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November 26, 2007

Obama's Excuse

I'm getting really tired of Obama's constant excuse that his health care plan isn't universal because "The reason Americans don't have health insurance isn't because they don't want it, it's because they can't afford it." The reason Americans don't all have flat screen televisions is because they can't afford those, too. But, normatively, we think everyone should have health care. So is Obama going to make health insurance free? A dollar? If not, then there will still be a class of folks for whom health insurance does not seem a good deal, and this class of folks will still need to be in the system, as they will still have accidents, and still contract catastrophic diseases. And, in a larger sense, it will still be true that our whole society should be covered, that we should embrace our capacity to come together and have the healthy aid the sick and the young aid the old and the rich aid the poor, all with the expectation that, one day when we are sick, or old, or poor, the luckier among us will help ease our burden. This is, I believe, absolutely core to progressivism.

And this was exactly the argument that, once upon a time, I thought Obama would be making. That we as a society needed to unify, come together, make temporary sacrifices to build a better world. When he said things like "We know that government can't solve all our problems - and we don't want it to. But we also know that there are some things we can't do on our own. We know that there are some things we do better together," I figured that this was the case for Obama: His remarkable eloquence rendered him uniquely able to articulate the larger progressive narrative, that our nation must move forward as "we," rather continuing on as a country of I's. That's what his appeal to unity meant -- not just that our politics would contain fewer dirty words, but that our polity would come together, because we, together, could create a better society than was possible on our own.

But he's sacrificing that appeal in this argument. His reply is exactly what Obama likes to swear he'd never utter: A hollow soundbite. Politics as usual. Indeed, it's worse -- it's a reply meant to keep other politicians from telling the truth. Clinton cannot come back and say, well, yes, there are many Americans who are too lazy to buy health insurance or too arrogant to assume they'll need it or too overworked to actually put aside time to purchase it. Yes, we need to do this as a people, and if that means setting down some rules, so be it. We are one nation, and we can make decisions as a society, for our society. We shouldn't pretend that there will be no dissent, or no problems, or that 300 million individuals will create the same world that our polity, united, can construct.

Obama's rejoinder sounds good, but it's bad politics for the Democrats. I understand that he needs to defend his plan, but he's making an argument that, I imagine, future Republicans will quote back at progressive reformers. To me, this is worse than the Social Security stuff. At least there, he's advocating a progressive policy, if buying into a Republican frame. Here, he's constructing a conservative frame to defend a bad policy, a policy I believe his campaign regards as a mistake. He talks a lot about honesty. He should be honest. The lack of a mandate was a mistake, born out of caution, and he should rectify it.

Hell, he's already said that, if he could go back to the country's beginning, he'd choose single-payer. So if he doesn't want to turn and mimic Clinton's position, and if he instead wants to say that having thought it through, the individual mandate is the wrong way to guarantee universality, and we should simply make insurance a right, guaranteed by the government because that's what sort of country we are, and he's sorry for letting consultants constrain him, that would be great. But to see Obama, day after day, argue against collective action and universality, is deeply disappointing, almost heartbreaking. He had the capacity to elevate those ideals, to do for them what Reagan did for individualism. He's letting that opportunity, that potential, slip away.

November 26, 2007 in Politics of Health Care | Permalink

Comments

The only changes I'd make to your argument here is to change the word "Clinton" to "Edwards" or at least "Edwards and Clinton" since Edwards's universal healthcare plan came out first and Clinton's is basically a mimic of that.

Otherwise, I think you've hit on a good point: Obama's plan is seriously flawed without the mandate, he knows it, and is trying to stick with the pig rather than make it into a silk purse.

Posted by: edgery | Nov 26, 2007 4:04:02 PM

You held out hope for him longer than I did, Ezra. Like you say, he really could have been the voice of our better, more generous instincts, for the notion that we are all in this together.

But even by late summer, the "where's the beef" question had gone unanswered for too long. I'm ready for a candidate who can bring us together, but he doesn't seem to be ready to bring us together around something particularly worthwhile.

