Did the Clinton Campaign Kill Mandates?

This year's extended primary just might be great for healthcare reform as the Clinton campaign's failure may have killed off the terrible idea of insurance mandates.  She ran on it, and lost---just like Arnold did in California last year.

If so, great news all around.  Working people, already struggling, will not face the prospects of having their wages garnished to pay off Blue Cross' inflated premiums, overhead, and denials.  Healthcare reformers can focus their work towards enacting genuine solutions, rather than fighting off this insurance marketing scheme masquerading as health care policy.  And all of us can debate the real issues at hand here, like the new report finding the number of underinsured is spiking as our healthcare system continues its death-by-insurer spiral.

We'll take a look at this and updates from single-payer movement below!

The big political advantage of health insurance mandates (laws forcing people to buy private insurance, no matter the cost or quality) is that insurance companies love them, and can create big coalitions of business-friendly groups that seem safely centrist but also reasonably effective.  They seem so dang politically viable.

But the Wall St. Journal points out they're not and argues that Clinton's Exit Deals Setback to the Push for Health-Care Mandates

Sen. Hillary Clinton's exit from the presidential race will deal a blow to supporters of a key element in the tussle over universal health coverage: the idea that all Americans be required to buy or have health insurance.

After gaining considerable political ground, especially at the state level, the concept has suffered other setbacks lately, too. Despite years of entrenched political opposition to the idea of a mandate, it was a key part of the 2006 universal health care legislation enacted in Massachusetts and of California Gov. Arnold Schwarzenegger's plan to overhaul health care in that state....

The Schwarzenegger plan, though, failed this year, in part because unions and business groups objected to its individual and employer mandates. In Massachusetts, results have been mixed. While the overall plan has cut the number of uninsured adults in that state by roughly half, the state authority responsible for overseeing the program has exempted nearly 20% of uninsured residents because it has deemed they can't afford the policy premiums on offer.

The California plan died when the public and legislators learned that nurses and labor unions were strongly opposed to the idea--and that their wages could have been garnished or a lien put on their home.  This same strategy will kill similar proposals nationally.  It is generous to call Massachusetts' experiment mixed; check out Dr. Steve B's more informed comments.

There are a number of problems with mandates.  On a macro level, they make genuine healthcare reforms--single-payer--impossible by showering for-profit insurers with millions of new customers and billions in new revenues and subsidies.  On a micro level, they trap patients into this broken system and saddle them with junk insurance that will drain their bank accounts only to offer them no protection in the case of a health crisis.

A new study today elaborates on this very problem of underinsurance:

About 25 million Americans -- or approximately one of every five adults younger than age 65 with health insurance -- did not have sufficient coverage last year to shield them from financial hardship if they ended up in the emergency room or were seriously ill, according to a new study to be released on Tuesday by the Commonwealth Fund.

I actually think that number is really low, but at least it focuses our attention on this:

As the nation debates how best to improve its health care system, including how to insure the increasing number of Americans without coverage, policy makers also need to discuss the quality of available coverage, said Karen Davis, the president of the Commonwealth Fund.  "Lack of insurance is only part of the problem, as even the insured have serious gaps in coverage," she said.

Meanwhile, hilarity ensues as The head of Blue Shield of California begs health reformers: "Stop demonizing health plans."  I don't think so.

Chellie Pingree is about to become a great Congresswoman from Maine, and she is running on a single-payer platform.  Rose Ann DeMoro from the California Nurses Association/National Nurses Organizing Committee,  finds a gold rush town that symbolized our healthcare crisis.

Elsewhere, a writer in the Tennessean reminds us why we don't have single-payer healthcare...the war...and the trend of getting married for health insurance continues.

Finally, Elizabeth Edwards, well, um, eviscerates John McCain's so-called health care plan.  Snap!



Display:


Re: Did the Clinton Campaign Kill Mandates? (2.00 / 5)

You are so obtuse.  Krugman disagrees with you.  Don't worry, health care reform is dead according to Dem's in the Senate.


formerly bookgirl
by masslib1 on Wed Jun 11, 2008 at 01:08:04 PM EST

Isn't single payer (2.00 / 2)

also "mandated"??

I prefer single payer, but I will take progress.


by TomP on Wed Jun 11, 2008 at 01:54:51 PM EST
[ Parent ]

I know, it's a big debate (none / 0)

But from here, it's hard to see how mandating more customers and revenue for the big insurance corporations is progress.


