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Posted at 2:21 PM ET, 12/13/2010

Cutting off your policies to spite your opponents

By Ezra Klein

To step outside the latest Supreme Court case, it's worth remarking on the long-term damage conservatives are doing their cause by focusing their fire on the individual mandate.

The political case for their strategy is clear: The individual mandate, like most taxes, is unpopular. In fact, it's one of the only unpopular elements of the whole bill. But it's also one of very few ways to have a health-care system where everyone has coverage but private insurers dominate. In the long run, it may be the only way. That's why Republicans originally thought up the idea, and why it's mainly been associated with a Republican health-care bill. Mitt Romney, Chuck Grassley, Orrin Hatch, Bob Dole, Judd Gregg and Mike Crapo are just a few of the prominent Republicans who've cosponsored legislation with individual mandates.

More internationally, you may have heard of the conservative affection for Singapore's health-care system. Here's how the journal of the American Enterprise Institute describes Singapore's structure in a gushing article: "In Singapore’s system, the primary role of government is to require people to save in order to meet medical expenses they don’t expect." Another term for the government forcing you to put money into a vehicle that helps protect you from a health-care crisis is, well, an individual mandate.

Switzerland and the Netherlands also use individual mandates to sustain universal health-care systems that are less centralized than single-payer arrangements. It's a pretty common device. But if Republicans get it ruled unconstitutional in America, they'd be wise to ask themselves what other options they have: After all, the constitutionality of Medicare is not in question, and that's really the other model we could eventually trend toward. As Matt Miller put it in a column a few months back:

Conservatives, either from confusion, or for the sheer fun of taking a political bite out of Democrats, are fighting the one measure that's essential if private insurance is to retain its central role in American health care ... [But] be careful what you wish for. By fighting the mandate needed to make private insurance solutions work, and doing nothing to ease the health cost burden on everyday Americans, you'll hasten the day when the public throws up its hands and says, "Just give us single-payer and price controls." Don't think the anti-government wave this fall won't reverse itself on health care if the most private sector-oriented health care system on earth keeps delivering the world's costliest, most inefficient care.

By Ezra Klein  | December 13, 2010; 2:21 PM ET
Categories:  Health Reform  
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Next: A world without an individual mandate

Comments

*sigh* Ezra's snark is becoming more and more Krugman-like. Attack Republicans, at all costs. Even if the attack is stretched and borders on dishonesty.

For example: "Another term for the government forcing you to put money into a vehicle that helps protect you from a health-care crisis is, well, an individual mandate."

No, that's not an individual mandate. It's a medical savings account.

The individual mandate doesn't insist people save up for catastrophic problems. It just insists people buy insurance or be fined.

Posted by: bradpeterson | December 13, 2010 2:37 PM | Report abuse

*sigh* Ezra's snark is becoming more and more Krugman-like. Attack Republicans, at all costs. Even if the attack is stretched and borders on dishonesty.

For example: "Another term for the government forcing you to put money into a vehicle that helps protect you from a health-care crisis is, well, an individual mandate."

No, that's not an individual mandate. It's a medical savings account. That's what Republicans enjoy the most about it.

The individual mandate doesn't insist people save up for catastrophic problems. It just insists people buy insurance or be fined.

Posted by: bradpeterson | December 13, 2010 2:37 PM | Report abuse

I cannot understand why expanding Medicare down to say age 50 would not be a wildly popular idea and would put a lot of money into Medicare. I would love to have the option of getting Medicare but will have to wait 10 yrs. I can see now that maintaining the private insurers was always the key elements of the Obama plan .

Posted by: sligowoman | December 13, 2010 2:38 PM | Report abuse

Given the subsidies involved in the plan, who is it that doesn't want health insurance at any price, who's rights are being defended?

Posted by: JkR- | December 13, 2010 2:48 PM | Report abuse

who is it that doesn't want health insurance at any price, who's rights are being defended?