Back in February and March, I was already favoring Edwards, but I was very open to being won over by Obama. That door closed awhile back.

If it comes down to Hillary and Obama, I'd prefer Hillary at this point, even though I know she's in bed with the corporate interests who will be glad of her help in co-opting the Democratic Party. At least with Hillary, I know what I'm getting, and I have confidence that she can both beat the GOP nominee, and handle the mechanics of governing.

Posted by: low-tech cyclist | Nov 26, 2007 4:11:48 PM

The only changes I'd make to your argument here is to change the word "Clinton" to "Edwards" or at least "Edwards and Clinton" since Edwards's universal healthcare plan came out first and Clinton's is basically a mimic of that.

Ezra is preparing himself for his inevitable Clinton endorsement. Most of left blogistan has been slowly trying to talk itself into thinking Clinton is an acceptable nominee over the past couple months; as long as Ezra pretends there are only two Democrats in the race, and focuses on one area (health care) where Clinton looks better on paper (except, of course, for all those millions of dollars coming from her buddies in the health care industry), he can coax himself into cheering on a Clinton campaign in the general. Until then, he can't afford to acknowledge that Edwards is out there - much less push back against Clinton at a time when she's polling worse than Obama in Iowa.

Posted by: Christmas | Nov 26, 2007 4:14:41 PM

If it comes down to Hillary and Obama, I'd prefer Hillary at this point, even though I know she's in bed with the corporate interests who will be glad of her help in co-opting the Democratic Party.

I'm curious. What is it, exactly, that you want out of your government, if you're content to have it run by a handful of corrupt corporate interests - the same corporate interests, in fact, that are running it right now? What, basically, do you expect to change once the corporate monkey is Clinton instead of Bush?

I have confidence that she can both beat the GOP nominee, and handle the mechanics of governing.

Wrong on both counts.

Posted by: Christmas | Nov 26, 2007 4:18:48 PM

How exactly does a mandate magically make a health care plan "universal?" If such a thing were true, I wouldn't need to carry uninsured motorist coverage.

Posted by: cms | Nov 26, 2007 4:23:36 PM

Ezra,

Interesting comment.

On this part we agree 100%:

But he's sacrificing that appeal in this argument. His reply is exactly what Obama likes to swear he'd never utter: A hollow soundbite. Politics as usual. Indeed, it's worse -- it's a reply meant to keep other politicians from telling the truth. Clinton cannot come back and say, well, yes, there are many Americans who are too lazy to buy health insurance or too arrogant to assume they'll need it or too overworked to actually put aside time to purchase it.

At the same time, though, you need to realize that the issue you are describing above is subtle, which is why a mandate is politically risky. Explaining this

then there will still be a class of folks for whom health insurance does not seem a good deal, and this class of folks will still need to be in the system, as they will still have accidents, and still contract catastrophic diseases,

which you do pretty well (I'd suggest the issue is broader than catastrophic care), is not an easy thing to do politically.

You've written several posts that you feel that HRC has demonstrated political astuteness in her health care proposal (e.g. the America's choices plan, etc.), that demonstrates she is better equipped politically to handle the job of President.

I'd argue that from a political perspective, Obama has actually one-upped her here. You can't ding him for "mandates" because he doesn't have them, but his plan ensures that everyone wants health care, can have health care.

In short-- universal access gives most what they're looking for, without the political baggage associated with universal mandated coverage. So he's giving the progressives 95% of what they want, without the real risk that "mandates" could damage the whole thing.

Finally:

But to see Obama, day after day, argue against collective action and universality, is deeply disappointing, almost heartbreaking.

This is where you are letting your wonkish biases get the better of you. He's offering a plan that promises affordable coverage to everyone. The purist in you sees an even better option which is universal coverage rather than just simply access. That's a lot different than saying he's arguing against collection action and universality. He's for universal access, just not universal coverage. Beyond the fact this is a difficult difference to highlight politically as I wrote above, from a pure health standpoint the difference only has incremental, minimal value anyways. IIRC he would still push for community rating with no pre-condition exclusions, so if a few individuals do get sick and need coverage, they'll still be able to seek it. This could of course lead to free-loading, which could become a problem if more and more people stop getting insurance until after they need it. At that point however, mandates will be more than politically acceptable, they'll be demanded. Which is exactly what Obama has said-- if his plan didn't lead to full coverage (we know it won't), then he'll close the loophole down the road. In the meantime however-- look what he's offered: a system where everyone has coverage who wants it, and for those who don't they still won't be left in the cold-- everyone gets health care.

