Why Progressives Are Nuts to Oppose the Mandate

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For years progressives (like me) have asked why we can’t have a health care system more like those in other countries. Well, folks, listen up — Jonathan Cohn writes,

The Netherlands and Switzerland require their residents to purchase health insurance from private carriers. Residents who do not are subject to fines. Yet most knowledgeable followers of health care policy have only good things to say about the Dutch system and mostly (though not always) good things to say about the Swiss counterpart.

The Dutch system, in particular, is widely considered among the world’s best and achieves most of the goals liberals in this country want: The insurance is universal and comprehensive, access to care is convenient and easy, the quality of medicine is high.

Cohn argues that if the public option is politically untenable, we should be pushing Congress for insurance regulations similar to the Dutch and Swiss systems. Then we might actually end up with universal health care similar to what they have in The Netherlands and Switzerland. That wouldn’t have been my first choice, but it’s a damn sight better than what we have now But the mandate is essential to that.

Cohn explains why the mandate is essential here, but see also Ezra Klein and Nate Silver. Please read Klein’s and Silver’s arguments before commenting here. I don’t have the time or energy to explain this for you.

27 thoughts on “Why Progressives Are Nuts to Oppose the Mandate”

  2. Wedge politics at it’s best. The way to beat Democrats is to divide them. Divide along abortion lines, because some Demorats are pro-life. Split off some with paranoia about illegal aliens. Fan the flames of fear about cost – we can’t afford it in a recession. Drag it out til the voters get tired and support wanes and the Democrats start fighting amongst themselves. Unified Democrats is a contradiction in terms.

    This is the closest we have ever been – our last at-bat was 16 years ago.

    But Democrats are easy to beat.

  3. Olbermann writes here:

    There could not be a finer line between the words compromise and compromised and tonight, with the greatest possible reluctance, I believe I have to go on the air and state my opinion that the Senate bill in its current form has clearly crossed that line and, as currently constituted, cannot be passed.

    We have all watched this bill shrink from limited but encouraging reform, to its current status as – in Dr. Dean’s frank assessment from last night – “a bailout for the insurance industry.” Surely the ratio of benefits to us, and benefits to our insurance overlords has shrunk to less than 1:1.

    Enough.

    At the risk of sounding as if I’ve just stepped out of “Blazing Saddles,” Howard Dean is right, and the White House’s reaction to him has been incendiary, short-sighted, and inaccurate. He argued not just to kill the bill but to salvage its societally useful components through reconciliation.

    Personally, I don’t know what to think. I tend to respect Dr Dean’s judgment.

  4. It’s kind of funny. They never went after anyone to their right this hard.

    Okay, I’ve read all the linked stories, and I remain completely unconvinced that there is anything to stop insurers raising rates right into the stratosphere for everyone.

  5. The title of this thread was “Why Progressives Are Nuts to Oppose the Mandate.” I’ll counter that and say “progressives would be nuts to accept the mandates.” That’s because there is every possibility that these mandates will not lead to lower insurance rates, but rather increase insurance company’s profits. I don’t see any upside to this for the peon class. In fact, I predict that many people will simply not be able to pay the mandatory insurance-company subsidy, and will either refuse or be forced to pay a fine instead, and then they still won’t have insurance. And they will be angry. VERY ANGRY! FOAMING AT THE MOUTH ANGRY!!! And they will blame Democrats, who will soon enough find themselves permanently out of power.

    Does Obama not see this possibility? Or is he just a Karl Rove operative who has been fooling us all along? I can see that opinions are divided on this board.

    When Obama got elected, I did say to many friends that we should give him a year before passing judgements. Alas, it has only been 11 disastrous months, but I give up.

    As many of you already know, I’ve left the USA to live abroad. Now I’m even afraid to pay a short visit to The Old Country to see relatives. I think the place is getting ready to plunge into civil war.

    Or am I being melodramatic?

  6. I also believe Marcy Wheeler’s been covering health care very well and consider her part of the required reading: http://emptywheel.firedoglake.com/2009/12/16/captive-consumers-and-oligopolies-do-not-make-effective-markets/

    She’s written more and I encourage you to consider that, as well.

