Clinton, Obama, Krugman, and Free Choice

Paul Krugman continues his vendetta against Barack Obama’s health care plan due to its lack of mandates. The consequence of lacking mandates is unclear as nobody knows for sure how many people would still go without insurance if it was affordable but voluntary, and nobody really knows for sure how many people would remain uninsured despite mandates. It does seem reasonable to assume that achieving near one hundred percent compliance with a mandate would require yet another new bureaucracy and the expenditure of funds which might better be used for actual health care.

There are a variety of views as to whose plan would really insure more people. Robert Reich has argued that more people would wind up being covered under Obama’s plan than Clinton’s. Krugman searches for the analysis which best fits his preconceptions and has now found a study by health care economist Jonathan Gruber:

Mr. Gruber finds that a plan without mandates, broadly resembling the Obama plan, would cover 23 million of those currently uninsured, at a taxpayer cost of $102 billion per year. An otherwise identical plan with mandates would cover 45 million of the uninsured — essentially everyone — at a taxpayer cost of $124 billion. Over all, the Obama-type plan would cost $4,400 per newly insured person, the Clinton-type plan only $2,700.

Grubner might be right, but so might Reich. Personally I suspect the truth is somewhere in between. Other health care experts are also fed up with this bickering over mandates. Considering human nature I do find it hard to believe that a mandate will cover essentially everyone without significant additional expenditures for enforcement. The number left uninsured by Obama’s is also greatly exaggerated compared to what others such as Reich believe will be the case.

There’s also a problem with the manner in which Krugman plays with the numbers to come up with what on the surface looks like an impressive difference when comparing $4,400 versus $2,700, falsely giving the impression that Clinton’s plan is some sort of bargain. If you ignore his creativity in using math, the real numbers here are that Obama’s plan would offer health care to everyone who desires to participate at a savings of $22 billion compared to Clinton’s plan. Providing affordable health care to all those who desire it but are unable to obtain it should be the real goal.

Using mandates to achieve universal coverage seems like quite a cop out to me. Regardless of whether the plan is good or the plan stinks, universal coverage is achieved because the government forces you to join up. In contrast Obama takes on the challenge of offering a plan so good that virtually everyone will want to participate to receive health coverage. There is also a clear philosophical difference here in that Obama isn’t obsessed with having every single person sign up. In contrast, a self-proclaimed government junkie like Hillary Clinton just can not live with the fact that somewhere, someone decides they do not want her help. Clinton will help them whether they want her to or not.

I know Clinton supporters will scream that I’m using right wing frames here, but again I must point out that freedom and choice should be considered virtues, not right wing frames. Liberty is what liberalism is ultimately all about, which explains whey Clinton prefers to label herself a progressive and not a liberal.

Some on the far left claim that Democrats lose when these alleged right wing frames about freedom are employed. They got it all wrong. Democrats lose when they concede traditional liberal values such as liberty to the right. If an election is framed so that one side is allowed to be defined as the party of freedom, that party will win virtually every time. Democrats have lost so many elections not because of using right wing frames, but because of conceding values such as freedom to conservatives, even though conservatives talk about freedom without really supporting it.

Krugman falls into this trap when he concludes:

If you combine the economic analysis with these political realities, here’s what I think it says: If Mrs. Clinton gets the Democratic nomination, there is some chance — nobody knows how big — that we’ll get universal health care in the next administration. If Mr. Obama gets the nomination, it just won’t happen.

The real political reality is that if you define health care reform as an intrusive government program, Americans will not go for it. If you offer a voluntary program which Americans find beneficial, then health care reform has a chance.

Update: Mandates are once again an issue with blogs from left and right linking to this post in September 2009.


  1. 1
    Mark says:

    Some observations:
    1. Many on the left seem to think universal care is an end unto itself. To them, it doesn’t matter how it is achieved, just that it is achieved. Nor does it seem to matter whether the universal health care achieves anything resembling a fair and efficient result.
    2. There are many deep-seated problems with our health care system, obviously, and reform is definitely necessary. But there are also a lot of things that we do extremely well; radical, overnight reforms risk throwing the baby out with the bath water.

  2. 2
    capt says:

    My idea (although pedistrian) is cover all children 0-18 years, take that cost off the backs of business and the individual.

    If we are going to spend the next generations tax dollars I think it makes sense to insure a healthy workforce in the future.

    Who wouldn’t want the kids covered. If the parents are poor or just not able – give the kids a chance to do and be better?

  3. 3
    Ron Chusid says:


    Yes, it is a problem that the goal has changed since 2004. In the 2004 election health Democratic health care plans were based upon improving the system, and it was seen as beneficial that the number of uninsured would be substantially improved. Even Edwards went with a non-universal plan. Suddenly in 2008 the plans are being judged based upon whether they offer universal coverage while other factors are ignored.


    Obama’s plan does require coverage for children since they can’t control whether they are insured, while he leaves the ultimate decision up to adults. There’s not really a need to take this expense totally off of businesses and individuals as many currently do have plans that cover the entire family. There’s no need to transfer this expense to the taxpayers. It would be better to reserve this for covering children in cases where the family cannot afford to cover them.

  4. 4
    capt says:


    My idea is intended as an incremental step to universal coverage. Not so much to address the cost of coverage per se.

  5. 5
    capt says:


    There’s not really a need to take this expense totally off of businesses and individuals as many currently do have plans that cover the entire family.

    And my idea doesn’t envision a requirement that anybody change from plans they current enjoy or can afford – just open the door so that all kids are covered.

