Progressives who have turned against the individual mandate in health care reform may want to highlight their one-time ally in that fight: President Barack Obama. Throughout the 2008 primary campaign, the mandate was one of the bigger debates between Obama and Hillary Clinton. Obama won the election but Clinton arguably won that debate, since the President took up the mandate in his health care plan. But he was pretty adamant about why he didn’t think a mandate was useful in the past. Perhaps the best distillation of that comes in this interview to CNN from Febuary 2008:
OBAMA: Let’s break down what she really means by a mandate. What’s meant by a mandate is that the government is forcing people to buy health insurance and so she’s suggesting a parent is not going to buy health insurance for themselves if they can afford it. Now, my belief is that most parents will choose to get health care for themselves and we make it affordable.
Here’s the concern. If you haven’t made it affordable, how are you going to enforce a mandate. I mean, if a mandate was the solution, we can try that to solve homelessness by mandating everybody to buy a house. The reason they don’t buy a house is they don’t have the money. And so, our focus has been on reducing costs, making it available. I am confident if people have a chance to buy high-quality health care that is affordable, they will do so. That’s what our plan does and nobody disputes that.
The problem that people resisting the mandate seem to be having is that the health care offered through the Senate bill is not completely affordable, particularly to those in the middle class, and more important, it’s not of high quality. As Ian Welsh notes today, the Senate bill does not have annual caps for insurance companies and has on the aggregate a 70% actuarial value, and even lower for certain key groups. Welsh notes, “100 billion in subsidies doesn’t mean squat if they come tied to an expense people can’t afford, making them buy insurance which is not particularly useful.”
The individual mandate makes sense if it locks in health care coverage that is actually worthwhile. There are compelling arguments that the coverage that can be offered in this bill does not meet that test. This is a policy dispute, and those who prefer passing the bill want to marginalize it by demonizing it as purely emotionally based and childish. But it’s not. People who have done serious work looking at the bill don’t think that it mandates quality health coverage, and if that’s the case, they think forcing people to buy it is misguided.
And they have support from then-candidate Barack Obama. If you follow his logic – that if people have a chance to buy high-quality health care that is affordable, they will do so – then it holds that if people see the coverage as neither high-quality or affordable, they wouldn’t buy it. But under his plan, they are being forced to do it.




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Great points David. No mandates…or KILL THE BILL !
Man, if I didn’t already have enough reason to despise Andrea Mitchell, she led off her show today on MSNBC saying that Howard Dean’s call for killing the Senate HCR bill is simply a matter of personal pique for being fired as head of the DNC AND because he wasn’t chosen to head HHS AND that he sees a political opening for himself by representing the DFHs. Never mentioning that he was still backing the bill until Emperor Joe shat all over the medicare expansion provision Sunday morning.
With Chris Cilizza nodding sagely and agreeing, and Charlie Cook looking a bit uncomfortable but not disputing their characterizations. What a collection of tools.
Score! Now get this clip on TV!
I’m opposed to mandates, and opposed to this bill period. HOWEVER…this false analogy with housing has got to go. It’s nonsense. Because the point of the health care mandate is that it is supposed to be the “compensation” to the insurance companies for the fact that they are required to accept every applicant without preconditions. There is no comparable situation in the housing market, so the analogy totally fails.
Having said that, a single-payer system in which health care is not a “for profit” item is the ONLY solution that makes sense, and, might I add, that includes not just doctors and hospitals but the drug companies as well. In other words, socialism.
This is a great start of a campaign to drag the President out into the street and make him defend his candidacy.
Somebody please ask ‘Scotty’ Gibbs about this in tomorrow’s briefing.
Way to go, David.
Kill The Bill Baby Kill The Bill!@!
The mandate is unconscionable without a strong government plan as an option. The way this thing is set up now, it’s no better than slavery. Take out the mandate, and I don’t care how awful the bill is, because I can take it or leave it.
This absolutely must be changed. The mandate is absurd, obscene, and un-American.
Yikes! The “s” word. /s
As Wendell Potter pointed out on KO last night… this bill will force millions more Americans to go bankrupt… there are mandates now and they will still go bankrupt (as Marcy elegantly pointed out yesterday as well).
