The Campaign Against the Mandate

by Brien Jackson

Ezra doesn’t quite go far enough here, in my opinion, but he does a pretty good job breaking down the shallowness of the progressive campaign against the backlash:

Indeed, last night, an activist friend angrily asked me why I thought I knew how to spend people’s money better than they did, which is exactly the attack I’d expected the right to launch. My friend is a supporter of Medicare-for-All.At the most basic level, Medicare-for-All and the House and Senate health-care reform bills are all coercive. Medicare functions through taxation. You pay your taxes, or you go to jail, or pay penalties. Affordability is dependent on getting the distribution of the tax burden right, which is no small task. Somewhat similarly, health-care reform functions through the mandate. You pay for insurance, or you pay a penalty (assuming that the monthly premiums would not be more than 8 percent of your monthly income, in which case you’re exempt from the mandate). Affordability is dependent on getting the distribution of the subsidies right, which is no easy task.

There is, of course, a big difference between forcing people to purchase a private product and forcing people to purchase a public product. But not, I think, as big a difference as some have implied. Many of my progressive friends warn of a backlash that will overwhelm health-care reform, but would spare a reform plan with, say, a public option. That doesn’t make sense to me. The comparison with Medicare-for-All, which I’d prefer to the current plan, is instructive. The idea that taxes do not cause backlash is belied by the past 30 years of American political history, which are largely the story of one sustained anti-tax backlash.

That last point, I think, is pretty important. The campaign against the mandate is ostensibly built upon two premises, the first being that they’ll be a political disaster. And while that may be true, there really isn’t any obvious corrollary to make one draw the conclusion that the inclusion of more public insurance options would make that any better, nor even that a full blown single-payer plan would be any better. As Ezra points out, there isn’t any obvious reason why a tax regime would necessarily be structured perfectly to achieve affordability for most people, at least any more than the mandate with subsidies and exemptions does, or at least could. And it really isn’t clear why a populace that has shown itself to be anti-tax to the point that even unions and some feminists have raised objections to the healthcare reform bill over taxes on unusually expensive insurance plans and a 5% tax on elective cosmetic surgery procedures would assuredly be more open to a system that achieved universality through taxes and direct spending than the mechanisms being proposed.

The second objection from the left is that the mandate represents a massive giveaway to corporations (I’ll have more on this so-called corporatism later). And while this may be true enough, the new found anti-corporate streak rings a bit hollow, to say the least. Keith Olbermann has been a bring proponent of it, and he’s spread his thoughts from the perch of his television show on MSNBC, a network owned by General Electric. And so far as Markos, Jane Hamsher, and Arianna Huffington go, they certainly don’t seem to have much of a problem appearing on those corporate television networks to promote their anti-corporate message. Beyond the superficial silliness of the messengers though, the message itself doesn’t really make much sense. While in a general sense I agree that, all else being equal, it’s a good idea to not take public money and give it to corporations, how exactly does one do healthcare reform without giving corporations any money? Even if we expand Medicare to everyone, the payments Medicare makes go to profit-drive doctors and corporate hospitals and other providers. If we somehow manage to construct an NHS style socialized medicine regime, payments will still be made to corporations that manufacture medical devices and pharmaceuticals. So unless you’re proposing we nationalize literally every aspect of the healthcare industry, the ultimate effect of healthcare reform is going to be to redistibute some public money to some corporation in the healthcare industry at some point.

More broadly than this, the aspect of the mandate debate I’ve found most troubling is the way in which those opposed to it have largely decided to just ignore its policy implications. To sum it up briefly, if you’re seeking to bring more sick people into the insurance pool, you also need to guarantee their will be healthy people in the pool over which to spread costs. If healthy people opt out, or see their incentives realigned by guaranteed access once they get sick, then you’re just spreading the cost amongst sicker people, which will have the effect of making the cost of insurance prohibitively high. This has been explained a number of ways by a number of places by a number of people, and for the most part it appears those arguing against the mandate just aren’t interested in hearing it. It wasn’t that long ago that people like Huffington and Hamsher were proud to be a part of the “reality based community” and were proud to listen to wonks on policy matters, but now that the center-left is back in political power and George Bush has exited the stage, they’re apparently just not interested in any policy explanations that don’t serve the conclusions they want to reach. Other mainstream progressives, bloggers, activists, or otherwise, need to recognize this, as well as its implications, and figure out what it means for broader progressive goals.