Mandate For A Backlash

Dean Baker raises [1] a very important point about health care reform without a public option: what happens to the mandate? He argues that for political reasons, if they jettison the public plan, the Democrats should not include mandates either, since they will only line the pockets of the insurance companies until the political pressure becomes so great that a public option will have to be formed anyway. The best thing would be to get rid of mandates now and bring that day closer.

In my view the Democrats are playing with fire in the worst way if they institute mandates without offering any option for reasonably priced insurance. In effect, they will be telling all the people who are currently uninsured that unless they buy unaffordable policies upfront (for which they may receive some money back at the end of the year when they file their taxes) that they must not just live in fear of getting sick as they already do --- they are now criminals. I can't think of a more politically inflammatory thing to do at a time like this. And the right will demagogue this thing in a way that makes Sicko look subtle by comparison.

I've always thought it was a political risk to create a new law that forced people to give money to insurance companies. It's worked in auto insurance, but there's a completely different set of risk factors involved and the costs are much more manageable for the average person. To get rid of the cost control mechanism while keeping the mandate is a recipe for political backlash.

Baker says:

We know that it will be necessary to revisit health care in the not too future in any case. The lack of mandates will help to ensure that this date comes sooner. Then we can talk about measures that will allow us to control costs, like a robust public plan.

But, if we can't get a public plan in this round, why should progressives be pushing for a regressive tax that will go into the pockets of the insurance companies and their overpaid CEOs? Let the insurance companies try to make a living in the market, when they grow up and feel strong enough to compete with a public plan, then we can have mandates.

And, if it is necessary to agree to mandates to get insurance reform through this round, then we should at least be clear what is going on. The insurance companies' employees in Congress will insist on taxing workers to line their bosses pockets.

That's certainly how it will be framed by the right --- and I can't see how anyone could argue with them. Insurance "reform" will end up being defined as the government acting in concert with the insurance companies to force Americans to buy their expensive product --- and it will play perfectly into the right wing populist argument that's gaining currency. Without a public plan as a low cost option, this thing looks a lot less like reform and a whole lot more like a shake down. I could see the rebranded Newtie Populist Republicans using that against all these Blue Dogs and Corporate Senators next time and taking them out. Personally, I'd be hard pressed to say they were wrong.

It was never going to be easy to sell mandates, but they are making it substantially harder if they tank the public plan. They're another stupid compromise anyway, made before anyone even got to the table, just like single payer --- health care should be paid for by higher taxes on the wealthy (who are the only ones winning in this godforsaken economy anymore) and the elimination of health insurance's obscene profits. But in the interest of "going to the middle" the reformers went with mandates and now, without the public option, they'll be stuck with a regressive tax that's going to be very politically difficult to defend.

If the administration and the congress can't be bothered to stick on the public plan, I see no reason why the left should stick with mandates.