So where's the heartbreak?

Posted by: wisewon | Nov 26, 2007 4:25:15 PM

So is Obama going to make health insurance free? A dollar? If not, then there will still be a class of folks for whom health insurance does not seem a good deal, and this class of folks will still need to be in the system, as they will still have accidents, and still contract catastrophic diseases. And, in a larger sense, it will still be true that our whole society should be covered, that we should embrace our capacity to come together and have the healthy aid the sick and the young aid the old and the rich aid the poor, all with the expectation that, one day when we are sick, or old, or poor, the luckier among us will help ease our burden.

Precisely so, Obama is making the case against any universal healthcare program or social insurance program for that matter.

Posted by: AJ | Nov 26, 2007 4:25:15 PM

Ezra,

Interesting comment.

On this part we agree 100%:

But he's sacrificing that appeal in this argument. His reply is exactly what Obama likes to swear he'd never utter: A hollow soundbite. Politics as usual. Indeed, it's worse -- it's a reply meant to keep other politicians from telling the truth. Clinton cannot come back and say, well, yes, there are many Americans who are too lazy to buy health insurance or too arrogant to assume they'll need it or too overworked to actually put aside time to purchase it.

At the same time, though, you need to realize that the issue you are describing above is subtle, which is why a mandate is politically risky. Explaining this

then there will still be a class of folks for whom health insurance does not seem a good deal, and this class of folks will still need to be in the system, as they will still have accidents, and still contract catastrophic diseases,

which you do pretty well (I'd suggest the issue is broader than catastrophic care), is not an easy thing to do politically.

You've written several posts that you feel that HRC has demonstrated political astuteness in her health care proposal (e.g. the America's choices plan, etc.), that demonstrates she is better equipped politically to handle the job of President.

I'd argue that from a political perspective, Obama has actually one-upped her here. You can't ding him for "mandates" because he doesn't have them, but his plan ensures that everyone wants health care, can have health care.

In short-- universal access gives most what they're looking for, without the political baggage associated with universal mandated coverage. So he's giving the progressives 95% of what they want, without the real risk that "mandates" could damage the whole thing.

Finally:

But to see Obama, day after day, argue against collective action and universality, is deeply disappointing, almost heartbreaking.

This is where you are letting your wonkish biases get the better of you. He's offering a plan that promises affordable coverage to everyone. The purist in you sees an even better option which is universal coverage rather than just simply access. That's a lot different than saying he's arguing against collection action and universality. He's for universal access, just not universal coverage. Beyond the fact this is a difficult difference to highlight politically as I wrote above, from a pure health standpoint the difference only has incremental, minimal value anyways. IIRC he would still push for community rating with no pre-condition exclusions, so if a few individuals do get sick and need coverage, they'll still be able to seek it. This could of course lead to free-loading, which could become a problem if more and more people stop getting insurance until after they need it. At that point however, mandates will be more than politically acceptable, they'll be demanded. Which is exactly what Obama has said-- if his plan didn't lead to full coverage (we know it won't), then he'll close the loophole down the road. In the meantime however-- look what he's offered: a system where everyone has coverage who wants it, and for those who don't they still won't be left in the cold-- everyone gets health care.

So where's the heartbreak?

Posted by: wisewon | Nov 26, 2007 4:26:12 PM

"The reason Americans don't have health insurance isn't because they don't want it, it's because they can't afford it."

If Mr. Obama would like me to sit down and explain to him how it is that I can't GET health insurance because I will USE it (pre-existing conditions), I'm sure I could spare him some time...

