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The Definitive Case For The Obama Plan, Sort Of

I'm sympathetic to the Jonathan Cohn critique of Obama's health care plan (i.e., that it would leave millions of people uninsured). But, over at Slate, Tim Noah makes a pretty strong case for Obama's plan on political grounds--about the strongest case I think you can make for it:

Enrolling people in a private health care plan isn't the hard part; forcing people to pay for a private health care plan is the hard part. Yes, the government has procedures to collect student loans and unpaid taxes, but it's understood that such payments are obligations. There's little disagreement that if you take out a loan, you're obliged to repay it, and only slightly more disagreement (mostly among crackpots) that as a citizen you are obliged to share in the cost of government. I believe there would be a lot of disagreement about whether the government could compel you to buy a private health insurance policy.

If you want to drive a car, it's accepted that you have to buy private auto insurance. But that's conditional on enjoying the societal privilege of driving a car; you can avoid the requirement by choosing not to drive one. A mandate to buy private health insurance, however, would be conditional on … being alive. I can't think of another instance in which the government says outright, "You must buy this or that," independent of any special privilege or subsidy it may bestow on you. Even if such a requirement could pass muster in the courts—and I have my doubts—it seems to me that politically it would give the inevitable conservative opposition a nice fat target to rally around. Big Brother will steal your wages if you don't buy a health insurance policy! Harry and Louise had a lot less to work with.

Advocates of individual mandates are right to worry about nonparticipation. "As a practical matter, letting people opt out if they don't feel like buying insurance would make insurance substantially more expensive for everyone else," Krugman points out. But the most logical solution to this problem, as Krugman himself has written elsewhere, is to make health insurance a function of the government, as it is already for the poor and the elderly. People may object to the specter of "socialized medicine," but at least they grasp that there's nothing unusual about the government collecting insurance premiums in the form of taxes for Medicare and Medicaid.

It may be necessary to achieve the goal of expanding government-administered health insurance in stages. All the health care plans of the major Democratic candidates are premised on that assumption, whether they acknowledge it or not. The only Democratic candidate I'm aware of who dispenses with such gradualism is Dennis Kucinich, whose solution—"Medicare For All"—is the only one that will solve the health care mess in the long run. Clinton, Obama, and Edwards all have plans that would steadily enlarge the role of government health insurance. These are accommodations to political reality. I question the wisdom of including, within such an accommodation, a mandate that would render that accomodation unattractive to a large bloc of voters. If we're going to create a ruckus, better to do it in the service of a more comprehensive solution than either Clinton or Edwards has put forth. If we aren't, Obama's resistence to an individual mandate makes perfect sense.

As I say, this argument comes pretty close to convincing me that Obama has the right approach. On the other hand, it's Obama who tells us that if we want to win the next election, we can't be afraid of losing it. If you accept Cohn's claim that his plan leaves millions of people uninsured, and Noah's claim that it's nonetheless the more politically viable way to structure a non-single-payer plan, then this seems like precisely the kind of overly-cautious thinking Obama was warning us about.

--Noam Scheiber