More On Man Dates

The John Edwards proposal to enforce his individual mandate for a universal health care plan leaves me a little confused. It started off that he would enroll anyone in the plan as soon as they came in contact with the health care system. Now this report suggests that it would coincide with Americans filing their income taxes.

Under the Edwards plan, when Americans file their income taxes, they would be required to submit a letter from an insurance provider confirming coverage for themselves and their dependents.

If someone did not submit proof of coverage, the Internal Revenue Service would notify a newly established regional or state-based health-care agency [which] would enroll the individual into the lowest cost health-care plan available in that area....The newly covered individual would not only have access to health benefits but would also be responsible for making monthly payments with the help of a tax credit.

....If a person did not meet his or her monthly financial obligation for a set period of time (perhaps a year, perhaps longer) the Edwards plan would empower the federal government to garnish an individual's wages for purposes of collecting "back premiums with interest and collection costs.

I think that's a pretty bad idea if it were the only way they were capturing individuals. First of all, lots and lots of poor people don't file taxes because they don't earn enough money to have to pay anything. And I share Kevin Drum's concern that the IRS shouldn't be the instrument for enforcing health care mandates, and that politically this is a big nonstarter. Capturing people at the health care "point of sale," as it were, and enrolling those who can't afford to pay in a subsidized public plan, would be a lot smarter.

But Edwards' website suggests that both are true, and ABC's reporting is a little shoddy.

"I have laid out exactly how my mandate would work. The fundamental structure of my plan provides subsidies and the subsidies go up to about $100,000 of income. So for lower income families they'll be basically 100 percent subsidized, and the subsidy decreases for up to about $100,000 of income. The way we bring people into the system is anytime they have contact with the health care system or the government they can enroll - they go to the hospital to the emergency room, they sign their children up to school.

Hm. That's actually a lot better situation. People are going to interface with the health care system a lot more often than filing their taxes, as they do once a year.

I do agree with Paul Krugman, however, that Barack Obama's attacks on this issue are really misplaced. How to get to the mandate is a legitimate subject for criticism; having a mandate at all, and by the way single-payer is an individual mandate, is not.

Why have a mandate? The whole point of a universal health insurance system is that everyone pays in, even if they’re currently healthy, and in return everyone has insurance coverage if and when they need it.

And it’s not just a matter of principle. As a practical matter, letting people opt out if they don’t feel like buying insurance would make insurance substantially more expensive for everyone else.

Here’s why: under the Obama plan, as it now stands, healthy people could choose not to buy insurance — then sign up for it if they developed health problems later. Insurance companies couldn’t turn them away, because Mr. Obama’s plan, like those of his rivals, requires that insurers offer the same policy to everyone.

As a result, people who did the right thing and bought insurance when they were healthy would end up subsidizing those who didn’t sign up for insurance until or unless they needed medical care [...]

Second, Mr. Obama claims that mandates won’t work, pointing out that many people don’t have car insurance despite state requirements that all drivers be insured. Um, is he saying that states shouldn’t require that drivers have insurance? If not, what’s his point?

Look, law enforcement is sometimes imperfect. That doesn’t mean we shouldn’t have laws.

Third, and most troubling, Mr. Obama accuses his rivals of not explaining how they would enforce mandates, and suggests that the mandate would require some kind of nasty, punitive enforcement: “Their essential argument,” he says, “is the only way to get everybody covered is if the government forces you to buy health insurance. If you don’t buy it, then you’ll be penalized in some way.”

Well, John Edwards has just called Mr. Obama’s bluff, by proposing that individuals be required to show proof of insurance when filing income taxes or receiving health care. If they don’t have insurance, they won’t be penalized — they’ll be automatically enrolled in an insurance plan.

That’s actually a terrific idea — not only would it prevent people from gaming the system, it would have the side benefit of enrolling people who qualify for S-chip and other government programs, but don’t know it.

Mr. Obama, then, is wrong on policy. Worse yet, the words he uses to defend his position make him sound like Rudy Giuliani inveighing against “socialized medicine”: he doesn’t want the government to “force” people to have insurance, to “penalize” people who don’t participate.

This is even worse when coupled with Obama's attacks from a right-wing frame on Social Security, which is a non-issue compared to all of the other challenges in the federal budget, most notably... health care!

My fear is that Obama is playing a dangerous game here, trying to appeal to seniors by attacking progressive proposals through scare-mongering. This also plays into the Beltway mania with entitlements like Social Security, which they don't really understand. So Obama gets praise from the Broders of the world, and he stays on the side of the Harry and Louises on health care by conjuring up images of people being forced to give health insurers money at gunpoint. Very upsetting.