Posted by: tatere | Nov 26, 2007 4:26:48 PM

You make a good argument, though somewhat hyperbolic--"almost heartbreaking"? Not really. What I'm wondering is, if the individual mandate is such a big deal, why didn't Obama include it in his plan? Did the campaign think including the mandate would be politically risky? And, per what you saying, do they now think that they miscalculated, allowing Clinton to attack Obama from the left on health care? Of course they can't go back now, though I've heard Obama make comments to the effect that he has no problem doing a mandate a couple years down the road.

Anyways if you listen to Obama's stump speech, for example, it's still deeply progressive. So I don't consider his "constructing a conservative frame to defend a bad policy"--and I'll take your word for it that this is so--in this one instance to be a particularly big deal. No winner is ever that pure, ever. No doubt it's true that Obama is not really meeting the standards he's claimed to set for himself, but then no successful politician in the history of the world has never met them (it's somewhat encouraging in and of itself that Obama has even bothered to set standards for himself). In the broader context, in the larger scheme of things, Obama's political potential is based on a lot more than whether or not he has an individual mandate in his health care plan.

Posted by: Korha | Nov 26, 2007 4:27:27 PM

"If Mr. Obama would like me to sit down and explain to him how it is that I can't GET health insurance because I will USE it (pre-existing conditions), I'm sure I could spare him some time..."

Obama's plan of course addresses your issues. It would be pretty crappy otherwise.

http://www.barackobama.com/issues/healthcare/

Obama's plan is very similar to both Clinton's and Edwards', with the exception of the individual mandate. That's the issue at the heart of Ezra's post.

Posted by: Korha | Nov 26, 2007 4:30:44 PM

Korha, thanks for the review of my book--it was very thoughtful.


Good post, Ezra. I don't like Obama's conservativish demonization of mandates, which smells like the right-wing complaints about Big Brother. But Edwards and Clinton need to come up with a better name than mandates. Edwards, for one, has automatic enrollment--I believe Clinton does too-so in fact insurance wouldn't be mandatory, it'd be guaranteed.

Not for nothing does the Union Leader prefer Obama's plan:

"Of the leading Democratic candidates for President, only Sen. Barack Obama doesn't pretend that his health-care plan is a panacea. He resists the temptation to promise the impossible -- provide universal coverage and control costs -- and for that he should be commended."


Posted by: david mizner | Nov 26, 2007 4:37:30 PM

Atrios has been saying for months that the solution is 'send everyone a health insurance card' (and I think he means with no way to opt-out of the automatic opt-in).

We should just say it: health insurance payment coverage is a feature right of US citizens and legal immigrants. You may have to contribute a portion of the cost in premiums collected by the government, depending upon your income. You may choose your health providers freely.

Obama's attemtpt to tack in the wind of moderation will not get him the nomination. The wind either blows left or right and the prevailing direction is progressive on this issue: the polls are unambiguous on the unity of the Dems, Independents and many Republicans. People are ready for a major change.

Posted by: JimPortlandOR | Nov 26, 2007 4:53:00 PM

Ezra,

I'm gonna quote myself to make another point:

This is where you are letting your wonkish biases get the better of you. He's offering a plan that promises affordable coverage to everyone. The purist in you sees an even better option which is universal coverage rather than just simply access. That's a lot different than saying he's arguing against collection action and universality. He's for universal access, just not universal coverage. Beyond the fact this is a difficult difference to highlight politically as I wrote above, from a pure health standpoint the difference only has incremental, minimal value anyways. IIRC he would still push for community rating with no pre-condition exclusions, so if a few individuals do get sick and need coverage, they'll still be able to seek it. This could of course lead to free-loading, which could become a problem if more and more people stop getting insurance until after they need it. At that point however, mandates will be more than politically acceptable, they'll be demanded. Which is exactly what Obama has said-- if his plan didn't lead to full coverage (we know it won't), then he'll close the loophole down the road. In the meantime however-- look what he's offered: a system where everyone has coverage who wants it, and for those who don't they still won't be left in the cold-- everyone gets health care.

