Democratic Debate Reaction: Health Mandates Are a Bug, Not a Feature

November 16, 2007

Hillary Clinton and John Edwards may have attacked one another last night, but they’re in agreement about the health care mandate issue – and that’s unfortunate. Most Democratic health reform plans include mandated coverage, and that’s a mistake on both policy and political grounds (although the Edwards plan offsets that somewhat with some interesting use of public insurance).

The Las Vegas Democratic debate was long on play-acting, short on substance. Meaningful exchanges about policy were hard to come by, and only three come to mind: Clinton vs. Obama on Social Security, Clinton vs. Obama on health mandates, and Clinton vs. everybody on her Iran vote.

Re health mandates, Obama may well be on the right track. When Clinton boasts, as she did last night, that her plan provides universal healthcare, what she’s not saying is that it does that by punishing people who don’t pay usurious prices to private companies in order to obtain coverage. Obama had the right response, althouch he expressed it in a passionless and somewhat detached way.

The New York Times is correct when it says that “many experts agree that that without a mandate, some people would not get coverage.” In addition, a voluntary enrollment plan will suffer from “adverse selection”: The sick will be more likely to enroll than the healthy, which will make the plan financially unstable.

But I disagree with many of my fellow “health wonks” on mandates. I’ve said they’re the wrong solution. They address the “selection” problem, but only partially. Compliance will continue to be a problem under the “mandate” approach unless fairly Draconian enforcement rules are put in place. (That’s what Obama was alluding to with his “garnishing wages” comment, which many viewers may not have understood.)

Secondly, mandates could become a political disaster. They could turn a Democratic political positive – public frustration with healthcare – into a negative. It’s easy to picture the Republican candidate talking about “nanny state” rules that “invade your privacy and seize your wages.”

No health plan will succeed if it forces Americans to overpay for insurance, on the hope that selection issues and other initiatives bring prices down in the future. It makes more sense to provide every American with a basic government-funded health plan. From there, policy options might include trading plan credits for enrollment in a private plan, or the purchase of supplemental private insurance.

But mandating that Americans buy insurance from private companies is a political and policy mistake. It’s true that mandates are the conventional wisdom today – but then, so was the wisdom of Massachusetts’ mandate-driven health reform initiative. We disagreed then, and said that the “Massachusetts miracle” would have serious problems. It now appears that – sadly – we were right (see here and here and here).

It remains to be seen whether mandates are a “feature” or a “bug” in the Democratic platform.

Advertisements

12 Responses to “Democratic Debate Reaction: Health Mandates Are a Bug, Not a Feature”


  1. […] Democratic Debate Reaction: Health Mandates Are a Bug, Not a FeatureHillary Clinton and John Edwards may have attacked one another last night, but they re in agreement about the health care mandate issue – and that s unfortunate. Most Democratic health reform plans include mandated coverage, … […]


  2. […] says he challenges the conventional wisdom among his fellow “health wonks”: He says health mandates are “a bug, not a feature” at The Sentinel Effect. I’d have to say that most of us “health wonks” […]


  3. I sure wish the Democrats and Republicans would do something about the bird flu.
    The risk of new cases of the deadly H5N1 bird flu virus “remains high,” said Chief Veterinary Officer of the U.K., Fred Landeg. The virulent strain of influenza has killed more than 200 people worldwide since 2003 and millions of birds either have died from it or been killed to prevent its spread.
    http://care-mates.com/blog/?p=4


  4. […] can’t have been the only one beating the drum about mandates (although it felt like a lonely position at times). It was clear long ago that any […]


  5. […] can’t have been the only one beating the drum about mandates (although it felt like a lonely position at times). It was clear long ago that any […]


  6. […] can’t have been the only one beating the drum about mandates (although it felt like a lonely position at times). It was clear long ago that any […]


  7. […] individual-mandate proposals in the 2008 primaries.  (In 2007 we called them “a bug, not a feature,” in health reform.) We pointed out that Massachusetts residents who were personally affected […]


  8. […] individual-mandate proposals in the 2008 primaries.  (In 2007 we called them “a bug, not a feature,” in health reform.) We pointed out that Massachusetts residents who were personally affected […]


  9. […] individual-mandate proposals in the 2008 primaries.  (In 2007 we called them “a bug, not a feature,” in health reform.) We pointed out that Massachusetts residents who were personally affected […]


  10. […] individual-mandate proposals in the 2008 primaries.  (In 2007 we called them “a bug, not a feature,” in health reform.) We pointed out that Massachusetts residents who were personally affected […]


  11. […] individual-mandate proposals in the 2008 primaries.  (In 2007 we called them “a bug, not a feature,” in health reform.) We pointed out that Massachusetts residents who were personally affected […]


  12. […] individual-mandate proposals in the 2008 primaries.  (In 2007 we called them “a bug, not a feature,” in health reform.) We pointed out that Massachusetts residents who were personally affected […]


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: