It figures that one of the few times I can't watch the Democratic presidential debate live, Hillary Clinton and Barack Obama would spend the first sixteen minutes talking about their competing visions for universal health care. But judging from the transcript and clips on CNN, it doesn't look like the discussion covered much new territory. Clinton argued why a individual mandate is important, Obama argued why it wasn't, and so on.
As most of you know, I think Clinton is absolutely right on the merits of the argument. (See here and here.) And I was pleased to see her use the Social Security analogy, which is not just politically effective but also accurate. Still, I want to defend Obama and his campaign on one key point.
From the get-go, Obama and his advisers have felt they were the original victims of unfair advertising in this argument. In their telling, it was Clinton (and, to an extent, John Edwards) who kept harping on the mandate issue, suggesting Obama's plan would leave out 15 million people. And putting aside the dispute over whether that the 15 million argument is substantively correct, Obama and his advisers felt the attacks made a second, darker implication: that Obama's failure to include a mandate meant that he simply didn't believe in universal health care.
Obama himself alluded to this tonight: “I have endured over the course of this campaign repeatedly negative mailing from Senator Clinton in Iowa, in Nevada and other places suggesting that I want to leave 15 million people out.” (Emphasis mine.)
With that quote, Obama was presumably talking about mailers like this one (via abcnews.com) that went out in Wisconsin. That mailer featured photos of seven people with the headline, "Barack Obama, Which of These People Don't Deserve Health Care?." On the next page, it says, "Barack Obama's Health Care Plan Leaves 15 Million Americans Without Coverage. Will It Be You?"
I
don't think the mailer is wrong substantively. If 15 million people
end up without health insurance, then one in seven people won't have
it. It's also possible that without a mandate, the reforms may not
work as planned – in which case a lot of people really wouldn't be
able to get health insurance, even if they wanted to do so. (For
example, if insurers feel they have to protect against adverse
selection – that is, healthy people gaming the system – they'll
keep their rates higher. Those rates might be high enough so that
some people really couldn't afford coverage.)
On the other hand, I can see how Obama or somebody working for him might think the mailer does paint Obama as an opponent of universal health care in principle – which, very clearly, he is not. You can argue that his plan wouldn't be as effective as Clinton's. You could also argue that universal health care hasn't been as central to his campaign as it has to Clinton's, raising questions of just how hard he would push for it if he became president. But you can't honestly suggest that Obama wants people to be uninsured.
Obama, after all, devoted considerable energy in the Illinois state legislature to expanding government health insurance programs and putting the state on a path to achieving universal coverage for its own residents. As a presidential candidate, he has put forward a plan that, whatever its flaws, would still expand coverage quite significantly – at no small cost in resources. And he has certainly embraced the principle of universal coverage at every possible turn.
In the grand scheme of things, this doesn't justify the mailers his campaign have put out – which are not only more misleading but also damaging to the cause of universal coverage itself. But at least I can understand why they might have felt such tactics were necessary. And, in a perverse sort of way, there's something comforting about the fact that Obama can play hardball when he needs to do so.
Which leads me to my final thought on this: I agree with my friend Jacob Hacker that the mandate debate has begun to crowd out other, equally important issues in the health care reform debate. If next week's contests in Ohio and Texas effectively end the Democratic nomination fight, as seems increasingly likely, then the real debate will change into a much broader -- and more important -- issue: Whether or not universal health care is a good idea in principle. Obama thinks it is. John McCain thinks it isn't.
Whatever the flaws in Obama's plan, I look forward to him making that case.
--Jonathan Cohn