do not mandate care — if we don’t force the government to get — to — if the government does not force taxpayers to buy health care, that we will penalize them in some fashion. I disagree with that because as I go around town hall meetings, I don’t meet people who are trying to avoid getting health care; the problem is they can’t afford it. […]
[…] the reason that I mandate for children is because children do not have a choice. Adults do, and it’s my belief that they will choose to have health care if it is affordable.
So are we to take it that as Obama goes around town hall meetings, he meets parents who are trying to avoid getting health care for their kids?
If you don’t have a “mandate” of some sort, some people won’t buy health insurance, for whatever reason: Because they’re young and healthy and don’t know that they’ll be diagnosed with diabetes or hit by a bus next year, because they’re cheap, because they hate big corporations and big government, whatever. Obama recognizes that when it comes to insuring children; some parents won’t “choose to get health care” for the kids “even if it is affordable,” which is why Obama favors a mandate. But it’s duplicitous to recognize this fact when talking about insuring kids, but pretend that this fact has gone away while talking about insuring adults.
Now, there is an honest argument against mandates, which isn’t “there’s no need for a mandate, because everyone wants insurance if they can afford it” but “we shouldn’t have a mandate, because we should let people be uninsured if they don’t want insurance.” But Obama didn’t make that argument. By attacking “mandates,” however, he certainly is helping to legitimize Republican talking points against Clinton’s and Edwards’ plans.
By the way, I’m for mandates. The large majority of those who choose not to buy affordable health insurance are those who believe they’re never going to be sick (or at least, not for years to come); and when those uninsured people get sick, or get into accidents, they’ll be left with no choice but to draw on a health system they haven’t been paying into. Like social security, decent health coverage has to be universal, because it only works if everyone pays into it.
As for the claim that the government will “will penalize them in some fashion,” referring to those who don’t get mandated health insurance — the phrase is a scary one, and one I’m sure the Republicans will be using a lot. A more specific statement, that would have actually helped the voters understand the issue, is that under a mandated health insurance plan, those who don’t enroll in a health insurance plan will be enrolled in one by the government, and they’ll have to pay for it just like every other American does. Everyone pays a little more, in exchange for universal health care. That’s what universal health care is; it doesn’t work if we give some people the right to be free riders, benefiting from the system but not contributing to it.
Update the second: By the way, we just had a debate with the four leading Democratic nominees — and only one is a white man.
“My husband has been promising to change since the day I met him. Believe me, America, I know all about change.”
1. Universal health care costs less than the current US system, due to lower administrative overheads, better long-term thinking on care and more bargaining power on drug costs, among other things.
2. What are children if not free riders? How about retired people, and people who can’t work due to ill health and need care in order to return to the workplace? There will always be people who are not capable of contributing to their own healthcare costs. UHC works because we know these people will contribute in the future (and that those retirees have contributed in the past).
3. The point of UHC, as I see it, is that it is inevitable that not everyone can afford health insurance and (because it CAN be provided) it is morally right that these people get care. This happens to have a greatly beneficial economic effect, as well as improving public health; free care prevents the economic damage caused by ill health, and it’s been suggested by the Journal of the American Medical Association that even the wealthiest people in the USA would benefit from the social support for health provided by UHC (link: http://news.bbc.co.uk/1/hi/health/4965034.stm ).
Regarding your three points:
1. I pretty much agree. I mean, I could nit-pick at this, but I think I know what you mean and I agree.
2. If I don’t work until I’m 20, work (and contribute to paying for the common medical system) until I’m 65, and then retire, it’s not true that I’m a free rider; I contributed. (We don’t call retired folks and children free riders on social security, or using public roads, for the same reason). Also, I believe that retired people do pay taxes.
You’re correct, however, that my argument did fail to consider people who don’t contribute economically to the system because they’re incapable of earning money, at any point in their lives. I certainly would want any decent health care system to cover those folks as well.
Nonetheless, if the healthy can opt out of contributing to Obama’s system, and then sign on once they cease being healthy, that will make the system as a whole much more expensive per person paying for it. There’s no way around that fact.
3. I quite agree.
I watched the Republican debate and then fell asleep.
Romney is amazingly assholish.
