Back on February 26, 2008, Barack Obama criticized Hillary Clinton for offering the same health insurance mandate that he endorsed just two days ago. (Thanks to Adam Eidelberg for looking up the transcript of the primary debate.)
Obama was right to question the mandate when Clinton proposed it. I’ve written more about the matter elsewhere (such as here.) For now, as a prelude to the before-and-after Obama quotes, I’ll summarize the main arguments against the mandate.
1. People have the right to choose which products to buy. It is immoral for politicians to force people to buy politically-controlled products.
2. The main reason some fraction of “the young and healthy” currently decide not to buy insurance is that politicians try to force the young and healthy to subsidize other people’s health care through jacked up insurance premiums. This is especially true in employer-paid insurance, and it is also true for directly purchased insurance due to state benefit mandates.
3. Obama’s pretense that the mandate solves the problem of forcing “the rest of us to pick up the tab” is laughable. The entire point of the mandate is to force some people to pick up the tab of other people’s health care through higher insurance premiums. That’s why Obama must force people to buy it. Without this coercion, Obama’s other insurance controls would dramatically increase costs of premiums and thus the numbers without insurance.
4. Real free-market reforms would lower the cost of insurance premiums so that more people could afford it. Roll back controls that jack up premiums. Expand Health Savings Accounts so that people can buy lower-cost insurance (as well as routine care) directly with pre-tax money.
5. The main reason why some people rely on expensive emergency room treatment, rather than seek out less costly alternatives, is that the federal government forces emergency rooms to offer care without compensation. That policy is wrong, and it predictably introduces perverse incentives.
6. People without insurance do not necessarily force others to fund their treatment. Many fund their treatment out of pocket. Again the solution is to legalize insurance they can afford and want to buy.
7. Mandated insurance is expensive insurance. Obama wants to force insurers to cover more routine care, continuing the federal push to pervert insurance into pre-paid medical care. When routine care is “free” (or nearly so) at the point of service, patients have practically no incentive to monitor costs. Also, under a mandate special interests continually try to get more services covered, jacking up premiums, as has happened in Massachusetts.
With that background, let us turn Obama’s position on mandates, then and now:
I have endured, over the course of this campaign, repeated negative mail from Senator Clinton in Iowa, in Nevada, and other places, suggesting that I want to leave 15 million people out.
According to Senator Clinton, that is accurate. I dispute it and I think it is inaccurate. On the other hand, I don’t fault Senator Clinton for wanting to point out what she thinks is an advantage to her plan.
The reason she thinks that there are more people covered under her plan than mine is because of a mandate. That is not a mandate for the government to provide coverage to everybody. It is a mandate that every individual purchase health care.
And the mailing that we put out accurately indicates that the main difference between Senator Clinton’s plan and mine is the fact that she would force, in some fashion, individuals to purchase health care.
If it was not affordable, she would still presumably force them to have it, unless there is a hardship exemption, as they’ve done in Massachusetts, which leaves 20 percent of the uninsured out. And if that’s the case, then, in fact, her claim that she covers everybody is not accurate.
Now, Senator Clinton has not indicated how she would enforce this mandate. She hasn’t indicated what level of subsidy she would provide to assure that it was, in fact, affordable. And so it is entirely legitimate for us to point out these differences.
The Democrats now have “indicated” how they would “enforce this mandate:” they would subject defectors to hefty fines.
While Obama claimed “the plan I’m proposing will cost around $900 billion over ten years,” he wasn’t specific about how much he would subsidize individuals.
For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need… [F]or those Americans who can’t get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill…
Now, even if we provide these affordable options, there may be those — particularly the young and healthy — who still want to take the risk and go without coverage. There may still be companies that refuse to do right by their workers. The problem is, such irresponsible behavior costs all the rest of us money. If there are affordable options and people still don’t sign up for health insurance, it means we pay for those people’s expensive emergency room visits. If some businesses don’t provide workers health care, it forces the rest of us to pick up the tab when their workers get sick, and gives those businesses an unfair advantage over their competitors. And unless everybody does their part, many of the insurance reforms we seek — especially requiring insurance companies to cover pre-existing conditions — just can’t be achieved.
That’s why under my plan, individuals will be required to carry basic health insurance — just as most states require you to carry auto insurance. Likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still cannot afford coverage, and 95 percent of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements. But we cannot have large businesses and individuals who can afford coverage game the system by avoiding responsibility to themselves or their employees.
As I have noted, it is the mandate (not the public option) that defines Obama’s current policy. Mandated insurance is morally wrong and destined to generate bad consequences. We do not need more mandates. We need more liberty.