November 27, 2007
Edwards and the Man Date
As Jon Cohn rightly points out, John Edwards probably has the best of the Man Date positions, favoring a (slightly vague) version of automatic enrollment: Every time you come into contact with the medical system, you'll be signed up for a plan. "Basically," Edwards says, "every time [people] come into contact with either the healthcare system or the government, whether it's payment of taxes, school, going to the library, whatever it is they will be signed up."
I'm a bit curious as to how that'll work -- how does it interact with the subsidies? What happens if someone just says no? How do you force them into the billing process? Is the public plan the default? -- but as a basic approach, it's probably quite achievable, and is good way to basically erase the uninsured population. To think of it in a sightly clearer way, his individual mandate works a bit more like a government mandate -- the onus is less on the individual to seek coverage, and more on the government to present them with it. Assuming the policy works, the individual mandate would really only exist in odd cases when individuals simply refused to accept insurance -- in which case, it would be like if they declined to pay their taxes. Beyond that, it would largely be the government sending you a form that either enrolls you in insurance, or records your preexisting enrollment.
So, as it stands now, Edwards has the best, and most defined, mandate plan. Hillary is second. And Obama, for all his talk, simply doesn't have one. Some say, "well, these mandate plans don't actually establish universality. I know this guy Bob, right, and Bob lives in Montana, and he's got, like, sixty fucking guns, big guns, and also a butterfly knife, and he hates the government, and won't sign up!" Maybe so. But these plans actually strive towards universality and construct mechanisms which could plausibly achieve something very, very close. That Obama's doesn't is a real failing, both on the policy merits and on the politics. If he thought man dates were too unpopular, or too ineffective, he should've been bolder in response, not more timid. That's not what his campaign was sold as.
"That Obama's doesn't is a real failing, both on the policy merits and on the politics. If he thought man dates were too unpopular, or too ineffective, he should've been bolder in response, not more timid. That's not what his campaign was sold as."
Don't you believe in hope?
The problem with the Obama campaign is not one of timidity, it's one of priorities. Universal healthcare just isn't a priority for them.
Posted by: Petey | Nov 27, 2007 12:36:36 PM
It's the closest any of the major candidates get to Atrios' "Just sign people up!" position.
Posted by: Nicholas Beaudrot | Nov 27, 2007 12:40:11 PM
That said, I really, really, really don't want to get the IRS into the business of figuring out who does and doesn't have health care. But I think there are ways to make this "just sign people up!" position work. It's clearly the best of the bunch if you believe in the need for a Man Date. But it's not going to be super simple.
Posted by: Nicholas Beaudrot | Nov 27, 2007 12:45:33 PM
If you had an actual "Just sign people up!" position (which this isn't), then you could stop using the politically tone-deaf "mandate" language (as well as produce something more resembling what most people think of when they hear "universal coverage").
Posted by: KCinDC | Nov 27, 2007 12:54:56 PM
Edwards is going to require everyone to sign up. This will be enormously popular. At $500/month/family member, everyone will be able to afford it easily, and no one will try to evade it. (OR maybe it will be 3% of income + $400 a month/family member, if we keep MediCare; that will make it much more affordable.)
Posted by: SamChevre | Nov 27, 2007 1:04:11 PM
"If you had an actual "Just sign people up!" position (which this isn't)"
You can certainly say "which this isn't", but then you'd be prevaricating.
Posted by: Petey | Nov 27, 2007 1:05:17 PM
as well as produce something more resembling what most people think of when they hear "universal coverage"
KC: Did I miss the part where you explained how Edwards's proposal isn't what "most people" (by which I imagine you mean you) would consider universal coverage?
Posted by: Herschel | Nov 27, 2007 1:11:01 PM
"KC: Did I miss the part where you explained how Edwards's proposal isn't what "most people" (by which I imagine you mean you) would consider universal coverage?"
No. You missed the part where he decided that prevarication was the best way to support his candidate.
Posted by: Petey | Nov 27, 2007 1:12:10 PM
Correct me if I am wrong, Liberals are going to simplify our healthcare system and save billions in administrative cost by turning every public agency into an enrollment center for national healthcare? Brilliant, I can’t foresee any problem asking people to complete enrollment forms with their personal health information and giving it to the clerk at the DMV. I can’t wait to see this unified national database that contains every citizens’ enrollment information accessible by every agency in every town large and small. Isn’t the IRS system 45 years old and been in some stage of upgrade for half that.
So my 3-4 hour wait at the DMV will now be extended even further so people can enroll in insurance, can’t wait for my plates to renew now.
I have seem countless claims that Liberal’s plan’s will reduce administrative cost, doctor’s can barely bill correctly for work they perform now your asking them to enroll people?
