Robert Reich, former U.S. Secretary of Labor, and now at UC-Berkeley, makes a lot of sense: The individual mandate is the wrong thing to focus on in health reform. Those who are spending lots of time on this particular component, either promoting mandates or opposing mandates, are missing the main debate.
Read the whole article. He first makes clear: the three Democratic presidential candidates have very similar, comprehensive plans:
Mandates are a sideshow, and fighting over them risks turning away voters from the main event. In almost every important respect, all major Democratic plans are the same.
They require employers to “play or pay” — either provide coverage to their employees or contribute to the cost of coverage. They create purchasing pools that will offer insurance to anyone who doesn’t get it from an employer. They offer a public heath-insurance option. The plans preserve freedom of choice of doctors. They aim to save money through more preventive care, better management of chronic disease, and standardized information technology. All of them subsidize lower-income families. Despite some skirmishing over whose subsidies are most generous, the subsidies are about the same.
This description of the Democratic presidential candidates also mirror the pending California health reform, AB x1 1.
Reich effectively demolishes the notion that there’s a major difference between Obama on one hand, and Clinton and Edwards on the other, with regard to the individual mandate:
Take a closer look and even the candidates’ positions on mandates aren’t all that different. John Edwards has proposed to automatically enroll people in health insurance on their tax returns, but has said this mandate won’t apply until premiums are affordable. Hillary Clinton says she favors mandates, but isn’t sure there should be a penalty for noncompliance. Barack Obama favors an immediate mandate for children, but doesn’t include one for adults. He says he’s willing to revisit the issue after making health insurance more affordable and enrollment easier, and is also considering an automatic enrollment with an opt-out for those who don’t want to be included.
As a practical matter, the difference between Sen. Clinton’s and Sen. Obama’s approaches come down to timing and sequencing. Mrs. Clinton wants a mandate first, believing that enrolling the younger and healthier will help reduce costs for everyone else. Mr. Obama thinks forcing people to buy health insurance before it’s affordable isn’t realistic. He wants to lower health costs first, and is willing to consider a mandate only if necessary.
This fight is little more than a distraction, given that a mandate would matter only to a tiny portion of Americans. All major Democratic candidates and virtually all experts agree that the combination of purchasing pools, subsidies, easy enrollment and mandatory coverage of children will cover a large majority of those who currently lack insurance — even without a mandate that adults purchase it.
Those who oppose the individual mandate and embrace Obama on that issue neglect that fact that Obama has not opposed the individual mandate; he merely wants to focus on affordability first. That’s similar with the California proposal, which conditions the individual mandate on affordability, and provides for exemption if there isn’t affordability.
As I have blogged before, the real issue is not the mandate–the vast majority of people want coverage–but what the proposal does to help people to get and afford the coverage in the first place.
In conclusion, Reich make the important point about the individual manaate.: “It’s the least important aspect of what they’re offering.” The much more important issues are the expansions of public programs, the increased bargaining power of purchasing pools, the “guaranteed issue” regulation of insurers–those are the big deal. Those are the main issue, deserving of the marquee.