End fringe debate over mandates - Kuttner
Examining Clinton & Obama’s Stances on… Universal Healthcare…
Amy Goodman and Juan Gonzalez interview Robert Kuttner
Democracy Now!
February 8, 2008
Amy Goodman: Let’s talk about the healthcare plans of Hillary Clinton and Barack Obama.
Robert Kuttner: …Clinton has what’s known as a mandate. She requires people to get coverage. Obama doesn’t. Clinton and some liberal commentators, like Paul Krugman, have whacked Obama for not having a mandate. I think a mandate is a very bad idea. I think the difference between universal social insurance and a mandate is that universal social insurance, like Medicare, says that, as an American or a permanent resident of the country, you get health insurance, the same way you get Social Security. A mandate takes a social problem and makes it the individual’s problem. And in the Massachusetts version of this, on the website it says “new penalties for 2008.” You get penalized if you don’t buy health insurance, even if the health insurance that’s available is not high quality and is not affordable.
The other problem with this whole approach is that you don’t get the cost efficiencies that you get from universal health insurance, because you still have all this paperwork, you still have all the profit by private insurance companies, you still have doctors being given incentives to go for the reimbursable procedures. And as a result, the cost-containment pressures hit patients. They come in the form of less care, rather than in the form of less waste.
Juan Gonzalez: …both Krugman, in his various articles, and Clinton have claimed, on the one hand, that Obama does have mandates — he has mandates for coverage of all children — so that the mandates issue is not a principled issue, it’s a tactical issue as to what you think could be approved. Your sense of that?
Robert Kuttner: My point is that a mandate, in a situation where the whole system is sick, makes that sickness the problem of the individual. Instead of putting a gun to people’s heads, typically people who can’t afford good quality insurance, and saying to them, “You must, under penalty of law, or pay a tax or pay a fine, go out and find decent insurance,” it’s so much better policy to just have insurance for everybody. Then there’s no question of a mandate.
I think it’s a very bad position for progressives to back into, because it signals that government is being coercive, rather than government being helpful. Now, we can split hairs and argue whether Obama is being principled or tactical, but I think his discomfort with the idea of a mandate is something that I applaud. I wish that both he and Clinton had gone all the way and said, let’s just to do this right and have national health insurance. I think they could have used this as a teachable moment. They could have bought public opinion around. Medicare is phenomenally popular. Medicare is national health insurance for seniors. Let’s have national health insurance for everybody.
(Clip of Clinton/Obama debate)
Amy Goodman: It’s interesting to note something Hillary Clinton says in that clip. When she mentions a single-payer system, the audience applauds and cheers, even though it’s an option rarely seriously discussed by politicians or the corporate media. And Hillary Clinton acknowledges the applause by saying, “I know a lot of people favor [it], but for many reasons [it’s] difficult to achieve.” She doesn’t explain why she thinks it’s difficult to achieve. And polls repeatedly show a majority of Americans favor it. An A.P. poll in December found nearly two-thirds of voters want universal healthcare, in which everyone’s covered in a Medicare-type program, while more than half of voters explicitly said they support single payer. But it’s the insurance companies that are against it. Robert Kuttner, can you talk about that?
Robert Kuttner: Well, one of the reasons that it’s difficult to achieve is the lack of leadership on the part of leaders like Hillary Clinton and, for that matter, Barack Obama. I mean, if you had Hillary Clinton and Barack Obama say, “You know, this is an intramural debate that we should not be having, this debate about mandates; we should do this right: we should have national health insurance,” public opinion would turn around on a dime. And instead of it being this fringe idea, all of a sudden, just because the two of them had blessed it, it would become a mainstream idea, and we would be having a debate that we should have been having all along.
http://www.democracynow.org/2008/2/8/examining_clinton_obamas_stances_on_the
Comment:
By Don McCanne, MD
Talk about incompetent framing of the health care reform debate. Clinton and Obama are engaged in a cat fight over coercing the purchase of unaffordable and inadequate private plans, versus allowing individuals to go without coverage because it is unaffordable. Neither is acceptable.
Robert Kuttner is right. We need leadership on this issue. Affordable, comprehensive health care for everyone is fundamental to the Democratic position on reform, whereas this fundamental principle is nowhere to be found in the Republican proposals.
Either party could pull it together and support a universal, comprehensive national health program. For Democrats, it would require only minor policy adjustments and a revision of the framing. Republicans would have to build an entirely new policy infrastructure.
Barack Obama has said that, if starting anew, he would support a single payer system. Hillary Clinton understands that there is considerable public support for single payer and has said that she would sign a single payer bill if it came to her desk as president. So, how about showing a little leadership? Both of you.