Individual mandates also make sense if there is a single pool. Then it becomes, er, insurance–risk pooling.
As I typed in the prior thread, O’s definition of what is affordbable is quite a bit different from the definition of those who will have to pay for it.
Yes, but in actuality as Howard Dean pointed out this morning on MoJoe… people with pre-existing illnesses will be accepted, but you have to pay much higher premiums… which will not be affordable for many people.
So the widely spouted meme of ‘no more pre-existing illnesses’ in support of mandates is not true.
Getting sick isn’t a risk, it’s a certainty. Insurance model breaks on that issue.
Duplicitous change of policy for political expediency is not the kind of change I voted for.
Fixed it for ya.
And, of course, so many of those people with pre existing conditions will not have the means to pay for obscenely expensive junk insurance.
Obama should take his own advice and dump the mandate, I say.
This Bill is nothing less than Legislative Extortion on the behalf of the Insurance Companies who wrote and manipulated it..!
We need Emancipation from bondage to these corrupt Insurance Companies an Emancipation Proclamation from these Insurance Overlords..!
Dr. Dean is an Emancipator so is Bernie Sanders of course, Obama quite the opposite…!
i can no longer look at the silverFORKED tongue dandy
wow. thanks David! now off to play mailbox baseball with a few of my pragmatist friends, c’mere bitch! :D
feel sorry for the poor fugly,as her upteenth cosmetic surgery let her brains leak from the nose job…..g
Two points. The final bill is going to get passed through reconciliation, and we don’t have the slightest idea what it is going to look like (only what it will leave out). Second, if the ‘pay more, get less’ mandate gets through, the shit storm that it produces will force the Critters either to junk the whole programme, put in real regulatory teeth on a private system like in Switzerland, or go public.
The other thing this debate is doing is stripping the mask off of who actually runs this country, and as for decades. I’m with Norske on this one.
oh and by the way….great catch
That’s the way it looks in Junior High, and that’s where the Villagers live.
It’s hard to imagine how Democrats could have come up with a worse bill. Truly amazing.
Obama is on the record as wanting single payer and no mandates and yet he refused to fight for those things or even for halfway decent alternatives.
In my book, that’s a lousy President.
I’m looking into this. It’s not quite as bad as Dr. Dean describes.
and an absolutely fabulous companion piece on how they do it by thererisnospoon over at Big Orange, can not recommend it enough
Mandates are a necessary tool to create a pool of insureds large enough to spread risk, meaning spreading the cost of providing health care for the aged and aging, the chronically sick, the unlucky, the stupid and those maimed by poor health care itself.
The trick, which this Senate bill fails to perform entirely, is what is being mandated. The Senate’s mandate simply pushes most people into the welcoming and soon-to-be-more profitable health insurers. The bill doesn’t reform their practices, rein in their most egregious excesses, or provide credible oversight with the money and political will to back up its observations of negligent or intentionally harmful conduct.
A credible mandate would give the people it coerces – via the power of government – choices, all of which would yield reasonably access to health care. This bill simply obliges most people to pay money to insursters, with health care about as iffy a result as it is now. That’s why this bill’s mandate is deeply flawed. The price Obama wants us to pay is for him to give the insurance companies virtually everything they ask for.
Krugman is right that we have a dilemma. If we accept this bill, then immediately turn round and start round two of reform, why should we expect a different outcome. Why would Holy Joe vote differently if he’s just been re-elected for doing what he does? The dilemma, though, isn’t avoided for those, like me, who say kill this bill and start over. It runs smack into the same Kneepads Lieberman and the same, “I’ll give you whatever you want, nice Mr. Insurester,” Barack Obama.
What’s different for me is that accepting this bill gives insuresters a major victory, a bird in the maw or paw, as it were. Real reform would have to start not where we are today, but in the deeper hole this bill digs for Main Street Americans. And it gives the insuresters more money and a stronger hand to prevent that reform ever taking place. Killing this bill means they failed sufficiently to game the system. They have to start over, too.
Krugman is right, though, in that inertia heavily favors the insuresters. The present system is nearly as unaffordable as this bill’s under-regulated subsidies that it shovels toward the insuresters. So if we advocate killing this bill, it means voting for even greater efforts in the New Year. That’s 2010, the year of mid-term elections. They don’t often favor the party in power.
