This is exactly what I was worried would happen with health care reform

19 Aug 2009 11:36 pm
Posted by: Donna

Hasn’t happened yet but I’ve got a bad feeling it will. Marc Ambinder’s report today is not alleviating my worry:

The president continues to operate under the belief that liberals will warm to the bill when presented with a goodybag that includes includes an individual mandate, community rating, guaranteed issue, and a minimum required package. There’s no chance, really, that a bill WON’T feature these reforms. Quietly, to secure and keep Democrats on board, the White House is going to bargain, providing inducements, like more money for favored projects, etc., in order to secure individual votes.

Great. I was assured that I need not worry about mandates because there would be a public option that would be affordable and no one would be forced to pay blood money to the insurance cartel. I reminded mandate proponents that what emerged from the sausage-making in Congress might end up looking more like insurance lobbyist’s wet dream than progressive “universal coverage”. A mandate with no public option was what I feared, and I fear I was right. Ambinder is getting this from an “unnamed source” and I hope it’s bunk because this would be quite a reversal from the Obama of the primaries, who shrewdly opposed mandates on adults. It was shrewd of him because his voter base skewed young and minority, both demographics less likely to be insured. Clinton’s base was older and more likely to be insured, hence more inclined to favor mandates.

Certainly there is some basis for the notion that mandates are a ‘goody’ for liberals. I’ve come to the conclusion that mandates are to Democrats what tort reform is to Republicans. Conservatives believe that malpractice suits drive up the cost of health insurance while many liberals blame uninsured people*. The truth is that lawsuits add maybe 1 – 2% to the average premium according to most estimates. The most generous estimate of the added cost of the uninsured is about 8%. 8% is not insignificant but it belies the notion that forcing everyone to buy insurance will make it dirt cheap. It’s also no justification for some of the harsh memes that have been pushed about the uninsured. When you want to force something on a particular group of people, it’s useful to paint them in an unsympathetic light and this is what happened to young and healthy uninsured people. They were turned into Welfare Queens. The perception of them as freeloaders, selfishly and wantonly withholding their considerable disposable income from the insurance system and sticking responsible citizens with the bill for their ski accidents and coke binges gained traction. They could easily afford insurance but choose instead to spend their money on cell phones and flat screens. Oh yeah, I hear that one quite often. I make it a point to inform people who subscribe to this attitude that a) most uninsured young people are uninsured because they are in crappy low paying jobs with no benefits and don’t qualify for state aid and b) the type of “catastrophic” policies currently available to them on the market are a joke. If you are 25 and in good health and your job doesn’t provide insurance, it’s a perfectly rational decision to go without it. You’re going to be several thousand dollars out of pocket before the coverage kicks in, and the insurance company has many ingenious methods to deny you coverage after you meet your deductible. Catastrophic insurance is notorious for that. Shoot, at least you’ll get some enjoyment out of the plasma TV.

That said, the other inducements in the “goody bag” may mitigate the situation for the uninsured. Regulations on insurance companies may mean that the coverage they are offered is legitimate, not bogus. It won’t, however, put extra money in their pockets to pay mandatory monthly premiums to private insurance companies. “But Donna, there will be subsidies!” Right, and that means that the 25 year old waiting tables or working retail who can barely afford toilet paper and gas will be presented with a new monthly bill of some unspecified amount, with subsidies that will ostensibly make it “affordable” but won’t cover the whole cost. Am I alone in seeing a problem with this? People 30 and under vote overwhelmingly for Democrats. Why are Democrats going out of their way to alienate them? Single payer is the best plan for the uninsured but a public option would at least soften the blow of a mandate. The Obama administration is missing the point when they dismiss objections to the way they accommodate Republicans and corporate lobbyists as noise from the “left of the left”. They were never his base. The post-Baby Boom generations, who have never trusted their elders to provide for their security, are his base.

* Conservatives love to blame health insurance costs on a subset of the uninsured, illegal immigrants, but are loathe to attribute costs to the uninsured as a whole. That would mean they had to admit that a large number of Americans are uninsured, which would require them to admit that the glorious free market isn’t working as it should.


  1. Comment by Katie on August 20, 2009 9:47 am

    This is my new mantra re: healthcare reform.

    The Republicans have made it clear that they do not intend to support any kind of reform bill, no matter how much it is watered down. So, we need to stop with the watering down (I mean, compromising) and produce a plan that gives liberals everything we want. If we’re going to do this, we need to do it right, not try to give the Republicans what we think they might want, when they aren’t going to vote for it anyway.

    I guess that’s a little long for a mantra.

  2. Comment by Eli_Blake on August 20, 2009 8:04 pm

    Mandates without a public option. Sounds like Mittcare, which is proving a dreadful failure in Massachusetts.

    And Katie, you are right.

    Remember on the stimulus the President even went to capitol hill to negotiate with the Republicans and they got him to cut out over 20% of the bill, including all construction for schools, and end up with a bill that was 43% tax cuts, and he STILL only got a total of three GOP votes between both chambers.

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