And it’s going to be set up much like the Massachusetts plan with mandates. The use of a mandate in health care is just the latest in a long line of reversals Obama has made from his campaign. It was the very concept of a mandate that was the main difference between Obama’s and Clinton’s plans. Nonetheless, Ezra Klein has confirmed with several administration officials that the use of an individual mandate is the direction Obama is going:
Here’s how it will work, according to the officials I’ve spoken to. The budget’s health care section is not a detailed plan. Rather, it offers financing — though not all — and principles meant to guide the plan that Congress will author. The details will be decided by Congress in consultation with the administration.
One of those details is “universal” health care coverage.
That word is important: The Obama campaign’s health care plan was not a universal health care plan. It was close to it. It subsidized coverage for millions of Americans and strengthened the employer-based system. The goal, as Obama described it, was to make coverage “affordable” and “available” to all Americans.
But it did not make coverage universal. Affordability can be achieved through subsidies. But without a mandate for individuals to purchase coverage or for the government to give it to them, there was no mechanism for universal coverage. It could get close, but estimates were that around 15 million Americans would remain uninsured. As Jon Cohn wrote at the time, “without a mandate, a substantial portion of Americans [will] remain uninsured.”
What Cohn really means is that without a mandate, the healthy will refuse to buy health insurance, and since it’s the premiums from those healthy Americans that will be needed to offset the costs of those who are unhealthy and who will cost more to treat, a mandate is necessary. We don’t yet know what the consequences of not buying insurance will be yet. It will come in the form of fines, but we don’t know how much.
The Cato Institute explained in a policy report in October 2007 that there are a number of problems with individual health insurance mandates. One big one is that mandates don’t result in 100% coverage. For example, as Cato notes, those states that mandate auto insurance still have a fairly significant amount of their population uncovered. In California, 25% of drivers still don’t auto insurance even though they are required to under law.
Another issue with the individual mandate that Cato discussed is the problem of defining minimum coverage. This is an easy issue with auto insurance, but it’s a very complicated one with health insurance when you’ve got lobbyists from the various health care service organizations all vying to have their services covered. The more that services covered, the higher the premiums. The higher the premiums, the more people will ignore the mandate.
Tom McGuire writes about Obama’s sudden interest in individual mandates after criticizing Hillary Clinton for promoting the same idea:
As a nostalgia piece here is a link to a lefty wondering why his party was so committed to forcing young, healthy members of the working class to subsidize the rest of us on health care; that seems like a good question but I am long resigned to not being smart enough to be a lefty.
And now it is on to mandates, which was always inevitable since lefties are never happier then when telling the rest of us what to do. As the great Warner Wolf might say, if you thought that during the campaign Obama was just tossing up a lot of happy horseshit about individual choice… YOU WIN!