We can expect this ConservaDem White House to be as shrill as they claim Dr. Dean is, as it comes out into the open and opposes real reform, but claims it’s trying to implement it. Rahm and Obama will pull out the stops to stop it in Congress. That will either be a gift to ConservaDem and GOP representatives at the polls, or give voters for once a real choice between those doing the corporations’ business and those doing theirs. Either way, their opponents will make sure that DFH’s will take it on the chin. So gear up, pups, whatever ticket you buy, it’s gonna be a long, bumpy ride.
Wait till Bill Nelson is through with the bill.
Aha, looks like the President pulled a Lieberman. Or is it that Lieberman pulled a Obama? I cannot keep things straight anyways. BTW, who would have thought that Clinton was the only one speaking the truth on the campaign trail. Not me for sure.
earlofhuntingdon, i must disagree. mandate financing is not credible because it requires people to pay for insurance (or prove they can’t) before being covered for healthcare. it is, at heart, a neoliberal policy based on a false notion of choices and insurance market competition. a progressive policy is one where universal healthcare is financed via some form of taxes – not a policy that requires the sick and poor to either pay a monthly fee or figure out how to fill out the paperwork required in order to get the healthcare they need.
Jon Walker has a fresh cross-post available: “This is Nothing Like The Netherlands; That Is Why Individual Mandate Is Unacceptable”
I think this result on health care is all about Obama seeking to be above the fray on everything.
He absolutely refuses to get dirty on ANY issue. He asks other people to do his fighting. Always. During the campaign, it was all about us. That was his way of saying that he can’t be BOTHERED to take a principled stand. He’s a follower at heart.
This is not as confusing as it seems! The only question candidate Obama had was “How are you going to enforce that?” And they’ve got that covered now. Welcome from the Anteroom of Hell to HELL.
Who is this 40-something percent of people polled who still say YES they approve of Obama’s job performance? You know 2-thirds of the ones saying NO are just the teabaggers. Where are the progressives in vast numbers? These dim-bulbed holdouts are the people whom the bastards bet everything on, and they never, ever lose their bet.
“They” have it fixed now so you can’t refer to Nazi Germany or you’ll sound like a teabagger “making use of hyperbole.” I’ma do it anyway. The number of “Good Germans” in America has dropped to below 50% now. I guess that’s SOME kind of progress, though not nearly enough. The bastards are still winning their bet. Democratic spokesmen all say they are GOING to pass “health care,” they are on the verge of passing this bill and GOING TO do it, which means the dirty freedom-stripping worst bill of all time is as good as done. Guess who gets to be responsible for the nightmare that immediately ensues? Every “Democrat” in the country. You, me, all of us did this to the country, we’ll get blamed while Obama’s approval continues to hover between 49% and 55%.
Even Olbermann spoke of “a primary challenge” to Obama as if it’s some sort of HYPERBOLE that couldn’t really happen unless things get a thousand times worse if Obama doesn’t watch out.
If we don’t manage a primary challenge to Obama, the only way to get rid of Obama will be to vote republican. It wouldn’t make any difference anyway, so I will do it.
Yes, this needs to be on TV and I’m going to start working on that. Let’s just say I am very very close with the Vice President of The History Channel and I am encouraging her to get one of their technical whiz’s to help me put together the above clip with a contrasting soundbite documenting his 180…and maybe as the kicker at the end, Bush’s line where he bungled “Fool me once, shame on….what I’m saying is you can’t get fooled again.”
David, have you found the first part of Obama’s quote on video anywhere?
Some Josh sarcasm tto brighten the day.
Our drone-terror President Obama seems to be as corporatist as he can be in domestic policies. He bullied thirty Senate Democrats to vote against the Dorgan Amendment to allow drug importation from countries such as Canada, which would have been a great money-saver for Americans. We currently are paying the highest prices in the world for prescription drugs, thanks to Bush, the Republicans, Obama and the New Republicans (“Democrats”) support for Big Pharma (the major drug manufacturing corporations).
comment out. git out. OK!
A mandate would be moot under a plan where all have equal access to health care, by right.
last night, a front pager over at Big Orange pointed out that so many of the self styled pragmatists in this fight were for the Iraq War
I would suspect that killing the mandate might persuade one or two fence-sitters to support the bill.
