The New York Times reports on a series of regular health care policy meetings that have been taking place in the Senate between insurers, doctors, hospitals and business groups and staffers for Ted Kennedy. According to the article, there is an emerging consensus forming around the need for an individual mandate requiring that all Americans obtain health insurance.
During the Democratic primaries, one of the few major policy differences that existed between Obama and Hillary Clinton surrounded mandating the purchase of health care, and Obama argued fervently against the idea. However, his position was always untenable. Obama’s campaign health care plan called for requiring insurance companies to cover everybody who applied for insurance, regardless of risk factors or preexisting conditions. Yet every state that has tried this in the absence of a mandate has seen a mass exodus of insurance companies from the state, because healthy people make the rational decision to exit the insurance market, and insurers are stuck with the oldest and sickest patients.
Obama wants to create a government-run insurance exchange in which individuals are given subsidies to purchase insurance, and given choice among private plans and a government option modeled after Medicare. The idea is to steer people to the government option over time, but in the near term, he needs private insurers to participate in the exchange to give him cover so that he can argue that he isn’t imposing government health care, and that consumers will have a real choice. Insurers will not cooperate with him unless he reverses his campaign position and supports mandates. So, he’ll likely have to come out in favor of them.
However, were Obama to propose an individual mandate, it will complicate matters for him from a public relations perspective. For one thing, opponents would have an endless amount of video clips from his debates in the Democratic primaries in which he passionately argued against mandates. Furthermore, an individual mandate is the most controversial and unpopular element of any universal health care proposal, and it makes it harder to argue that you aren’t supporting government-run health care when you are having the federal government require that everybody purchase health insurance. It can also be attacked as a giant handout to big insurers, since government is requiring that Americans purchase their product.
The mandate trap may end up proving the most effective way for conservatives to defeat Obama’s push for government-run health care.
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