More writers are joining Robert Reich, who I quoted earlier in the week, in disputing Hillary Clinton’s claims that her health care plan will insure more people than Obama’s. The New York Times writes:
But while Mrs. Clinton is right that Mr. Obama’s plan would leave out millions, she is being misleading in implying that her own plan covers everyone. Mandates rarely achieve 100 percent compliance. In addition, they are almost impossible to enforce.
Because of those difficulties, Mrs. Clinton’s own plan would probably leave out millions.
Mandates have not worked with auto insurance. While all drivers are required to have it, 15 percent of the nation’s drivers have none, according to the Insurance Research Council.
Mr. Obama’s health plan could actually have a better compliance rate. The 15 million who would supposedly be left out equal about 5 percent of the population — a smaller portion than are going without auto insurance, said Joseph Antos, a health policy expert at the American Enterprise Institute, a nonpartisan group.
“If Obama’s plan were to leave 15 million people without insurance, I think Senator Clinton’s plan would certainly do the same, not because of a mandate but because of the fundamental problems of getting people to recognize that they should buy insurance and making them buy it,” Mr. Antos said.
Tapped has posted a response from the Clinton campaign to these criticisms. I have already commented on some of these arguments in previous discussions of individual mandates. A major philosophical difference can be seen in the Clinton argument that “the key reforms necessary to make insurance accessible will be far more difficult without an individual requirement.” Clinton has clearly not learned anything from the previous health care debacle. Any plan which is based upon excessive intrusion into the lives of Americans is a flawed plan and will face serious political obstacles. In contrast, any plan, such as Obama’s, which attempts to be more voluntary is both preferable and has a significantly greater chance of being accepted.
The real problem in these discussions is the manner in which the goal posts have moved between 2003 and 2007. In 2003 the Democratic candidates (including John Edwards) concentrated on plans to remedy many of the current problems as opposed to demanding universal coverage. Allowing everyone who desires health care the opportunity to purchase affordable care should be the benchmark, not whether the plan is universal and includes even those who do not desire the plan.
Clinton’s arguments that it would be preferable for everyone to have coverage certainly make sense, but that is not what matters. In a free society people will make bad decisions. The proper role of government in a free society is not to prevent everyone from making a bad decision but to help those who desire to make a good decision, such as obtaining health care coverage, capable of doing so.
John Kerry’s plan in 2003 was based upon this principle of voluntary solutions to problems. Kerry rejected the idea of mandates and worked to make the plan voluntary but Republicans still labeled this a “government take over of health care.” The plans advocated by Clinton and Edwards will make such arguments far easier for Republicans to make, and they will be far more convincing to a public which is finally willing to consider some type of health care reform. The individual market for health insurance has serious problems which the market is unable to address due to the financial motivation of insurers to simply deny coverage to those who are expensive to cover drop beneficiaries when more profitable. Health reform plans should concentrate on these problems as opposed to trying to impose a single system upon everybody.