On Mandates: Choice is Not A Right-Wing Talking Point

John Edwards has explained what he means by not offering people the choice of declining participating in his health care plan:

Under the Edwards plan, when Americans file their income taxes, they would be required to submit a letter from an insurance provider confirming coverage for themselves and their dependents.

If someone did not submit proof of coverage, the Internal Revenue Service would notify a newly established regional or state-based health-care agency (which Edwards has dubbed a Health Care Market).

Those regional agencies would then evaluate whether the uninsured individual was eligible for Medicare (which covers those over 65), Medicaid (which covers the indigent), or S-CHIP (the State Children’s Health Insurance Program which targets the working poor).

If the individual was not eligible for either of those existing public programs, the regional-health care agency would enroll the individual into the lowest cost health-care plan available in that area. The lowest-cost option could be a new Medicare-like public option or a private insurance plan.

The newly covered individual would not only have access to health benefits but would also be responsible for making monthly payments with the help of a tax credit…

If a person did not meet his or her monthly financial obligation for a set period of time (perhaps a year, perhaps longer) the Edwards plan would empower the federal government to garnish an individual’s wages for purposes of collecting “back premiums with interest and collection costs.”

The process, according to the Edwards campaign, would resemble the process used to collect money from Americans who are delinquent on federal student loans or child support payments.

Just what most Americans want–more involvement by the IRS in their lives. Student loans and child support hardly provide good models for a health care plan. John Edwards has moved full circle from personally evading Medicare taxes to wanting to use the IRS to enforce his health care program. There’s still no explanation as to how he’ll enforce his requirement for mandatory preventative care. Perhaps he’ll resort to water boarding those who are noncompliant.

Anyone who thinks that its a good move to use the IRS to force people to sign up for a health care plan misses why Clinton’s previous plan was rejected and why the Democrats lost control of Congress. We’ve finally reached the point where scare stories about “socialized medicine” don’t cause people to reject the entire idea of reforms to make health care more affordable. This time around opponents of Democratic plans won’t need any Harry and Louise ads. All they will need are clips of John Edwards talking about using the IRS to force people into their plan, or how he will make preventative care mandatory.

Barack Obama has taken a lot of heat from the left for discussing the problems with mandates, including attacks from John Edwards, Hillary Clinton, and Paul Krugman. Krugman believes that Edwards somehow called Obama’s bluff after Obama said, “Their essential argument is the only way to get everybody covered is if the government forces you to buy health insurance. If you don’t buy it, then you’ll be penalized in some way.” Krugman apparently believes that having the IRS garnish your pay does not constitute being penalized.

Krugman’s makes the same mistake in attacking Obama as conservatives commonly do in reverse when attacking all government involvement in health care:

Mr. Obama, then, is wrong on policy. Worse yet, the words he uses to defend his position make him sound like Rudy Giuliani inveighing against “socialized medicine”: he doesn’t want the government to “force” people to have insurance, to “penalize” people who don’t participate.I recently castigated Mr. Obama for adopting right-wing talking points about a Social Security “crisis.” Now he’s echoing right-wing talking points on health care.

Just as it is erroneous to label any government involvement in health care “socialized medicine,” it is incorrect for Krugman to say any criticism of a government plan based on maintaining choice represents the same type of argument. Just as not all government action is necessarily “socialized medicine,” not every effort to avoid mandatory programs is the same as screaming “socialized medicine.” Attempting to keep programs as voluntary as possible is not in itself bad. In fact, striving to provide choice is a virtue.

The main argument for mandates is that without mandates in a program which prohibits exclusions for preexisting conditions people would be motivated to delay purchasing insurance until they have a medical problem. It doesn’t take much imagination to find ways around this problem while preserving choice. You could prohibit exclusions for preexisting conditions at the start of the program, when people change from one insurance plan to another, and at other predetermined times, but still allow exclusions in cases of people who chose not to have insurance. It might make things a little more complicated, and it might be argued that this would allow people to make foolish decisions, but that is what freedom is all about. Freedom is both messy and includes allowing people to make bad decisions. Contrary to what Krugman claims, providing people with choice is not a right-wing talking point. It is a fundamental liberal value.

Related Story: The Edwards Mantra: “You Don’t Get That Choice”

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