Join the California Nurses Association/National Nurses Organizing Committee to fight for guaranteed, single-payer healthcare: www.GuaranteedHealthcare.org/blog
by California Nurses Shum on Wed Jun 11, 2008 at 04:54:25 PM EST
[ Parent ]

Re: Isn't single payer (none / 0)

"Isn't single payer also "mandated"??"

Yes, single payer is mandated, and all taxpayers would have to  have to pay for it as part of their tax burden. All the same arguments apply as to the mandate in question.

Of course, if we had a national single payer system in place, and no more employer based health insurance as it takes it's place, then as soon as the political pendulum swings and  tax cutting Republicans take over again, they immediately start playing "starve the beast" as with all entitlements, they will cut the coverage down to the bare bones and then some, and the only alternative will be ghastly expensive private health insurance for people to try to buy on their own, or go without health care. People see the wide swings in government services, and do not trust the same people who brought us Katrina bringing us our open heart surgery.

At least with the Massachusetts mandate they do exempt people who cannot afford to buy insurance plans.  When was the last time you tried to tell your employer or the IRS that you "couldn't afford" to pay your taxes?

Of course, Nurse Schrum, you are brutally misrepresenting the Clinton health care mandates, which would cap costs at 6-10% of family income, and subsidize the rest, so people would not be "forced to buy plans they could not afford".  And you misrepresent the Clinton plan also by saying that people would be forced to buy private insurance - Clinton strategically included a public program modeled on Medicare that people could buy into as an alternative to private or employer based insurance. That program was the seed of a single payer national health insurance program, but had you the eyes to see it.

Hillary was the last candidate standing  who cared enough about giving single payer a chance to offer that option, even though it opened her to new political attack on the "no new bureaucracies" front. She also vowed to fight the insurance and drug companies to regulate them on their high priced snake oil and usurious rates, and swiss cheese coverage, so we could have mandates that made sure everyone was in the system and covered, with the health insurance industry heavily regulated much like it is in Europe, where the insurance and "sickness funds" are technically private entities, but function essentially as public services. Little functional difference between that and true single payer, as they are "private" insurance in name only.

Did progressives and single payer advocates support Clinton for her progressive health care plan? No. You are still stuck in the denial that American voters want a single payer system and it is only the big bad money interests that are preventing it from being passed. Wrong. Far too many Americans have lived under nationalized governments and do not want that here. I somewhat disagree with them, but I assure you it is the VOTERS who do not support single payer that remain the obstacle to it, not industry. Kucinich supported single payer, and got 2% support from voters.

Hillary Clinton listened to her constituents and devised a plan that they asked her for, not business. She was never "bought out" by the insurance or drug companies, there is no quid pro quo with her, she does what she believes in and honors what her constituents ask for.

You have to win over the hearts and minds of the American public to win single payer. And Hillary knew the people would need to see PROOF, to see it working well for them, so she included the Medicare for All option in her plan so the American public could see it working with their own eyes, and be convinced it is a good thing. They might have flocked to it in droves, making it the new "Medicare for All" program we have needed for generations already.

Now Clinton's candidacy is destroyed, and all hope of that is gone. Instead of cynically attacking and destroying your best candidate, you progressives should have been behind her all the way.

Now how happy will you all be with the "bipartisan" Obama/Biden/Bennett "Healthy Americans" Act? The free market will be unleashed to solve all our health care woes [not]. You have only your blindness to thank.


by 07rescue on Thu Jun 12, 2008 at 05:38:16 AM EST
[ Parent ]

Re: Did the Clinton Campaign Kill Mandates? (2.00 / 6)

Funny you attack Hillary but give a shout out to Elizabeth Edwards, who shares Hillary's views on health care.  Lovely.


formerly bookgirl
by masslib1 on Wed Jun 11, 2008 at 01:18:04 PM EST

Re: Did the Clinton Campaign Kill Mandates? (none / 0)

I didn't attack Hillary.  I suggested--and hoped--that her campaign signals the end of a very bad idea she ran on.  Many nurses do like Hillary.


Join the California Nurses Association/National Nurses Organizing Committee to fight for guaranteed, single-payer healthcare: www.GuaranteedHealthcare.org/blog
by California Nurses Shum on Wed Jun 11, 2008 at 04:55:12 PM EST
[ Parent ]

Obama's making it his priority (none / 0)

I've heard it's going to basically be the first legislation he tries to pass.  The lack of mandates will ease its passage, no doubt, with the Republicans.

