We Democrats have waited SINCE PRESIDENT HARRY TRUMAN (the late 1940s!) for a chance at universal health care. It's within reach. Let's not blow it on a candidate whose plan is weaker and who's already making ill-considered policy shifts (see below for a sad description of Obama's illogical backpedaling on mandates by considering the imposition of penalties on those who don't sign up).
Here's the "money quote" from Paul Krugman's column in tomorrow's New York Times (February 4, 2008):
If you combine the economic analysis with these political realities, here's what I think it says: If Mrs. Clinton gets the Democratic nomination, there is some chance - nobody knows how big - that we'll get universal health care in the next administration. If Mr. Obama gets the nomination, it just won't happen.
Krugman cites essential new information -- that every voter should know -- from an M.I.T. study by a renowned health care analyst comparing the two candidates' plans, important because, Krugman notes, the "principal policy division between Hillary Clinton and Barack Obama involves health care":
[A]s I've tried to explain in previous columns, there really is a big difference between the candidates' approaches. And new research, just released, confirms what I've been saying: the difference between the plans could well be the difference between achieving universal health coverage - a key progressive goal - and falling far short.Specifically, new estimates say that a plan resembling Mrs. Clinton's would cover almost twice as many of those now uninsured as a plan resembling Mr. Obama's - at only slightly higher cost.
Twice as many people. That's huge. Obama has attacked Hillary Clinton repeatedly for mandating coverage -- but there are critical reasons that everyone be covered.
NOW Obama is suggesting (as you'll see below) that he may "penalize" people who don't participate. WHAT? Penalize them? Why not just include them in the first place?
Talk about making up non-sensical policy on the fly!
Update [2008-2-4 2:24:17 by susanhu]: Ezra Klein, in "OBAMA'S "HARRY AND LOUISE" AD," his story at Prospect, offers a more detailed explanation of the penalty -- forcing people to pay back premiums -- that Obama would impose:
Obama not only has a mandate for kids in his own health care plan -- what if the parents can't pay, one might ask? -- but he said, in last night's debate, "If people are gaming the system, there are ways we can address that. By, for example, making them pay some of the back premiums for not having gotten it in the first place." That, of course, is exactly what a mandate does. Gaming the system, in this context, means not purchasing health care. And Obama is now threatening to force them to pay back premiums. That's a harsher penalty than anything Clinton has proposed.
Here's one key reason why mandatory universal coverage works: It forces insurance companies to cover everyone. Another reason is that even young, robustly healthy people can face enormous medical bills from accidents or from rapidly growing diseases hitting the young, including diabetes and high blood pressure (that can be discovered and treated before they become expensive). And if they sign up before they get sick, the plan's costs would be lower. (Find out more here, including great analyses from Ezra Klein, Steve Clemons and The Urban Institute.)
Krugman continues:
[B]oth 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. [...]Mr. Obama claims that people will buy insurance if it becomes affordable. Unfortunately, the evidence says otherwise.
[W]e already have programs that make health insurance free or very cheap to many low-income Americans, without requiring that they sign up ... many of those eligible fail, for whatever reason, to enroll.
An Obama-type plan would also face the problem of healthy people who ... don't sign up until they develop medical problems, thereby raising premiums for everyone else. Mr. Obama, contradicting his earlier assertions that affordability is the only bar to coverage, is now talking about penalizing those who delay signing up -- but it's not clear how this would work.
Krugman reports that Jonathan Gruber of M.I.T., "one of America's leading health care economists," explains in a new paper how Obama's plan leaves far more people uninsured -- and costs more:
Mr. Gruber 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. ...
Krugman refers to the Obama campaign's ugly tactics against Clinton's health plan, and why "Mr. Obama's campaigning on the health care issue has sabotaged his own prospects":
You see, the Obama campaign has demonized the idea of mandates -- most recently in a scare-tactics mailer sent to voters that bears a striking resemblance to the "Harry and Louise" ads run by the insurance lobby in 1993, ads that helped undermine our last chance at getting universal health care.
I showed you that pamphlet the other day. It's important to display it again. It is UGLY, Chicago-style campaigning -- and, as Dr. Krugman points out, would sabotage the realization of even Obama's own weaker plan:
In a February 1 NYT blog post, "Obama Does Harry and Louise Again..." -- which I quote in my February 1st story, "Common Sense + Expert Opinions on Obama's Dangerously Flawed Health Care Plan " -- Krugman points out:
The Obama campaign sends out an ugly mailer. Sorry, but this is just destructive -- like the Obama plan, the Clinton plan offers subsidies to lower-income families. And BO himself has conceded that he might have to penalize people who don't buy insurance until they need care.
Read all of tomorrow's NYT column, "Clinton, Obama, Insurance."
THIS is the candidate who can make universal health insurance a reality:
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