If you don’t have a “mandate” of some sort, some people won’t buy health insurance, for whatever reason…. Obama recognizes that when it comes to insuring children; some parents won’t “choose to get health care” for the kids “even if it is affordable,” which is why Obama favors a mandate. But it’s duplicitous to recognize this fact when talking about insuring kids, but pretend that this fact has gone away while talking about insuring adults.
OK, this elicited a serious “whaaaaaat???” I’m not understanding what’s duplicitous about it. Parents can choose to not insure their kids for all sorts of reasons, but the salient point is that it’s not the children’s choice, it is made for them by others.
That’s the argument for a mandate for children that doesn’t apply to one for adults.
Outlier, I understand that. If Obama had said:
“I think it’s acceptable if adults decide for themselves not to be insured. So that’s why I don’t have a mandate for adults. But children cannot decide for themselves, and without a mandate some children will be uninsured, so I have a mandate for children.”
…Then I would find that a consistant arguement. But that’s NOT what Obama said. What he said, in essence, was this:
“I have a mandate for children’s health insurance because children cannot decide for themselves, and without a mandate some children will be uninsured. As for adults, there’s no need for a mandate for adults, because if it’s affordable adults will buy health insurance without a mandate.”
That makes no sense. He’s pretending his plan provides universal coverage by pretending that without a mandate, everyone will buy insurance anyway: but he knows that’s not true.
This is a problem not only because it makes no sense, but because it enables him to weasel out of addressing the free rider problem his plan would create, compared to Edwards’ or Clintons’ plans.
Basically he knows perfectly well to make it work, he’ll have to take away freedom. But he’s politically astute; he gets the fact that saying “you dumb fucks can’t run your own life, I’ll do it for you” won’t fly with the moderate voters he’d need to win the main event.
He’s just being prudent in his rhetoric. After the inauguration, there’ll be plenty of time to say “oh, well, now our studies show that we won’t get enough compliance, so reluctantly we have to mandate this…”
He’s a lot more politically astute than the tin-eared twins. Probably deserves the nomination just on that basis.
OK…I see…He’s glossing over the issue of voluntarily uninsured adults. I haven’t read enough to really understand the “free rider problem,” but I will do so…
Thanks for the clarification.
Outlier, free rider is very simple. If you can go on the roller coaster for free, then you will. If the coaster operator is selling tickets to pay for the maintenance and operation of the coaster, then the ticket price has to be set high enough to cover those expenses. If lots of people find out a way to ride for free, the ticket price has to go up and up and up to pay for those riders. Eventually the ticket price goes up so high that nobody will pay it, and everyone starts to ride for free. Which works great until the coaster falls apart because there’s no money for maintenance, or the owner moves it somewhere else.
Maybe I haven’t had enough coffee or my blood sugar is low, but I don’t see much difference between these two. The fact is, a lot of people don’t have insurance because they can’t afford it. Mandating it won’t change that hard economic reality. The point of UHC is to make health care available regardless of one’s ability to pay for it. None of the candidates proposes a plan that does that. They propose universal health insurance, that is health coverage tiered according to one’s ability to afford private insurance or receive government assistance in affording a health plan, private or government designed. The insurers are the main obstacle to UHC and should be either eliminated or, for the sake of so-called “choice” for the rich, sidelined as specialty services.
My understanding is that Obama would mandate health insurance for children that is affordable, so I don’t think his argument is that nonsensical. And Robert is right about one thing: regardless of what candidates say now, what we get from the legislative sausage-maker is going to look much different. I tend to favor Edwards because I take him as his word that he will fight like a badger for the poor and middle classes.
The end of the debate ended up being focused on economic issues, and that’s an area where Edwards really speaks with more passion and conviction than the other candidates. No idea if that would translate into more policy success, though.
Which leads to one of the things that I look for in a candidate; does he or she sound like they’ve got a clue what they can actually get done vs. what they’d like to do?
Kevin:
A mandate alone won’t change that hard economic reality, but neither Edwards or Clinton are offering a mandate alone. All three of the leading candidates’ plans include measures to make insurance more affordable, especially for low-income folks.
I agree. I suspect all three of the candidates agree with that, too, if you asked them while there’s no recording device in the area.