Though if Reid remains the senate majority leader and lets Republicans get away with automatic filibusters on this one, I'mma gonna bust some caps.


In this avalanche, the pebbles get to vote.

That One/Another Fella '08

by Dracomicron on Wed Jun 11, 2008 at 01:20:17 PM EST

Re: Obama's making it his priority (2.00 / 1)

"Though if Reid remains the senate majority leader and lets Republicans get away with automatic filibusters on this one, I'mma gonna bust some caps'

If Democrats get the 67 Senate seats I'm guessing they will, they won't have the GOP to use as an excuse for failure to enact a Democratic agenda.


Anybody's vote is worth having. But not everybody's vote is worth campaigning for.
by Freespeechzone on Wed Jun 11, 2008 at 01:39:25 PM EST
[ Parent ]

I don't think we can get 67 (none / 0)

We might get 60 if we're incredibly fortunate, but not 67.


In this avalanche, the pebbles get to vote.

That One/Another Fella '08

by Dracomicron on Wed Jun 11, 2008 at 01:41:41 PM EST
[ Parent ]

Re: I don't think we can get 67 (none / 0)

We only need 62.  Right now according to polls were at 56.  Now is the time to start work on the down-ticket races.  Right now.


He that lives upon hope, will die fasting. -Ben Franklin
by TxDem08 on Wed Jun 11, 2008 at 02:44:59 PM EST
[ Parent ]

Re: Did the Clinton Campaign Kill Mandates? (2.00 / 2)

Not really. Because as everyone who has studied this knows you need mandates to make it work. Obama said he was going to renegotiate Nafta which isn't going to happen either. Who knows what a final bill will look like but what I do know is that one small element of campaign rhetoric aint going to have much to do with it.


by ottovbvs on Wed Jun 11, 2008 at 01:23:52 PM EST

Re: Did the Clinton Campaign Kill Mandates? (2.00 / 3)

actually I killed mandates, with the candlestick, in the library.


by alyssa chaos on Wed Jun 11, 2008 at 01:26:12 PM EST

Actually, it was a boydate. (none / 0)


Anybody's vote is worth having. But not everybody's vote is worth campaigning for.
by Freespeechzone on Wed Jun 11, 2008 at 01:42:30 PM EST
[ Parent ]

umm (2.00 / 1)

are u nuts?


vote blue in 2008
by sepulvedaj3 on Wed Jun 11, 2008 at 01:31:20 PM EST

Re: Did the Clinton Campaign Kill Mandates? (2.00 / 2)

By the way she won the popular vote, and in exit poll after exit poll she won the health care debate.  


formerly bookgirl
by masslib1 on Wed Jun 11, 2008 at 01:36:17 PM EST

By the way she won the popular vote (none / 0)

Only if you pretend nobody voted in the caucuses Obama won.


Anybody's vote is worth having. But not everybody's vote is worth campaigning for.
by Freespeechzone on Wed Jun 11, 2008 at 01:41:46 PM EST

Re: By the way she won the popular vote (2.00 / 2)

Actually, no, she won the popular vote if you count all the votes case and reported by Secretaries of State (primaries) and state Democratic Parties (caucuses).  That's exactly the way that the popular vote is always tallied, by counting the votes.

Not that it makes much difference any more.  But trying to discount the historic accomplishments of a candidate that 18 million people voted for is a pretty stupid way of trying to build unity.


by markjay on Wed Jun 11, 2008 at 02:24:36 PM EST
[ Parent ]

Re: By the way she won the popular vote (none / 0)

So in order to unify the party we must discount the facts and pretend that clinton received more votes then Obama?


by venician on Wed Jun 11, 2008 at 03:43:37 PM EST
[ Parent ]

Re: By the way she won the popular vote (none / 0)

There are at least four scenarios for who won the popular vote. Hillary gets 2 and Obama gets 2. As far as I'm concerned it was a tie. But I'll never sit back and let the myth that Hillary was robbed go unchallenged with facts.


Anybody's vote is worth having. But not everybody's vote is worth campaigning for.
by Freespeechzone on Wed Jun 11, 2008 at 04:41:24 PM EST
[ Parent ]

Re: Did the Clinton Campaign Kill Mandates? (2.00 / 1)

While I respect your organization and commitment to universal health care, I completely disagree with your strategy and tactics.