I could see myself going uninsured as a young, single person. The risk of a debilitating injury or illness is very remote. And I'd have auto insurance with medical coverage to handle the most likely situation of a traumatic car accident. But are the chances of cancer or something for a 22-year-old guy worth the couple hundred a month in insurance premiums? they are if you need the kids to prop up the system. that's what this is about. insurance companies need premiums from people who are statistically unlikely to file expensive claims to cover the new goodies of guaranteed issue and no lifetime caps.

Posted by: NoVAHockey | December 13, 2010 3:00 PM | Report abuse

Not much of a rallying point. Support the leaches of society who are choosing beer money over contributing to their own health expenses...

Posted by: JkR- | December 13, 2010 3:05 PM | Report abuse

For once Matt Miller gets something right: we have now stepped on the gas on the road to joining the rest of the advance world with a single payer system!

The only countries that do have an ind. mandate regulate their insurers much tighter than we proposed to - and that's perfectly acceptable. But the ACA mandate purchases from companies that had anti-trust exemptions, no ability to control price, and the coverage reforms were unenforcable - and that's perfectly unacceptable.

Posted by: michaelh81 | December 13, 2010 3:05 PM | Report abuse

sigh, bradpeterson you need to look up the definition of "mandate."

Posted by: steveh46 | December 13, 2010 3:11 PM | Report abuse

"to cover the new goodies of guaranteed issue and no lifetime caps."

Yeah, because all those freeloading cancer patients expect that they'll still be treated for their debilitating and life threatening disease instead of the insurance company giving up them to protect their precious profits. But no no! That's not the real death panel! Look over there, its a socialist!

This is why republicans never responded to Obama's proposals for a universal health care system with one of their own. Its because their ideal health care system is utterly heartless.

Posted by: ogvor | December 13, 2010 3:12 PM | Report abuse

During the 2008 presidential campaign, Obama argued against the individual mandate, just like conservatives are now. He said then that the goal was to make health insurance affordable, because if insurance was cheap enough most people would buy it without being forced. Too bad he strayed from that sensible approach.

Posted by: cummije5 | December 13, 2010 3:18 PM | Report abuse

It's irritating to see Ezra pull out the ol' "Well, Switzerland, Singapore and The Netherlands are doing it...."

Isn't that the same arguement you gave your mother when you were seven and you wanted to do something your parents didn't want you to do?

Posted by: WrongfulDeath | December 13, 2010 3:34 PM | Report abuse

"After all, the constitutionality of Medicare is not in question"

Ezra, with Republican appointed justices the constitutionality of ANYTHING can be in question if the Republicans don't want it. We've seen this in many rulings since Bush vs. Gore.

It's one of the worst ways Republicans are moving us toward being a third world country.

Posted by: RichardHSerlin | December 13, 2010 3:34 PM | Report abuse

Not to beg the question, is Medisave like the US insurance mandate or like the non-compulsory Health Savings Accounts (HSA) that gets the GOP all hot... and the answer is:

"Participation in Medisave is mandatory for the working population"

Source: http://www.kaiseredu.org/Issue-Modules/International-Health-Systems/Singapore.aspx

It is almost comical how fast the AEI/GOP/etc. would turn against Singapore’s solution if it was ever tried in the US.

@Chris_Gaun
ChrisGaun@gmail.com

Posted by: chrisgaun | December 13, 2010 3:49 PM | Report abuse

"Not much of a rallying point. Support the leaches of society who are choosing beer money over contributing to their own health expenses."

I have no problem denying care for those who gambled and lost. None whatsoever. We're talking about people who can afford insurance and declined to purchase it.

"Yeah, because all those freeloading cancer patients expect that they'll still be treated for their debilitating and life threatening disease instead of the insurance company giving up them to protect their precious profits"

I'm just pointing out the rationale for the mandate. You can address this problems in other ways. I'd rather insurance not cover the routine stuff and have the policy only kick in for the truly catastrophic.

