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President Obama's biggest concession to Democratic congressional leaders going into this process was allowing an individual mandate for health insurance to be included in the bill. During the primary campaign, he staked out a position in opposition to individual mandates, warning that it would force Americans to buy insurance that we may not succeed in making affordable.

Given where we are right now, his warning seems quite prescient. At a time when health care is hanging in the balance and many Progressive Democrats are caught between a rock and hard place in deciding what our leaders should now do with this bill, there are two things that are pretty clear:

  1. Letting healthcare reform collapse is not an option.  That would pretty much make legislating for the next year impossible and quite possibly hand the keys to congress to the Republicans.
  1. Creating an individual mandate without ensuring that healthcare is affordable is a potential disaster of even greater proportions, both in terms of its negative effect on society and in terms of the political cost it could reap on those who vote for it.

But many of us also know that there are some elements of the healthcare reform proposal such as those barring insurance companies from denying care for preexisting conditions or barring rescissionthat quite simply are absolutely necessary.  Killing the bill and letting more people die because their insurance wouldn't cover them just isn't an option.

So I propose we push for the one thing that will allow all of these considerations to be met, if not optimal: Congress should pass a more limited bill that drops the individual mandate.  At this point, it's pretty clear that we are not going to get any kind of public option past the Senate. And barring that, the consequences of doing nothing are just as bad as the consequences of doing something that hurts more than it helps.

I don't really think we have any other solid course of action, unless the political considerations revolving around healthcare change drastically in the next month.

Originally posted to BryanBarash on Tue Dec 15, 2009 at 02:32 PM PST.

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Comment Preferences

  •  Tip Jar (6+ / 0-)

    Bryan Barash is a political operative from New York specializing in new media technologies.

    by BryanBarash on Tue Dec 15, 2009 at 02:32:47 PM PST

  •  Yes. The debate about the mandate was very (6+ / 0-)

    open and the President was right. If we were debating his initial health plan...the one he proposed in 2007, it would be sailing through right now because it was more tightly focused on promoting competition rather than achieving universality by mandate.

    •  I'm not sure the public option would've passed (2+ / 0-)
      Recommended by:
      Fabienne, Terrified Liberal

      But I think we need to remember just how important the core of the bill is. We should increase subsidies for the poor and regulate the insurance industries worst practices.  We can always build on what we start here.

      We'll be coming from a much stronger position in five years if we pass a bill now that works versus passing nothing now and not getting another shot for at least a decade.

      Bryan Barash is a political operative from New York specializing in new media technologies.

      by BryanBarash on Tue Dec 15, 2009 at 02:43:22 PM PST

      [ Parent ]

      •  But it doesn't work. (2+ / 0-)
        Recommended by:
        Lovo, laker

        You need to read the Senate bill. The regulations you speak of are weak, and filled with loopholes. Furthermore, there is a Republican idea in there about buying insurance across state lines that will lead to junk health insurance.

        This is an awful bill, mainly because of the mandate. Strip the mandate, and its just green eyeshade stuff.

  •  Kos agrees with you (2+ / 0-)
    Recommended by:
    mahakali overdrive, BryanBarash

    Strip out the mandate, and the rest of the bill is palatable. It's not reform, but it's progress in the right direction.

    And I agree that in the current bill, the mandate is horrible.

    It doesn't do much to move us towards universal coverage, though.

    "The smartest man in the room is not always right." -Richard Holbrooke

    by Demi Moaned on Tue Dec 15, 2009 at 02:42:57 PM PST

  •  Well Look At That! (3+ / 0-)
    Recommended by:
    Fabienne, Blogvirgin, ItsSimpleSimon

    why don't people say this more often when they bring up mandates?

    Why don't more people say let's go with Obama's original proposal and get rid of mandates?

  •  The insurance companies won't buy ... (0+ / 0-)

    elements of the healthcare reform proposal such as those barring insurance companies from denying care for preexisting conditions or barring rescission

    without the mandate. And with some reason, because otherwise the incentive is for individuals to not get insurance until they get sick, which skews the risk pool.

    "The smartest man in the room is not always right." -Richard Holbrooke

    by Demi Moaned on Tue Dec 15, 2009 at 02:49:36 PM PST

    •  But isn't there the possibility that once (0+ / 0-)

      everyone has health insurance, everyone will have something for which to be treated, since it is in the interests of the medical profession, a for-profit industry, to treat as many people as possible in as expensive a manner as possible?  I don't like insurance companies, but they are not the only thing that is wrong with our healthcare system.  True healing should be as benign as possible and geared toward the individual.  When was the last time our healthcare system embodied that?

      •  You raise some big questions ... (1+ / 0-)
        Recommended by:
        ItsSimpleSimon

        that I don't particularly want to get into here, but I very much agree with you when you write:

        I don't like insurance companies, but they are not the only thing that is wrong with our healthcare system.