You continue to play the "single-payer-or-bust" game while 47 million Americans have no health insurance. If you really want all Americans to be covered, you would recognize that there is more than one way to achieve UHC and the approach your taking is only keeping us in the tragic rut we've been in for the last couple of decades.

Stop continuing the be part of the problem and become part of the solution.


by LakersFan on Wed Jun 11, 2008 at 01:55:15 PM EST

I rec'ed your comment, though.... (none / 0)

I am not particularly thrilled with your username today.


formerly bookgirl
by masslib1 on Wed Jun 11, 2008 at 02:02:04 PM EST
[ Parent ]

Re: I rec'ed your comment, though.... (none / 0)

Ha, ha!

We have similar political views, but opposing basketball views. That's okay. Just like politicians, we can be vicious opponents with deep-seated hatred in June, but we'll still set aside our differences and come together in November. (But unlike politicians, we don't have to be gracious about winning or losing in June.)


by LakersFan on Wed Jun 11, 2008 at 02:19:03 PM EST
[ Parent ]

Re: I rec'ed your comment, though.... (2.00 / 2)

OK, masslib, I have stood shoulder to shoulder with you for a full year now, but we finally have to part our ways.

Go Lakers!!!!!


by markjay on Wed Jun 11, 2008 at 02:21:14 PM EST
[ Parent ]

Re: Did the Clinton Campaign Kill Mandates? (none / 0)

Thanks for saying you respect us.

Here's why we do what we do:  nurses are on the frontlines in hospitals everyday...they argue with insurance companies every day...the RNs at CNA have come to think that these insurance companies hold back health care refrom, and shouldn't be the basis on which reform proposals are built.

So it's not single payer or bust...it's healthcare reform or bust.


Join the California Nurses Association/National Nurses Organizing Committee to fight for guaranteed, single-payer healthcare: www.GuaranteedHealthcare.org/blog
by California Nurses Shum on Wed Jun 11, 2008 at 04:57:41 PM EST
[ Parent ]

Re: Did the Clinton Campaign Kill Mandates? (none / 0)

Believe me, I know what nurses do. They run the darn hospitals! Doctors are lost without them.

I understand the belief that insurance companies hold back health care reform, but if there's a way to reform with them, it's something we all should be looking at, including your organization of nurses. Because as you well know, getting care for everyone is of utmost importance and we shouldn't overlook any options just because they involve mandates.

Since you're well aware that single-payer also creates a mandate, you really shouldn't be demonizing the idea of mandates. You're poisoning the well for your own issue by making people believe that any system that they're forced to participate in is bad. We need to convince everyone that contributing to a universal health care system -- whether it's through a payroll deduction, higher taxes, or writing a check every month -- is an excellent investment for them as individuals, for their fellow Americans, and for the economic future of our country.


by LakersFan on Wed Jun 11, 2008 at 06:40:19 PM EST
[ Parent ]

Re: Did the Clinton Campaign Kill Mandates? (2.00 / 3)

The only way to make any healthcare reform work is to require young people who figure they are healthy and don't need insurance to be in the system.  That means mandates.  You think that if there is a single payer system, everyone isn't going to be forced to contribute in some way?  Just need to make the system progressive.

Does any country that has universal healthcare allow people in their population to not participate?


by Dave B on Wed Jun 11, 2008 at 02:14:16 PM EST

Re: Did the Clinton Campaign Kill Mandates? (none / 0)

Okay good points

I should have been more clear: hopefully, the end of her campaign signals the end of proposals to mandate the purchase of products from for-profit insurance corporations.


Join the California Nurses Association/National Nurses Organizing Committee to fight for guaranteed, single-payer healthcare: www.GuaranteedHealthcare.org/blog
by California Nurses Shum on Wed Jun 11, 2008 at 05:01:34 PM EST
[ Parent ]

Re: Did the Clinton Campaign Kill Mandates? (none / 0)

"the end of her campaign signals the end of proposals to mandate the purchase of products from for-profit insurance corporations."

Clinton's proposal never mandated the purchase of products from for profit health insurance. That idea is still alive, in the bipartisan "Healthy Americans" Act, poised to pass the Senate and really mandate the purchase of insurance from private industry.without the option Clinton included of a Medicare for All program.

So much more  died with the destruction of Clinton's candidacy, it was really the end of the hope for single payer.


by 07rescue on Thu Jun 12, 2008 at 05:50:23 AM EST
[ Parent ]

Re: Did the Clinton Campaign Kill Mandates? (none / 0)

Sorry, but mandates, just like SS is a mandate, is necessary for healthcare.  