    I hear Ezra and Nate, but I hear Marcy, Glenn Greenwald and Dr. Dean, too. And I still believe a stronger bill can emerge than the one that’s been watered down to the point that solid matter floats.

  7. I think that all the people complaining about how the HC bill as currently constituted in the Senate is a gross disappointment, surely have valid reasons for those complaints.

    Having said that, I refer to Point 8 in Nate Silver’s post the MaHa has linked to:

    8. How many years is it likely to be before Democrats again have (i) at least as many non-Blue Dog seats in the Congress as they do now, and (ii) a President in the White House who would not veto an ambitious health care bill?

    If this is the best we can do today, then let’s take it. We may not be happy with it, but it is better than what we have today.

    As I’ve said many times, I’d rather have 50% of something than 100% of nothing.”

  8. MN and Ozonehole — as has been noted elsewhere, this argument is dividing itself between the wonks and the activists. I’m siding with the wonks at the moment.

    We don’t know how much regulation of the insurance industry might be in the final bill. The House bill is much, much better in this regard than the Senate bill. The House bill strips health insurance companies of their antitrust exemption and outlaws price fixing, bid rigging and “market allocations” by health insurance companies. The Senate bill doesn’t go nearly that far, I don’t believe.

    Whether to support the final bill or not depends on a number of factors. But the factor we should be fighting over now is insurance industry regulation, not the mandate. A mandate is essential to any bill that might be passed.

  10. Don’t you think the next task of Lieberman and his ilk is to go to the mat to deny any regulation at all? It’s just beginning.

  11. Don’t you think the next task of Lieberman and his ilk is to go to the mat to deny any regulation at all?

    Probably, but that’s the fight we should be having now, not over the mandate. Regulating insurance companies is a less politically risky fight, seems to me. Fighting over the mandate is playing the Right’s game.

  12. Theo — Jon Walker makes some good points, but where I’m coming out on this is that arguing against the mandates is the wrong fight. This is playing the Right’s game. The real fight should be over insurance regulation.

  13. With apologies to Nate, and to you, maha, the fundamental issue of our time is whether we are to remain a society of individuals, all equal before the law and the state, or descend into a new feudalism, where those few who have, by birth, by luck, or by stepping on the heads of their fellows achieved control of the corporations — who will, under the new regime, have no checks on their ability to use the individuals for their own profit.

    This “health care reform” is just a piece in the puzzle, being fitted into place in that overall trend.

    Personally, I think it’s pretty obvious what’s going to happen. They’ll pass this piece of excrement as a bill, with supposed protections for the individual, and the insurance companies will immediately circumvent those protections (it’s what they do best) while raising the cost to us of health care by siphoning off an ever-increasing share of the expenses as their profit. But they’ll be “too big to fail” by the time people wake up to the situation.

    I’ve already written to my senator (the only one of two who would even blink at a massive transfer of power from the individual to the corporation, the other one is a corporate whore) in opposition to the Senate bill.

    Spitting into the wind, but that’s about all I, as an individual, have left to offer in resistance.

  14. Ezra quoting a prospect guy on the regulations:

    If things go as well as may be realistically expected, the Senate will pass a bill no later than January. Under normal circumstances, a House-Senate conference would then write a final bill, which would have to be approved by each house. But because of the difficulty in keeping all 60 votes in the Senate, congressional leaders may have to weigh another option: just putting the Senate bill up for a vote in the House.

    If that approach proves necessary, there should be one last effort to incorporate some of the stronger provisions from the House in the final Senate bill. The House bill would create a national program with clear federal regulatory authority, while the Senate bill would probably result in an uneven patchwork of state programs. The House has also set an early date for the extension of coverage — Jan. 1, 2013, which would make the reforms a fait accompli if a new administration takes office later that month.

    That doesn’t sound tremendously hopeful but I guess there is where you are going to want to focus.

  15. One “BIG FACTOR” not included here is that all the health care insurance companies in the Netherlands and Switzerland are “NOT for PROFIT”. Just a minor detail – Sheeez!