But trying to get there in a single step is a guaranteed policy failure, because the majority of Americans like the insurance that they have now. A policy which takes away insurance that people like and are used to, and replaces it with something new and strange, is a guaranteed failure in congress. What good is a great UHC policy if you can’t pass it into law?
All three of the leading Dem plans offer an option for anyone, regardless of income, to choose to take the government health care plan rather than a private insurance company. Hopefully, with a decade or two of head-to-head competition, most consumers will realize that the government is just better at providing this service than private insurers are, and more and more people will gradually switch to government coverage. At some point, we’ll reach critical mass, and then it will be possible to pass a law switching the US to some form of single-payer health care, with an option for private insurance for those who want it.
(And if the government health care is less effective — as conservatives claim — then that’ll never happen. But I think many conservatives realize that their beloved private market is doing a lousy job providing health insurance; that’s why they fear giving Americans a real choice.)
It’s nonsensical to claim that there’s no need to mandate health insurance for adults as long as you’ve made it affordable (because they’ll buy it if it’s affordable), but to simultaniously claim that we must mandate health insurance for children. Either mandates are necessary to get everyone to buy in to the plan, or they’re not.
I’m sure it’ll look different, which is why too much worrying about the details is a problem. What bothers me more about Obama’s argument isn’t just that I think it doesn’t make sense, but that he’s attacking the Edwards and Clinton plans from the right.
That’s what I like best about Edwards, too. But I’m not sure that the policy differences between him and Obama will be large, after the legislative meat-grinder does its grinding. (If you look at Obama’s voting record, he’s been consistently on the left, as Dems go.) On foreign policy — an area in which the President is much less fettered — I think Obama is preferable. I also think he’s more likely to win a general election.
Plus, given two candidates who are equally good on most policy matters (give or take, this or that), I think it’s time for a non-white president.
The other reason for not wanting to make the switch overnight.
Chaos. Uncertainty is pretty bad for economies. The idea that Gov’t will eliminate an industry without any problems is silly.
When kevin says he wants to get rid of the insurance companies I think he’s imagining the CEO being show the door. I don’t think he’s thought about abe and beth in the mail room. A lot of people are currently employed in the health care industry. It’s not really creative destruction when the gov’t says they’re doing all that themselves now.
I don’t mind so much if BCBS takes business from HAP and HAP has to cut heads. It’s the way things work. Generally it means that BCBS is doing a better job for the customer than HAP.
Also, a lot of people (mostly pension funds afaik) have invested in those insurance companies. They’re going to be interested in if the company has just been legislated out of existence.
I’m not saying any of that is a deal breaker. But it’s got to be part of the deal. Especially if I’m running for president and want those people to vote for me.
Has anyone here ever been dependant on a social medicine system? It isnt pleasant. People often go outside the system to get care because true care simply is not available through the system. The budget constraints on a working medical system would have to be stretchier than elastic to make it truly work. I personally would not want to deal with it again. As for health insurance, I think a lot of it is a matter of priorities. I pay out of pocket for coverage for myself and my daughter. It isnt about being “able” to afford it if it is truly a priority, you just do it. You can live without electricity, but you make it a priority. You can live without a car/vehicle, but you make it a priority. You most certainly can live without the tv/dvd/vcr/nintendo…but WAY too many people make it a priority. Put health care up there on the list in front of new shoes or a fancier car and most of the people who don’t have care can afford it…not all, there are legitimately poor people still in the US…of course don’t most of them already qualify for some sort of coverage?
Oh, yes. My dentist is very social. We always have a pleasant little conversation before he starts poking around inside my mouth.
ed, when I lost my job, I could have opted for COBRA at close to $400/month. That’s one brand new high-end gaming system per month. I didn;t know how much I’d be recieving in UI benefits, so I didn’t sign up for it.
(And no, I don’t normally buy myself $400 worth of electronics per month, so it wasn’t just a matter of prioritizing.)
“Has anyone here ever been dependant on a social medicine system? It isnt pleasant.”
Yes, Mass Health, and when we had it it was better coverage for everything I needed than what I have now through my employer, and my employer insurance is still very good. I’d go back to MassHealth in a minute if we needed to.