Posted by: NoVAHockey | December 13, 2010 3:50 PM | Report abuse

I'm seeing a pattern here. The Democrats add an individual mandate partly to appeal to the GOP. They do cap and trade instead of a straight carbon tax. The list goes on. They try to adapt progressive policies to be more GOP/market friendly. It always seems to backfire. Maybe they are just incompetent, but this approach not seem to give progressive policies wider appeal. It just seems to alienate the liberal base. Obama, in particular, seems to try to please everyone but ends up pleasing no one.

Most of all, it appears ditching the public option got more GOP votes but decreased overall public support. Maybe if the individual mandate is killed, they will have to bring back the public option. That may make ObamaCare a lot more popular, too.

Posted by: TheWacoKid | December 13, 2010 4:14 PM | Report abuse

Seems like pretty wishful thinking to me. I'd say the likeliest route to single payer or some kind of nationwide public option runs through HCR as it is currently written. And I think the real movement will come once states begin experimenting with their own programs. It wouldn't surprise me to see maybe a half dozen states go to some kind of state-run insurance option which greatly simplifies things and provides better outcomes at less expense. HCR getting torpedoed now doesn't seem to move the ball forward at all.

Posted by: willows1 | December 13, 2010 4:26 PM | Report abuse

"...it's worth remarking on the long-term damage conservatives are doing their cause by focusing their fire on the individual mandate...."

You don't know what you are talking here.

"...you'll hasten the day when the public throws up its hands and says, "Just give us single-payer and price controls." Don't think the anti-government wave this fall won't reverse itself on health care if the most private sector-oriented health care system on earth keeps delivering the world's costliest, most inefficient care."

Totally wrong.

Look for India like system where everybody pays out of pocket fully (only now insurance is making head way). That is where Conservatives want to go.

They will defraud Obamacare which means continued Fed Medical Cost without any coverage increase. That means you either go Palin-Ryan plan of 'vouchers' or completely eliminate Medicare/Medicaid and all that.

This is a classic case of 'starve the beast'. You do not want cost controls because that will force 'blow off' the entire involvement of Government in Health Sector.

That is what is coming. All other for 'single payer' is wishful thinking on Ezra and Progressives. Do not understand what 'water' they drink to see 'bright side' in every disaster one after the other....

Posted by: umesh409 | December 13, 2010 4:36 PM | Report abuse

All of the comparisons to other systems miss what I think is a key point: In those systems, the mandate is *universal*, everyone is in the same boat. Switzerland, Singapore, the Netherlands -- indeed every country that has mandatated individual insurance, requires that *everyone* buy his/her own insurance. They don't discriminate among individuals; it is a national, universal program.

The legislation in dispute now is in no way comparable since the requirement to purchase coverage applies only to individuals who don't have someone else to pay for their coverage.

It's distressing to read how uniformed liberals seem to be. After 12 years in the wilderness, all they can talk about is single-payer and/or public option. In fact, the most popular universal plans world-wide are not single-payer and many, if not most, ost universal systems are more privatized than the US is now.

As Uwe Reinhardt wrote last week, maybe if this thing fails, the public and the politicians might actually spend some time studying what works elsewhere and stop talking about models that will not solve our problems.

Posted by: Athena_news | December 13, 2010 9:53 PM | Report abuse

I agree on this one, to a point. If instead of the individual mandate, I was required to put money in an HSA, that would be fine...

The problem with the mandate, is not the mandate. It is the plans that we are limited to. It is the insane design of the plans that we are limited to, where I have to pay for people's massages, for their kids getting overprescribed ADHD medicine, for stomach stapling, for diabetes from overeating and 100s of other things that I spend time working hard to avoid. Where I have to pay for the latest drugs that are going to be recalled in five years. A system where I have to pay for MRIs for people that go ski jumping. Where I have to pay for drunk people that get alcohol poisoning.

If I am forced to pay for all this, could you all at least cut down on the salt and sugar and spend a little time walking this week for me?

Posted by: staticvars | December 13, 2010 11:50 PM | Report abuse

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