In other words-- or in your words-- Obama is taking a sequentialistapproach to mandates. He doesn't think they are politically feasible now, but as I just cited, its pretty clear that his current proposal would lead to them pretty soon thereafter. Right after HRC came out with her proposal, I questioned your approval of her plan, which leaves out so many needed elements of reform. You responded with this "sequentialist"/"political reality" argument, suggesting that HRC's plan is as good as could be given the circumstances. Obama has one difference, under the same guise of sequentialism. But you're going to ding him for this and not HRC for the complete lack of real reform in her plan?

Posted by: wisewon | Nov 26, 2007 5:09:29 PM

"Korha, thanks for the review of my book--it was very thoughtful."

You're welcome. It was a good book.

Posted by: Korha | Nov 26, 2007 5:26:41 PM

I'm curious. What is it, exactly, that you want out of your government, if you're content to have it run by a handful of corrupt corporate interests - the same corporate interests, in fact, that are running it right now? What, basically, do you expect to change once the corporate monkey is Clinton instead of Bush?

::sigh::

Whether or not you're a hardcore Naderite who's learned nothing from the past seven years, WTF, I'll at least give a few for-instances:

You may have noticed a few changes around here when the corporate monkey went from being Clinton to being Bush. Those changes should mostly reverse themselves, though I do expect this Clinton to (a) be more hawkish than the previous one, and (b) take advantage of some of Bush's power-grabs that the previous Clinton didn't have the opportunity to.

I expect she'll try to do the things she's said she'll try to do. She'll get us out of Iraq - but since she's never said by when, I don't expect her to be in any hurry about it. She'll do her best to pass the very good climate change legislation she's come up with, and ditto her health care plan.

She'll nominate SC Justices who will uphold Roe and be generally moderate, in the Ginsburg-Breyer mold. That isn't radical, but it's better than a bunch of Scalias and Alitos and Robertses.

Anything good that she hasn't come out in favor of already, I don't expect from her. But you won't get any of the above from Rudy or McCain or the Huckster or Mitt - just more war and more goodies for the rich.

Wrong on both counts.

Assertions without evidence or arguments to back them up are worthless.

Posted by: low-tech cyclist | Nov 26, 2007 5:31:40 PM

In the broader context, in the larger scheme of things, Obama's political potential is based on a lot more than whether or not he has an individual mandate in his health care plan.

Don't you mean, "whether or not his plan gets us to universal coverage?" Obama's doesn't, and, in the primary stage, that's a deal breaker for me.

A newly robust, expanded, better funded safety net is my biggest priority in 2008. It's not my only priority. But it is number one. It's too bad that Obama isn't as strong as he could be in this department, because his candidacy has a lot to offer the country. But I'm tired of mucking about: The tea leaves strongly favor a Democrat in 2008, and I want to make sure the Democrat taking the oath shares my priorities. If he's still viable when the Massachusetts primary comes around, I'll strongly consider John Edwards. But as of right now, I'm a Clinton supporter. Should Obama heed Ezra's advice and publicly resharpen some of his domestic policy plans (especially on healthcare), I may reconsider. Heaven forbid a politician change his mind about something he's plainly wrong about.

By the way, Hillary Clinton's plan, which, we all acknowledge, was basically right out of Edwards's playbook (with one or two improvements), was politically very astutely written and presented. My own take on the Hillarycare fiasco of 1993 is that its biggest flaw was that it didn't get the politics of healthcare right. So, her efforts this time around tell me that she has learned from her mistakes, and that having failed the first time around, Hillary Clinton is -- as she claims, and contrary to her critics -- more, not less, likely to succeed in giving every American meaningful healthcare coverage. We are correct in avoiding people who make the same mistake again and again. But people who learn from their mistakes are usually some of the most effective people around.

Posted by: Jasper | Nov 26, 2007 5:41:11 PM

Obama can wait. Eight years from now, with a little more experience in the Senate, he can make his run and win.

I had a host of freshman/sophomore college students traipsing though my rental apartment this weekend...not elite students, inner-city high achievers, mostly, both sexes and all races.

