Drop the Mandate?


Markos Moulitsas says it’s not so much the absence of a public option as the presence of an individual mandate that makes him dislike the senate health care legislation. I’m sympathetic to this insofar as I think the inclusion of an individual mandate illustrates the needlessly kludgy nature of this approach to reform. In my view, the best way to handle this would be to not only have a public “option” but to have people enrolled by default in a public insurance scheme, with some provision existing for people to opt-out and get a voucher to buy private health insurance. Something like how by default kids go to their local public school but can opt-out and go to a charter school instead.

But assuming you’re not going to have default enrollment, which has never been on the table throughout this process, you need an individual mandate to make the insurance function work. Ezra Klein lays this out in some detail. But the basic point is that if you want to force insurance companies to stop blocking people with pre-existing conditions from buying insurance, you need to guarantee that healthy people will be in the risk pool as well.

Personally, it’s always been my view that it would be smarter, politically speaking, to do what Barack Obama campaigned on and produce a plan that didn’t include an individual mandate. Then during the course of the legislative process, such a mandate could be put it as a concession to industry in exchange for something or other. In that sense, arguably everyone got the legislative tactics wrong months and months ago. On the other hand, Henry Waxman thought putting the mandate in from the get-go was the smart play and he knows a lot about legislating. But however you look at it, this is really a matter of tactical politics. As substantive policy you can’t make a national health insurance system work unless you don’t let people opt out of the system. And with or without a public option, the basic framework is sound.

Rather than trying to kill the bill, I think the following would be a better use of people’s energy—(a) work to ensure that as few public option opponents as possible are defeated in 2010, (b) work to ensure that some seats currently held by public option opponents are taken by public option supporters. Then see if that means the votes are there to add a public option in 2011. If not, then you need to do the same thing again in 2012.

Times like these are a good time for Max Weber’s “Politics as a Vocation”:

Politics is a strong and slow boring of hard boards. It takes both passion and perspective. Certainly all historical experience confirms the truth–that man would not have attained the possible unless time and again he had reached out for the impossible. But to do that a man must be a leader, and not only a leader but a hero as well, in a very sober sense of the word. And even those who are neither leaders nor heroes must arm themselves with that steadfastness of heart which can brave even the crumbling of all hopes. This is necessary right now, or else men will not be able to attain even that which is possible today. Only he has the calling for politics who is sure that he shall not crumble when the world from his point of view is too stupid or too base forwhat he wants to offer. Only he who in the face of all this can say ‘In spite of all!’ has the calling for politics.

And that’s how it is.