I know that they say we have a very short attention span here in America, but I don't. Although I favored Barack Obama as my candidate for the Democratic nomination for a number of reasons and dedicated considerable amounts of time and money in the effort, one of the only policy issues that he really distinguished himself from Hillary Clinton and John Edwards was the question of the individual health insurance mandate, i.e. requiring everyone to purchase health care insurance if they weren't already otherwise covered.
Although in the big scheme of things, it's a somewhat minor issue, for me it was a signal that he was a candidate who had an independent, progressive, politically-savvy, people-centered approach to policy-making, as opposed to a candidate like Clinton who seemed unable to "see the forest through the trees". The individual mandate to me is dumb policy because the "opt-out" optioon is for me another basic way to ensure affordability, and it's dumb politics because it's going to be seen by many as a giant new tax, unprecedented in its nature in that it's in the form of a health insurance "premium" to be paid not to the government, for the most part, but to private corporations (depending on the strength of the public option).
In any event, here are the relevant quotes:
Now, even if we provide these affordable options, there may be those - particularly the young and healthy - who still want to take the risk and go without coverage. There may still be companies that refuse to do right by their workers. The problem is, such irresponsible behavior costs all the rest of us money. If there are affordable options and people still don't sign up for health insurance, it means we pay for those people's expensive emergency room visits. If some businesses don't provide workers health care, it forces the rest of us to pick up the tab when their workers get sick, and gives those businesses an unfair advantage over their competitors. And unless everybody does their part, many of the insurance reforms we seek - especially requiring insurance companies to cover pre-existing conditions - just can't be achieved.
That's why under my plan, individuals will be required to carry basic health insurance - just as most states require you to carry auto insurance.
-- Barack Obama, September 9, 2009
Less than two years ago, however, Obama said this:
Their essential argument is the only way to get everybody covered is if the government forces you to buy health insurance. If you don’t buy it, then you’ll be penalized in some way. What I have said repeatedly is that the reason people don’t have health insurance isn’t because they don’t want it, it’s because they can’t afford it."
-- Barack Obama, Nov. 24, 2007
Now, believe me, I do understand the policy arguments here. Healthy people will game the system and only sign up once they hit the emergency room. You need a bigger risk pool to offset the additional costs of the new requirements on insurance companies. All great arguments. But if that's all true, then what about illegal immigrants? From what I understand, they will not be subject to the individual mandate. But they will still be treated at the emergency room. So, all of the arguments about emergency room costs of the uninsured and risk pools are compelling enough to make Obama go back on his campaign positions when it comes to citizens and legal residents, but with respect to 12 million illegal immigrants, not so much?
Again, I think Obama's basic point during the primary is the right one: if health care is affordable, people will sign up for it. Making it affordable is the key thing, not making people sign up for it. To the extent that you want to argue that making it affordable is dependent on otherwise healthy people paying into it, I would say that is the extent to which you are in fact taxing those people instead of selling them an insurance policy. I'm not opposed to a tax, but if there is to be one, make it a regular tax, make it progressive, and make it payable only to the government, not private corporations.
I do acknowledge that a strong public option changes this logic somewhat. If the public option is good and affordable and available immediately to everyone, then it is more similar to Medicare, which is a tax and an insurance program at the same time, and I would be more willing to support it. But a Medicare-like public option hasn't really been on the table so far, so that seems to be a moot point.
But outside of all that, I'm just curious as to how it is that everybody seems so willing to give Obama a pass on his change of heart relative to the private option. It's not as though it wasn't talked about extensively during the primaries. He made television ads and sent mailers specifically criticizing Hillary's position on this. Paul Krugman wrote numerous pieces about in the New York Times. At the time, many said that Obama was in fact risking health care reform itself, because they correctly predicted that he'd have to reverse himself at a later point in time.
Maybe I'm wrong, but the gravity of his change of heart also seems to be underestimated. It's not a big issue in Washington for the obvious reason that the industry lobbyists have given enough money to both sides that nobody, Democrat or Republican, is going to raise a stink about it. But it very well could become a major issue upon the implementation of it, depending again on the existence or not of the public option, as well as how "affordable" the required plans actually are.
I guess it all remains to be seen, but I would think a bit more focus on this issue is warranted. Thoughts?