Let me point out another little reality for all you, in Insurance they have a general rule that for security you don’t let the same person that pays claims enter eligibility. From experience they found people where to tempted to enter fake people, pay a claim for them, then have the check sent to their sister. You’re going to ask the doctor who is providing the treatment to also enter the person’s eligibility? LOL if you only knew how foolish you sound. The day this passes we will also solve our homeless and unemployment problem; unscrupulous providers will be running enrollment/treatment mills bilking taxpayers for billions within 6 months. Medicaid had problems like this decades ago, nothing like learning from our past. Private plans have problems like this even today, we helped bust one in CA where a doctor was recruiting patients from employers with good insurance and billing for surgeries he never did. They cut the patient in for a portion and made a killing till they got greedy.
15% of people refuse to pay their taxes, why would you expect a higher rate to not refuse your mandated insurance/tax? Aren’t we at 15% uninsured now?
I wish I had more time to make Swiss cheese of this but work calls. Funny but the problem de jour is a large union client where the members want to take their Health & Welfare contributions as wages instead of enrolling in the Health Plan. We tried to be more flexible about it but all the young healthy workers where dropping out. If they did get sick they would come on at open enrollment, the plan was getting killed both ways. As this blog as frequently expressed such trivial realities don’t matter if you got good policy. Policy and liberal intent trumps reality every day!
Posted by: Nate O | Nov 27, 2007 1:33:36 PM
How come I can spot your posts after the first few words?
Posted by: A Canadian Reader | Nov 27, 2007 2:01:56 PM
I think that Clinton and Edwards ought to be ashamed of themselves for being so in bed with the insurance industry that they are willing to make criminals of the uninsured in order to prevent the adoption of the superior single payer model.
So if Obama's plan doesn't have mandates, its superior.
Posted by: Dilan Esper | Nov 27, 2007 2:13:58 PM
There are so many problems with these plans that you might as well wait.
Posted by: Floccina | Nov 27, 2007 2:16:38 PM
I am so glad that we have someone truly grounded in reality to let shine some truth on this situation. Sounds a bit like the guy works in private insurance doesn't it.
I think it does shine some light on what surely will be some good Republican talking points.
First of all Democrats will save billions of dollars by preventing cherry picking, implementing electronic health records and encouraging preventative and coordinated disease management. And for those who want it, but cutting out private insurers as the middle men and getting cheaper and more efficient care if they so choose.
Edwards' plan calls for making signing up easier by offering the requisite forms at all government agencies. This kind of thing is already done with Medicaid, and certain other benefits, and it hasn't required any increase in manpower nor has it in reality caused the agencies to be any more or less efficient. I think the majority of those signing up will not require this service because they'll want to sign up on their own and there will probably be some kind of public information initiative similar to but hopefully more efficient then what happened with Part D.
Why would you need a databsae for eveyone in the U.S. when only 15% of the population at any given time is uninsured? Those who lose coverage when they lose their job would simply have their forms included in the information required to get unemployment benefits.
Also, you go forget that most of the insurance options are private and thus there will be an advertising push by the inusrance companies to enroll most of the uninsured.
Now a public awareness campaign coupled with a private insurance push will probably enroll 60 to 70% at least of the insured who are themselves only 15% of the population. This gives you 5% of the population, tops who are still uninsured. At the very least this cuts the uninsurance rate by two thirds.
Now, fraud is a definite possibility, but no more for a new insurance plan then for current private and public insurance. By itself that's a pretty dumb reason not to have universal coverage. 5% of new recipients or new providers getting over on the system is not a good reason to prevent 95% of everyone else from getting coverage, especially when those not currently recieving coverage will cost us in the end.
Laslty, doesn't you last speil kind of prove the point as it relates to mandates and their need?
Posted by: j | Nov 27, 2007 2:19:25 PM
Oooo.. The DMW comparison! How quaint!
Posted by: Tyro | Nov 27, 2007 2:25:25 PM
I know this guy Bob, right, and Bob lives in Montana, and he's got, like, sixty fucking guns, big guns, and also a butterfly knife, and he hates the government, and won't sign up!
You! Bob! Out of the gene pool! No health care for you!
Posted by: gonzone | Nov 27, 2007 2:27:22 PM
Here are some Atrios quotes about "Just sign people up!" I know I'm just a prevaricating Edwards hater (apparently Petey has a better insight into my view of the guy than I do), but do they really sound like the Edwards plan to any of you?
I really don't understand the thinking behind the various health plans that are floating around now. You tell people they have to have coverage. If they don't you punish them. If you're poor you can jump through hoops to prove you're poor and the gov't will subsidize you.
All this stuff just provides an extra layer of complexity and bureaucracy. Even if you aren't cutting private insurers out of the game, there's a way to go from A to B in a straight line. Just sign everyone up for a goddamn health plan - or let them choose from a menu - and pay for it out of taxes. Poor people will pay less because, you know, they pay less in taxes. Rich people will pay more. Same result, it just cuts out all the dancing on the way there.