Also if a deal could be worked out with Dorgan about rural reimbursement, taking Medicaid to 150% to save $100 Billion over those folks being on subsidy might help get them onboard too.
You can say “must,” but what if it isn’t taken out? They don’t HAVE to do anything. They will do what they want as they did in the previous 8 years. What have we been able to do to stop ANYTHING evil they do? Are we a country whose CIA used to do mind control experiments on conscripted soldiers during an illegal undeclared war? Doesn’t everyone pretty much know it happened? Don’t Americans still run around crying “Best country on earth!” while labeling other regimes as forming “axises of evilness”?
So what if they don’t take the mandate out?
BTW: they aren’t taking it out.
second that!
We’ll have to disagree, in that mandates exist in Europe and work well, whether it’s a government run system financed through taxes (the UK) or a public-private partnership involving insurance companies (France, The Netherlands). That’s because of what the public gets in exchange, which is a lot more than here.
What’s different here is the level of corporate control over this legislative process and that those corporations have succeeded over the last hundred years, especially the last fifty, in literally demonizing government when it works for the people as much as it does for them. Europeans are agog that we are laboring through – and failing – at what they succeeded in doing sixty years ago. It’s one more signal that the pole around which they will build their future has shifting, to themselves and the East.
i guess since the iraq war turned out so well, maybe we should listen to them this time? /s
if you think “working” is a matter of market choice and not one of regulation, then we most definitely do disagree.
Kill It !!
We don’t want this for sure
Mandates and no public option ,geez I coulda swore I heard Obama say these were a necessary part of reform.
Where are ya now Mr Prez ?
But I don’t think killing the bill would be inertia. “They” would call it that, the MSM and the treasonous corporatist monsters in the congress, but what it would be is a joyful, massive stompass of these boogers, a crazy wild VICTORY for Americans, at this point.
Equating (not you, them) refusal to lie down and welcome this bone-crusher of a false reform bill with “stopping reform” is ridiculous, but they’re getting away with it.
“They” have half or more of all Democrats supporting this thing just because to not support it means “the teabaggers win.” Unbelievable. Pure reverse-Bushies, one and all, who would support anything for such a reason.
Didn’t watch or listen to video. I’ve heard it all many times, don’t need to hear it any more. I’m to the point I can’t stand the sight of his goddamn lying face or the sounbd of his goddamn lying voice.
OBAMA: Let’s break down what I really mean by anything I say regarding health care in America: $$$$$$$$$$$
INSURANCE INDUSTRY: Let’s break down what I really mean by anything I say regarding health care in America: $$$$$$$$$$$
LIEBERMAN: Let’s break down what I really mean by anything I say regarding health care in America: $$$$$$$$$$
WALL STREET: Let’s break down what I really mean by anything I say regarding health care in America: $$$$$$$$$$$$
REPUBLICANS: Let’s break down what I really mean by anything I say regarding health care in America: $$$$$$$$$$$$
SENATE DEMOCRATIC LEADERSHIP: Let’s break down what I really mean by anything I say regarding health care in America: $$$$$$$$$$$$$$
If his lips are moving he’s lying and spinning.
The European health care systems that rely on insurance for their payment mechanism work well because of extensive, well-managed regulations, not despite them. That regulation does what is burn-at-the-stake heretical to Villagers. It drives out profits as the driving force behind the business or medical payments management. It’s what we need, because we can’t afford to obtain health care and keep Aetna and Well-Point and Blue Cross CEO’s in Rolls Royces. So I don’t think we really disagree.
Next step, equally abhorrent to Villagers, is reforming medical practices to incentivize outcomes rather than payment for services, a mentality that arose, in part, owing to the excesses of the American health insurance model.
I think this is unfortunately very true. I think Obama fell in love with being loved, which is something no politician can ever do who hopes to be a leader. For all his faults, George Bush just really never gave a crap what people thought about him, which is why he was able to push his agenda so thoroughly. Guess it’s too much to ask to have that same resolve from this administration. They are too worried about looking and acting cool.
Sigh…
Congrats DDay.
KO led with this tape tonight.
Obama is such a lying whore. Send this clip to Lanny Davis.