        There's nothing in any of the proposals being floated (much less the bill under discussion) that does anything to address the rapidly rising cost of healthcare (as opposed to insurance). There are too many incentives in our current system to promote unnecessary (or marginal-value) treatment.

        "The smartest man in the room is not always right." -Richard Holbrooke

        by Demi Moaned on Tue Dec 15, 2009 at 03:05:32 PM PST

        [ Parent ]

        •  Health promotion should definitely be a bigger.. (0+ / 0-)

          concern than it currently is. I think it's fairly obvious that we need a major investment in public health.  We need to create policies that encourage and reward people for staying in shape, eating right, etc.

          It also wouldn't hurt to have a larger portion of our r&d done with government funding, such that it didn't require a massive payback when breakthroughs occur.

          Bryan Barash is a political operative from New York specializing in new media technologies.

          by BryanBarash on Tue Dec 15, 2009 at 03:08:43 PM PST

          [ Parent ]

  •  The Problem Is (1+ / 0-)
    Recommended by:
    gramofsam1

    ...the only reason the insurance companies didn't balk at the preexisting conditions / rescission clauses was that the mandates made them affordable.

    You disagree with his conclusion that Obama is a boot licker...give examples where this can be shown to be false. -- Dumbest Poster in dKos History

    by TooFolkGR on Tue Dec 15, 2009 at 02:57:18 PM PST

    •  Unfortunately, the mandate does not make the (0+ / 0-)

      insurance companies palatable.  Nor does the rest of the bill.

      I'd rather have a bottle in front of me than a frontal lobotomy.

      by beemerr90s on Tue Dec 15, 2009 at 03:10:07 PM PST

      [ Parent ]

      •  Well If Our Government Believes That (0+ / 0-)

        Here's hoping they pass something ELSE in the next couple days.

        Because what nobody is here saying (what nobody COULD say) is that more people WOULD have access to health improving and potentially life saving health care even under this bill.  Nobody has even touched actual access of care, because to do so would be to admit, "This bill is going to save lives and I don't care."

        So if killing this bill is the most important thing we can do, the people killing it had better get there alternative passed in pretty short order, using whatever mojo they chose not to use the first time around.

        After this round of HCR reform work dies, the blood changes hands.

        You disagree with his conclusion that Obama is a boot licker...give examples where this can be shown to be false. -- Dumbest Poster in dKos History

        by TooFolkGR on Tue Dec 15, 2009 at 03:13:48 PM PST

        [ Parent ]

        •  I sure hope they can do something. (0+ / 0-)

          But I wouldn't bet on it.

          I'd rather have a bottle in front of me than a frontal lobotomy.

          by beemerr90s on Tue Dec 15, 2009 at 03:20:07 PM PST

          [ Parent ]

          •  If You Really Believe That Then What's (0+ / 0-)

            the solution?  Do you actually think mandates that would at least get some people help are worse than the status quo?

            You disagree with his conclusion that Obama is a boot licker...give examples where this can be shown to be false. -- Dumbest Poster in dKos History

            by TooFolkGR on Tue Dec 15, 2009 at 03:22:03 PM PST

            [ Parent ]

            •  The same mandates that help some people (0+ / 0-)

              force others that don't find it's a good deal into a system they don't want, and isn't good for them.  Yes, I think it very likely that it could be worse than the status quo.

              I have insurance now that I would like to drop, and I might just do so.  I have little confidence that they will be there for me if I end up with a serious need for them.  And as far as I can tell, that's the only reason to have them, because they cost me a lot more than they ever cover.  I'd like to be able to walk away from a bad deal, rather than have an insurance company be able to turn me in to the criminal system because I won't pay them.

              I'd rather have a bottle in front of me than a frontal lobotomy.

              by beemerr90s on Tue Dec 15, 2009 at 03:32:40 PM PST

              [ Parent ]

  •  Killing the mandate IS killing the bill.....nt (1+ / 0-)
    Recommended by:
    catchaz
    •  That's Ludicrous . . . (0+ / 0-)

      . . . Killing the public option was supposed to kill the bill.  I think its a fair swap.  No public option, no mandate.

      You want a mandate, you have to accept a public option.  

      It is political suicide to pass a bill with both a mandate and no public option.

      If you don't stop lying about me, I'm going to have to start telling the truth about you. Barack Obama

      by dbratl on Thu Dec 17, 2009 at 07:26:45 AM PST

      [ Parent ]

  •  prove it's not a giveaway - kill the mandate (0+ / 0-)

    then we'll see if the bill does any real good or is just a giveaway to insurance interests.

    secession = treason. Haters are Traitors!

    by catchaz on Tue Dec 15, 2009 at 03:41:44 PM PST

  •  I'm with you (0+ / 0-)

    mandates have always been a deal killer.

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