    Just musing more than anything . . .

  6. 6
    Wayne says:

    It is interesting to note that in many states automobile insurance coverage is mandated, yet it is estimated that almost the same percentage of drivers lack automotive coverage as citizens lack health insurance coverage, both around 15%. Now I realize that this does border on comparing apples to oranges due to the differences in types of coverage, but I am just using it to point out the fallacy that mandated coverage will equal universal coverage. I also find it distressing that when it comes to abortion Clinton (like Edwards and Obama) favor a woman’s right to make health care decisions without government interferance, yet when it comes to health insurance, Clinton and Edwards feel that freedom of choice is a hinderance, not a right.

  7. 7
    capt says:

    Like a womans choice to carry a pregnancy to term is like choosing an insurance plan?

    Wowser, I am fairly creative but find it beyond my ability to wrap my pointed head around that analogy.

    Kind of like comparing apples and mustangs.

  8. 8
    Ron Chusid says:

    The analogy has faults but there is some validity to Wayne’s argument if we look beyond the issue of mandates to the arguments used against Obama.

    Obama is being attacked for opposing mandates by some such as Krugman who claim that the very idea of basing the argument on the freedom to choose is a right wing frame. This argument seems to say that defending the freedom to chose itself, regardless of the situation is a right wing frame. The abortion issue debunks the idea that supporting choice, regardless of the situation is a right wing frame.

    There might be valid reasons to support choice in one case and oppose it in the other, but it is not valid to argue that the idea of choice itself is a right wing frame which should never be mentioned by liberals.

  9. 9
    Wayne says:

    More like a woman has the choice of carrying a pregnacy to term or not, but an 23 year old grad student in good health doesn’t have the choice of paying for Health Insurance or not. It’s their body, why are they being told how they have to spend it?

  10. 10
    Wayne says:

    Oops clarification,
    the above should have read “its their body, why are they being told how to spend their money on it?” When I reworked the start of the last sentence, I forgot to rework the end of it.

  11. 11
    capt says:

    Reductio ad absurdum

  12. 12
    capt says:

    Abortion is gender specific and from the names posting I doubt anybody here can say what it means to even consider the choices when we missed our period.

    Abortion has been around as long as having babies. In humans and in all of the animal world. A miscarriage is called a “spontaneous abortion” and can be caused by the actions of the pregnant woman. In simple terms the government has nothing to do with any of the “choices” a woman makes with regard to taking a pregnancy to term.

    We know the government could outlaw abortion but no law has ever stopped a person from breaking the law.

    Comparing abortion to “FICA” or social security is absurd and trying to compare it to any tax, program or payroll deduction so demeans the gravity and all of the emotions a woman has to work through anytime her period is late that it is an insult to women and mothers.

    Shame on you.

  13. 13
    Wayne says:

    1 – I am not comparing abortion to a government program, I am making an analogy. I am not deamining or insulting anyone, I am just attempting to point out that if the government has nothing to do with the choices a woman makes with regard to pregnancy, why should the government have anything do to with deciding that somemone MUST purchase health insurance?
    2 – Comparing a miscarriage by a woman who has been trying for several years to give birth to a medical procedure is an insult to women with fertility problems.

  14. 14
    ToniC says:

    I agree that the issue of liberty is being ceded. Perhaps I’d describe the method of mandating as anti-Libertarian more than anti-liberal though. For the record I support Obama and think the issue is being overblown because of the few real policy differences.

    Suppose home owners insurance was so expensive that many could not afford coverage. Thus many would adopt to take only fire damage and take their chances on flood for tornado for example. If everyone got coverage for flood/fire/wind/property premiums would go down. Would mandating that all homeowners get total insurance be a good idea so that everyone could get lower premiums?

    What happens when there is some sort of catastrophic event and the government comes in to help those that had insurance? Should they not help those that didn’t?

    For Mr. Obama. Life insurance is a choice. But the state may have to care for the children if there is none. So should we mandate life insurance for parents? We can’t function with this sort of mentality in a liberty based nation.

    While these examples strain the analogy they are appropriate in some ways. People don’t have to have health insurance anymore than they have to have life insurance. But they want it more. I certainly had health insurance when I was 20 to 25 but I never once went to a doctor or ER until about 30. The reason you wanted me “in the pool” is so that overall premiums go down.

    I would have been perfectly fine to have to pay my medical IF I then needed it. And invest the money because it was unlikely I would need the coverage. That would be my choice. And in fact I would have opted for catastrophic only coverage if it was available. (i.e. nothing other than life saving treatment is covered.) I’ll pay for my own broken leg, arm, flu shot, or whatever.

    The problem I have with taking away the liberty of one who would choose this approach is real. It’s also a reason that it becomes easy to “Harry and Louise” the issue. There is no universal coverage as there is no universal enforceable mandate unless it becomes a healthcare police state.

    Let’s take it a step further. Instead of a ticket for seat belt violation have hefty fines that supports health care. People that don’t wear seatbelts raise health care costs. Same for smokers. Same for skateboarders. Same for motorcyclists. On and On. Why should those that don’t smoke, sky dive or skateboard be paying so much? The progressive would say because they have that liberty to take risk… :But I don’t?

    The same liberty that allows the sky diver to take a risk allows an individual to risk nothing more than catastrophic coverage. If mandates were limited to that, I might be for it. If not, it’s just seeking to add those to the pool that liberty would say should not have to be if they choose not to be.

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