  16. phastphil — That’s mostly true. Insurance companies in Switzerland and The Netherlands are required to provide basic health insurance package mandated by law without profit, but they can make a profit on “supplemental” insurance. They’re still private companies. If we could enact the regulatory provisions in the House bill we’d end up with a somewhat more expensive version of the Swiss and Dutch programs, I believe. This would still be enormously beneficial to a lot of people and should bring down costs a lot.

  17. another thing to consider is that hcr would not even be on the table if the repugs were in the majority. Now we have a president who is willing to sign a hcr bill. we should not give up the fight to get agood hcr bill. Not this piece of shit floating around now. Do you honestly beileve the insurance industry will do right by us if we mandate everyone to purchase insurance

  18. In this country we have the best congress money can buy. Whoever has the best lobbyists wins. Just look at what Health Care Insurance CEO’s are paid. They have their SHAREHOLDERS best interests in mind. The customers? Not so much. Look at AETNA – due to price increases next year they anticipate losing 600,000 customers.

    http://sickforprofit.com/ceos/

  19. Thanks maha – I personally have a problem with basic health care as a profit center. Yes – Doctors are respected professionals who deserve to be paid well, however hospitals, clinics and basic health insurance should all be not-for-profit by law. Al Franken tried with his amendment requiring 90% of premiums to go for care, but of course our bought and paid for Senators could never allow that.

  20. I’m sorry Maha, but this is just warmed over Massachusetts RomneyCare. There was never, ever a chance of passing a good health care reform bill in the Senate. 40 Republicans plus Joe Lieberman control the filibuster. The ONLY route to useful reform is reconciliation. Then 50 votes plus Joe Biden can give us a public option without denying women health care.

    • mahakal — it may be that reconciliation is the way to go, but that comes at a cost also. Besides having to jump a number of procedural hurdles, a healthcare bill passed under reconciliation would have to be rewritten so that it would reduce the federal deficit over five years by at least a billion dollars and be deficit neutral after that. Plus, any part of the bill that does not significantly impact the budget could not be included in the bill. You’d get the public option but lose insurance industry regulations and other reforms needed to make the overall program workable. So, yeah, it’s a choice, and maybe we should go that way. It’s something to consider. But it’s not ideal.

  21. I think doctors are paid too much actually. Doctors are not paid much in France or Britain but can still live pretty well. Upper middle class. A part of that is they don’t come out of school with huge debt.

    So I think doctor payments should go down, but I also think their costs of schooling should go way down, but the standards should probably also be raised a bit though they’re not that bad now.

  23. I think that the most under-considered fact in this debate is the visceral hatred that many Americans have developed, and with good reason, for the health insurance industry.

    So I’m afraid that, rational or not, an individual mandate without a public option will become an enormous _political_ loser for the Democrats — even if, overall, the eventual bill improves things for many people, the emotional reaction to being required to write that first premium check to Aetna will be intensely negative. The benefits will all still be in the future, hypothetical, but the cost in the present will be all too immediate. I predict people will feel that their political representatives have sold them out to the insurance companies, and I’m not sure they’d be wrong.

    I am also convinced that the insurers will find ways to deny care that is already paid for, as has been their predatory habit for a couple decades at least.

    As long as the bill under consideration included a 90% floor on the insurer’s Medical Loss Ratio, I was a supporter. But that provision was a serious threat to the insurers’ business practices, and so it has of course been scrapped. I assume cynically that any other serious threat has also been scrapped, and what remains is window-dressing to get us to take the bait.

    I think you’re dreaming if you believe that any bill that threatens the obscene executive compensation of the for-profit insurers will pass this Congress, or will survive the political machinations of Mr. Emmanuel.

  24. Does anyone know if single payer could be put thro as a reconciliation bill??? It would never get 60 but MIGHT get 50. The big problem with a mandate is the Quality of what is mandated. To force people to buy insurance as it is in the US with out serious reform is ludicrous. Makes insurance companies salivate.

  25. Dyedinthewool, Single Payer did not pass the House of Representatives and could not therefore be put through as a reconciliation bill.

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