Otherwise, we will have the same people who refuse to buy health insurance and can afford it yet expect the rest of us to pick up the tab when they get really ill

no dice.  I have no problems with offsetting the cost of health care for those who really cannot afford it, but so many people who can afford it, don't buy it.

Cause they never will think it will happen to them.  Mandates are NOT off the table.

In fact, I think this was where Obama was the weakest and a lot of his supporters on mydd have stated that his health care plans need to cover everyone.


by colebiancardi on Wed Jun 11, 2008 at 02:23:51 PM EST

Re: Did the Clinton Campaign Kill Mandates? (none / 0)

Mandates are politically unviable.

You're going to tell middle class people that their wages will be garnished if they don't pay their Blue Cross premium...at whatever cost Blue Cross wants to charge?  That will not sell, ever.


Join the California Nurses Association/National Nurses Organizing Committee to fight for guaranteed, single-payer healthcare: www.GuaranteedHealthcare.org/blog
by California Nurses Shum on Wed Jun 11, 2008 at 04:58:36 PM EST
[ Parent ]

Re: Did the Clinton Campaign Kill Mandates? (2.00 / 1)

Your rights, mandates stink.   In fact, universal health care stinks -- because it only can exist through mandates (whether mandated fees or mandated taxes).  And public education stinks.  And public libraries stink.  And all government programs stink, because they all mandate that people pay for them through taxes or fees.

Thank God that such "mandated" programs are losing out, and we can all go back to living in liberty when people are "free" not to have health care, not to be educated, not to have social security, or not to have any other government-mandated protections.


by markjay on Wed Jun 11, 2008 at 02:27:29 PM EST

Re: Did the Clinton Campaign Kill Mandates? (2.00 / 1)

I always thought that Obama's position on mandates was more about protecting the Democrat's flank, so they could get the few Republican senators on board needed to defeat the inevitable filibuster (which is what killed health care reform in '92).

It's not impossible that the Dems will top 60 votes in the Senate this year, but the chances are very small.  The real window for reform will probably be between 2011-12 (because the Dems are poised to pick up a few more senate seats in the next cycle).

And once that closes, that's probably it.  The Dems will probably lose Senate seats in 2012 just because we'll be defending more than our usual share.

Thought the whole health care debate during the primaries (here talking about the marginal debate between the candidates, not their general focus on the issue) was kind of stupid, actually, because it didn't concentrate on what the Dems would need to get any plan passed.

This isn't like going to the supermarket and choosing between Hillary-Os and Barack-Os (and yet that's how people like Krugman wrote about it).  The default position here is that any Democratic plan will lose.  


by IncognitoErgoSum on Wed Jun 11, 2008 at 02:45:02 PM EST

Re: Did the Clinton Campaign Kill Mandates? (none / 0)

"Thought the whole health care debate during the primaries (here talking about the marginal debate between the candidates, not their general focus on the issue) was kind of stupid, actually, because it didn't concentrate on what the Dems would need to get any plan passed."

Only people who don't understand the first thing about health care reform think the debate on this issue is stupid. What is the point of getting something passed that will fail horribly in practice?

The problem with health care is skyrocketing costs, and the only way to control costs is by getting everyone into the system (mandates), invested in making it work and be affordable, and then getting the regulations passed on industry that will insure that patients and the public good are served, as it have been done in Europe.

Without the first step of mandates, all else will not occur. As long as people can opt out of the system, there will never be the political will to accomplish the needed reforms. Only mandates will lower costs for everyone, and even then we will need many futher measures to make health care affordable again.

The question of political viability is another issue. if you say mandates are not politically viable then you are saying we cannot reform health care and we will do nothing to lower costs or create universal coverage, because only mandates can create those great goods.


by 07rescue on Thu Jun 12, 2008 at 06:05:12 AM EST
[ Parent ]

Re: Did the Clinton Campaign Kill Mandates? (none / 0)

I agree that mandates is a bad idea.  I think that single payer is the right idea, but it will be very hard to get it thru congress.  Obama's plan is not perrrfect, but if he gets it thru congress it will be the next best thing.


by Spanky on Wed Jun 11, 2008 at 04:09:16 PM EST

Sweet. More Hillary Hate. (none / 0)

You've won my vote!


by aggieric on Wed Jun 11, 2008 at 10:33:17 PM EST


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