About the Mandate

By John Ballard

"Universal" means what it says. We're all in this together.

...under my plan, individuals will be required to carry basic health insurance -- just as most states require you to carry auto insurance. (Applause.) Likewise -- likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still can't afford coverage, and 95 percent of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements. (Applause.) But we can't have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees. Improving our health care system only works if everybody does their part.

As far as I'm concerned businesses could have been exempt, but that idea is politically unrealistic. But clearly no plan which covers everyone will work if participation is optional... until needed. Otherwise it would be like the person who crashes into a tree then decides to get insurance hoping to cover the costs. Nope. "Gaming the system" won't be allowed. 

During the primary campaign I favored Hillary Clinton for a variety of reasons, including the one slight difference between her health care plan and that of Barack Obama. I really don't know the details, but I remember clearly that her plan called for universal mandates and his did not. This struck me as unrealistic on his part (which it was) but I also knew her position was politically less appealing. 

So did Paul Krugman. This is from December 2007.

Imagine this: It�s the summer of 2009, and President Barack Obama is about to unveil his plan for universal health care. But his health policy experts have done the math, and they�ve concluded that the plan really needs to include a requirement that everyone have health insurance � a so-called mandate.
Without a mandate, they find, the plan will fall far short of universal coverage. Worse yet, without a mandate health insurance will be much more expensive than it should be for those who do choose to buy it.

But Mr. Obama knows that if he tries to include a mandate in the plan, he�ll face a barrage of misleading attacks from conservatives who oppose universal health care in any form. And he�ll have trouble responding � because he made the very same misleading attacks on Hillary Clinton and John Edwards during the race for the Democratic nomination.

He then recalls how effectively Mr. Obama had argued against mandates earlier in the debates.

... Mr. Obama has been stressing his differences with his rivals by attacking their plans from the right � which means that he has been giving credence to false talking points that will be used against any Democratic health care plan a couple of years from now.

First is the claim that a mandate is unenforceable. Mr. Obama�s advisers have seized on the widely cited statistic that 15 percent of drivers are uninsured, even though insurance is legally required.

But this statistic is known to be seriously overstated � and some states have managed to get the number of uninsured drivers down to as little as 2 percent. Besides, while the enforcement of car insurance mandates isn�t perfect, it does greatly increase the number of insured drivers.

Et cetara...Krugman advances the argument that mandates are [obviously] essential but that is not the point of this post.  My point is simply the smoothness with which that little factotum got buried this far into the debate. That did not happen by accident. Nothing in Barack Obama's original broad outlines to Congress called for mandates, but that requirement magically bubbled up into every plan hatched by either house.

Now how did that happen? Could it be that the insurance industry had anything to do with it, since making participation optional would diminish the pool of new customers?

Surely not. But no matter. What interests me is how smoothly the political medicine has gone down. Panic-stricken screams from old people and teabaggers notwithstanding, most objections are not based on facts but fear. As the facts get plainer the fear diminishes rational people see that Medicare is as much a sacred cow as exists in America. That is one revenue stream that will never be messed with in any real way. 

Washington knows this. A few people may be squirming about the next election or two, but they all know deep down that all the fuss will be forgotten as the country turns it's attention to other matters and nobody comes to kill off the old people.

The population that might have real cause to yell and protest is that young, healthy, uninsured group who now choose to "go naked" as they say, taking their chances with health care in the same way that some cyclists hate the idea of being forced to wear helmets and pickup truck drivers here in Georgia still are not required by law to wear seat belts . 

At this late date there could be a few protests, but as they say, the avalanche has already begin; it's too late for pebbles to vote.  As I said earlier about human nature: this president gets it.