Obama is the overwhelming favorite among them, but the lone dissenter-leaning towards Hillary- is the only one registered and committed to vote???

She's African-American, and she and I had a little huddle about this question as we basted the turkey.

The only reason she is where she is, having grown up in the nineties as the child of an African-American single working mother, is the same reason my son is where he is, having grown up in the nineties as the child of a white single working mother...

They are in college. They have great teeth, healthy bodies, good clothes, BECAUSE of the totally brilliant Clinton innovation named the EARNED INCOME CREDIT???

Anybody remember this?

Give Hill and Bill a little credit, a little gratitude?
A payback, a vote of confidence???

Or, at least, a vote?

Posted by: wobbly | Nov 26, 2007 5:58:27 PM

low-tech cyclist, when you refer to republican goodies for the rich does that include Mark Rich? Could we be certain another Clinton POTUS wouldn't enrich said Rich or similar Richs?

Posted by: NateO | Nov 26, 2007 6:11:40 PM

I am truly undecided who to support at this point. My top three issues are gay rights, UHC, and the war.

Obama is good on two of the three and Hillary is good on two of the three. However, HRC is a known-entity; so Obama has to do a little better on this for me to vote for a relative unknown and take the chance on voting for him.

But i also loathe Mark Penn. Decisions, decisions.

Posted by: BoyBlue | Nov 26, 2007 6:22:40 PM

FACT 1: Total annual US private health care expenditures are estimated to be $1.47 trillion dollars in 2010.

FACT 2: It's estimated that the private health-care industry takes about a third of expenditures for administration and profit.

Single-payer health care would mean the death of a $490 billion industry. A death threat to an industry that large, by Obama or anyone else, would be the death knell of his political campaign, and he knows it. If he didn't know it before he knows it now. You get ushered into the smoke-filled room, the lights dim as the little screen comes down, and . . .you get religion.

Posted by: Don Bacon | Nov 26, 2007 6:26:28 PM

"They have great teeth, healthy bodies, good clothes, BECAUSE of the totally brilliant Clinton innovation named the EARNED INCOME CREDIT??? Anybody remember this? Give Hill and Bill a little credit, a little gratitude?
A payback, a vote of confidence???"

Do you have evidence that Hillary Clinton played an important part in expanding the Earned Income Tax Credit? If so, that would be a good point in her favor. If not, then it's largely irrelevant.

Posted by: Korha | Nov 26, 2007 6:52:08 PM

I don't understand how this is a huge difference. Obama says that if people aren't buying insurance under his plan he'll address that issue. Clinton says if people don't buy in under her plan (despite the mandate), she's not sure what the penalties will be. A mandate is hardly going to guarantee that everyone is covered (just as with car insurance), so it seems to me that neither one actually provides universal health coverage, but either could be a path to it.

Posted by: KCinDC | Nov 26, 2007 7:57:34 PM

low-tech cyclist, when you refer to republican goodies for the rich does that include Mark Rich? Could we be certain another Clinton POTUS wouldn't enrich said Rich or similar Richs?

No.

Apparently, NateO, you have a reading problem.

ISTM that "she's in bed with the corporate interests who will be glad of her help in co-opting the Democratic Party" is pretty unambiguous.

But you should also note the "just" in "just more war and more goodies for the rich" that I said you could expect from the GOPers.

As in, you'll get war and goodies for the rich, but no serious plan to combat global warming, and no universal health care plan.

I'll shut up while our next President pardons a hundred Marc Riches, if s/he can also get a serious climate change plan and a universal health care plan through Congress.

Posted by: low-tech cyclist | Nov 26, 2007 8:54:47 PM

Theres a lot more at stake here then UHC. ..our prestige in the world, defense of the nation from enemies without as well as diasters here at home.. the collapse of our civil rights under a despotic executive, the falling dollar relative to other currencies, trade and manufacturing we depend on going to our erstwhile enemy china.

All these things need to be thrown into the balance.. UHC wont matter much if we have no economy, or the chinese military is knocking on the doorstep..

Posted by: david b | Nov 26, 2007 9:23:59 PM

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