The story focuses on the ongoing meetings of health care lobbyists that Senator Ted Kennedy began convening last year. Calling themselves the "workhorse group," they represent everybody from labor unions and doctors to large employers and insurers. And they're starting to reach consensus on at least one key point: They think health care reform should include a requirement that every American obtain insurance.
Aficianados of the health care debate--and if you're reading this blog, chances are good that means you--will recognize this as a call for an "individual mandate." And its logic is straightforward.
Many people underestimate their risk of illness and injury, then end up destitute when they can't pay their medical bills; without a mandate, they won't get insurance even if it's made available to them at reasonable rates. What's more, if government prohibits insurers from excluding people with pre-existing conditions--a step that's essential to making insurance available to all--people could then game the system by waiting to buy insurance until after they became sick. This could cause actuarial disarray and unravel the insurance market. Requiring everybody to get insurance more or less solves this problem.
Still, not everybody likes the idea of individual mandates. Legally requiring people to buy insurance (or imposing some sort of financial penalty for those who don't) touches libertarian sensitivities on both right and left. Many worry government would end up forcing people to buy coverage they can't really afford.
Among those who raised the latter objection was none other than President Obama--who, during the presidential nominating campaign, famously clashed with then-rival Hillary Clinton over this very issue. And he caught a lot of grief for that (in these cyber-pages, among other places). But Obama and his aides have also suggested his opposition to a mandate wasn't ironclad. Under the right conditions--with, say, a firm guarantee that good insurance would be available at reasonable prices--Obama might go along.
Of course, some people have speculated that Obama's opposition to mandates was a bit more clever--or, depending on your perspective, devious. In this telling, Obama understood that a mandate was essential to universal coverage. But he also knew it was politically unpopular. So he decided to oppose the idea, knowing that the Workhorse Group and other industry representatives would insist upon it--thereby forcing him to "compromise" and accept an individual mandate that he had known, all along, was necessary.
I'm not sure Obama and his advisers were thinking that far ahead in early 2007, when they decided on their health care proposal and ditched the mandate idea. But it's certainly possible to imagine the deal-making playing out in a way that enacts a mandate but spares Obama political fallout from it. At least in terms of policy outcomes, that wouldn't be such a terrible thing.