You could just sign everyone up and pay for it out of taxes one way or another. I'm flexible about how exactly it's implemented after that, but the biggest absurdity in all of these plans it that you have to add additional complexity to the tax code, and a ridiculous additional layer of adminstration/bureaucracy. If you want everyone to sign up, don't "mandate" that they "buy in" to the program. Just, you know, sign them up and take it from their paycheck. If they don't have a paycheck, they're still signed up.
You shouldn't have to make people, for yet another additional program, have to jump through hoops to prove that they're poor enough to be eligible for a subsidy, or to fill out yet another set of forms to get yet another refundable tax credit.
Even recognizing the political realities of the situation, it seems that the way to sign everyone up is to... sign everyone up. Instead of having "mandates" requiring that people sign up to some plan, just sign them up. Instead of mandating that they pay their premiums every month, just pay for it out of general tax revenues (adding a new payroll tax or raising top marginal rates or whatever to do so).
Even if insurance companies are in still in the mix I see no reason for people to have to proactively sign up for some plan they may or may not be able to afford.
But It's Still Ass Backwards
The whole personal mandate idea doesn't make any sense. Just sign everyone up.
I recognize that what Atrios is talking about is politically difficult to implement, but that doesn't mean I have to pretend that Edwards is talking about the same thing. And I'm not necessarily convinced that "The government will force you to buy insurance, even if you think you can't afford it, and punish you if you don't" is an easier political sell than "We're going to raise taxes to pay for health care for everyone."
Edwards' plan as it stands will almost certainly cover more people than Obama's (though we still don't have any real explanation of how the automatic enrollment works), but I don't believe that any of these plans is complete or will be implemented in its current form, so I'm not that worried about the differences between them.
Posted by: KCinDC | Nov 27, 2007 3:16:29 PM
KC, I'm not saying it's the same thing ... it's just much closer than the Clinton proposal, which, as far as I can tell, would be more or less the Massachusetts proposal.
Posted by: Nicholas Beaudrot | Nov 27, 2007 3:18:42 PM
Sorry, Nicholas, I was replying to Petey (and a little to Herschel), not you.
Posted by: KCinDC | Nov 27, 2007 3:25:33 PM
I live near Dallas, Ezra.
Posted by: bob mcmanus | Nov 27, 2007 3:27:32 PM
And I'm not necessarily convinced that "The government will force you to buy insurance, even if you think you can't afford it, and punish you if you don't" is an easier political sell than "We're going to raise taxes to pay for health care for everyone."
KC: The reason an individual mandate is an easier political sell is that the "raising taxes to pay for everyone" approach involved a lot more than just raising taxes. It also involves dismantling or eviscerating a healthcare delivery system, that, as much as we liberals might wish otherwise, remains popular with millions of Americans. It also involves legislating out of existence an $800 billion industry.
If it were only a matter of raising taxes, those of us who want radical reform would be off to the races. Unfortunately, it's not just a question of revenue.
Mandating individual coverage, on the other hand, leaves in place health insurance arrangements for those who are content with the status quo, and, initially at least, only targets a distinct minority of the population: the 15% or so of the population that lacks coverage. I believe such an approach is by far the most feasible path to quickly reaching universal access to healthcare. There is, after all, a "fairness" argument to be made: young, healthy, uninsured people get treated under the status quo if they fall seriously ill or are injured, but they're free-riding the system by not participating. We've already seen that it's possible for such an approach to garner enough votes to get enacted at the state level. AFAIK there's almost no evidence that a more radical approach would work.
Posted by: Jasper | Nov 27, 2007 3:42:33 PM
Petey was more fun before he started going on Man Dates with John Edwards.
Posted by: Sam L. | Nov 27, 2007 3:56:57 PM
"though we still don't have any real explanation of how the automatic enrollment works"
If you have any dealings with the government or the healthcare system, you'll be signed up.
Is this really so complicated to understand?
If you live like like the unabomber in the Montana wilderness, you can likely avoid being signed up. Otherwise, you can't. In other words, coverage will be 99.9%, not 100%.
Posted by: Petey | Nov 27, 2007 4:11:02 PM
"the library"?? The local library? Every time? Has Edwards started drinking?
Posted by: ostap | Nov 27, 2007 4:12:18 PM
"Petey was more fun before he started going on Man Dates with John Edwards."
Well, then, you're not going to be particularly fond of the entire Democratic Party starting in about two months.
Posted by: Petey | Nov 27, 2007 4:13:49 PM
Petey, how exactly does signing up at the library happen, what insurance do you get signed up for, and how do you end up being forced to pay for it?
Posted by: KCinDC | Nov 27, 2007 4:15:00 PM
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