Healthcare Mandate Blogging

I’m in total agreement with Kevin Drum’s criticisms of John Edwards’ now-more-detailed individual mandate plan. And I should say that I don’t think this is a problem with Edwards as such. Other advocates of an individual mandate have mostly evaded the flaws of Edwards’ plan by just avoiding discussion of how this is supposed to work in practice. I think that in a whole variety of ways, it’s just a fundamentally flawed approach. See Matt Stoller for more on this.

The best alternative would, of course, be a proper system in which we achieve universality by having the government either sign everyone up for a health care plan (universal!) or else sign up everyone for a health care plan who doesn’t have one. Unfortunately, of course, the only person in the race with a plan like that is Dennis Kucinich. And if people tell me something like that is politically infeasible in the short run, I’m happy to believe them.

Where my thinking departs from the current Democratic consensus is that I don’t think it follows from the desirability of a universal system and the impracticality of doing it right in the short run, that we ought to therefore put an absolute priority on creating something — anything — that counts as universal no matter how flawed the design. To me, the incrementalism-in-a-good-way aspect of both the Edwards and Clinton plans is the introduction of strong public sector competition with crappy, crappy private health insurance. Over the long run, I think that gets us where we want to be. The mandate itself is neither here nor there. But if the candidates insist on universality-by-mandate as the core principle, then there’s a real risk of the best aspects of these bills getting gutted by congress leaving only a shell of individual mandates and subsidies to insurance firms.