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:
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:
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.
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