One of the few actual policy disagreements between Barack Obama
and Hillary Clinton during the primary season arose because
Clinton's health care plan included a mandate requiring individuals
purchase health care, and Obama's did not. Obama argued
emphatically against a mandate in many debates, saying that the
problem wasn't that people didn't want to get health insurance, the
problem was that they couldn't afford it -- and said, rightly, that
a mandate would impose onerous fines on working people who failed
to purchase insurance.
But we now ABC reports that he may not be opposed to mandates
after all:
"Senator Obama is willing to consider any sort of
proposal that would bring together, not just the insurance industry
but . . . the consumers themselves," said Obama adviser Dr. Kavita
Patel....
Asked if Obama would be seen as reversing himself if he were to
endorse an individual mandate after clashing with Clinton on the
issue, Patel dismissed the concern.
"He has not said he is opposed to it," Patel told ABC
News. "He has voiced his disagreement with having that be a part of
his health-care plan last year. But he is not opposed to the idea
itself." Patel added that the Obama campaign is in touch with
former Clinton health-care advisers.
Of course, the Obama campaign pushed back on the story, with its
trademark slipperiness:
"Senator Obama does not have plans to change his
health care plan, which will achieve universal coverage," Obama
spokesman Bill Burton tells ABC News. "As he has consistently said
throughout this campaign, he will bring together businesses, the
medical community and members of both parties around a
comprehensive solution to this issue."
So which is it?
Actually, if Obama is elected, it wouldn't surprise me at all to
see an individual mandate become part of his health care proposal.
There's a simple reason why, which I explore at greater length in
my health care story for our July/August print edition.
Obama's plan, as currently structured, imposes a "guaranteed
issue" requirement on insurers, meaning that they have to provide
coverage to anybody who applies for a policy, regardless of risk
factors or preexisting conditions. But what this does is drive up
the cost of insurance for everybody else, and healthy people bolt
the market. After all, if insurers are required to cover somebody
no matter what, a healthy person can save money on monthly premiums
by simply waiting until after he gets sick
to purchase insurance. In every state where this has been tried, it
has been an absolute disaster. In my article, I note that when this
regulation was passed in Kentucky in the 1990s, it caused a mass
exodus of more than 60 insurers from the state, and Kentucky was
left with just one private insurer in the individual market. This
is why many liberal academics support a mandate requiring the
purchase of insurance as a way to keep healthy individuals within
the risk pool, so that insurers don't get stuck with only the sick.
A mandate, of course, hasn't worked very well in Massachusetts.
topics:
Trade, Health Care, Barack Obama, Hillary Clinton, Business, NATO
