Health care agonizing
Read Matt on mandates. It doesn't take an extremely thorough study of Congress to see that he's right about the risk here. My big fear since the mandate fight launched is that--having promised voters universal health care--President Hillary Clinton will have locked herself into a tussle with industry lobbyists that she can't possibly win. Forget for the moment that the mandate itself is actually beneficial to industry. It's also the policy manifestation of a very significant political promise--and, of course, they're well aware of that fact.
What industry bigwigs object to, of course, is just about every other part of her proposal, and, as such--having hooked HRC into negotiations--they'll spend tons of time and resources trying to lard up the plan with a bunch of terrible provisions that benefit... industry big wigs. At the end of the day, Clinton can reject these provisions (and see her bill die), accept the provisions (at the expense of a bad bill that fattens the pockets of insurance executives), or start over with a less ambitious plan. Either way she loses, and the question in my mind is how much political capital she takes with her in the fall. So much that she forfeits the ability of taking on other big issues like climate change? Hard to say. But if mandates are the consensus, then one way to blunt the potential for mischief would have been to just shut up about mandates. Oh well!
Comments
I worry a little bit about weird ratchet effects, too. Imagine a mandate with an underfunded subsidy program. (Subsidy programs seem, often enough, to be underfunded, and certainly there is pressure to understate costs when trying to get a bill through.) Now you have people who cannot afford the mandate, but who also get banged for the penalty of not buying insurance. (Someone on bh.tv made the point that this seems to be happening in MA and that this really makes those people angry.) Topping off the subsidy program will be a huge fight (see,e.g., the case of those people in Baltimore with SCHIP), damaging to the program, and it might not happen. Under a mandateless plan, those people still lack healthcare, but at least they don't get banged for the penalty, and so are less angry. Then the question is whether it's easier politically to extend the mandateless plan to incorporate new people, or easier to top off the subsidy program. Given the way that welfare/security net fights have gone in the recent past, I think it might be the former that's easier. I think a some of this is a matter of whether you prefer big battles or small ones. I prefer the latter.
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