Rossputin.com: Rational Thinking About Our World

As we get further into election season, the biggest domestic issue will almost certainly be health care, even amidst a housing crisis and slowing economic growth (or even a possible recession.)

Of the three people who today seem to have the highest chances of becoming president, there is a fairly clear range of policy proposals; even the two Democrats have enough difference between their positions to be worth mentioning, something you might not say about their position on income taxes, for example.

John McCain's position on health care is a fairly standard Republican line, and therefore generally a good free-market position, emphasizing that our problem is too much government interference, not too little, and that there is too much of a barrier between those who pay for health care and those who receive it.

Hillary's plan is nothing short of socialized medicine for a large number of Americans, including allowing people to choose between their current coverage (if they have any), or becoming part of the Federal Employee Health Benefit Program ("FEHPB") which Hillary says with a straight face can be done "without any new Bureaucracy", or choosing a new public plan like Medicare. It would be amusing if it weren't so frightening that she suggests her plan will reduce costs. Has she never studied the history of Medicare, or any other government entitlement program?

Obama's position is also socialized medicine, but is different enough from Hillary's to be worth describing separately. He also calls for "universal coverage" and also discusses a plan "similar to" that of the FEHBP.

Hillary's plan and Obama's plan share some important leftist similarities. Here are just to, to give you a flavor:

Hillary: "Employers will help finance the system"
Obama: "Employers that do not offer or make a meaningful contribution to the cost of quality health coverage for their employees will be required to contribute a percentage of payroll toward the costs of the national plan."

Hillary: "Insurance companies will end discrimination based on pre-existing conditions or expectations of illness and ensure high value for every premium dollar; while drug companies will offer fair prices and accurate information."
Obama: "No American will be turned away from any insurance plan because of illness or pre-existing conditions." and "Barack Obama will prevent companies from abusing their monopoly power through unjustified price increases. His plan will force insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profits and administration."

However, although it's not entirely clear from Obama's web page, Obama (sensibly) suggests that even "universal" coverage need not cover everybody. This key point came up in the last Democratic debate and was the subject of a recent Wall Street Journal editorial which I offer below for your edification. This is a subject which Americans must become more familiar with, and which I'll try to help provide facts about over the coming months including such things as the myth of 47 million uninsured Americans.

Here's the WSJ article:
The Wages of HillaryCare
Wall Street Journal, 2/4/08
http://online.wsj.com/public/article_print/SB120234937353949449.html

Hillary Clinton and Barack Obama agree on most policy issues, but that makes their rare differences all the more revealing. To wit, their running scrap over Mrs. Clinton's "individual mandate" for health care, which Mr. Obama has now had the nerve to expose for its inevitable government coercion.

Mrs. Clinton's proposal requires everyone to buy health insurance, along with more insurance regulation, a government insurance option for everyone and tax hikes. Mr. Obama likes all that but his mandate would only apply to children. He argues that the reason many people aren't insured is because it's too expensive, not because they don't want it. Mrs. Clinton counters that coverage can't be "universal" without a mandate.
[Barack Obama]

But then Mr. Obama had the impudence to defend his views. His campaign distributed a mailer in key primary states that claimed the Clinton plan "forces everyone to buy insurance, even if you can't afford it." It also featured an image of an anxious couple at a kitchen table. The Clinton apparat went apoplectic, claiming the flyer evokes the famous "Harry and Louise" commercials. A common article of liberal faith is that this "smear campaign" doomed HillaryCare in 1994 -- as opposed to, say, its huge cost and complexities. But never mind.

Yet if Mrs. Clinton's plan is better because it has a mandate, how does it work in the real world, where some people still won't be able to afford insurance, or would decline to acquire it? At a recent debate, the Illinois Senator drove the point home, asking Mrs. Clinton, "You can mandate it but there will still be people who can't afford it. And if they can't afford it, what are you going to fine them? Are you going to garnish their wages?" And in an interview with ABC's George Stephanopoulos on Sunday, Mrs. Clinton conceded that "we will have an enforcement mechanism" that might include "you know, going after people's wages."
[Hillary Clinton]

Well, well. In other words, HillaryCare II isn't all about "choice," but would require financial penalties for people to pay attention, including garnishing wages. To put it more accurately, the individual mandate is really a government mandate that requires brute force plus huge subsidies to get anywhere near its goal of universal coverage.

Mitt Romney's mandate program in Massachusetts is already expected to reach $1.35 billion in annual costs by 2011, up from $158 million today. And that's with only half of the previously uninsured currently enrolled; no less than 20% didn't qualify for subsidies and were granted exemptions because the costs were too much of a hardship.

Most experts calculate that a national mandate with subsidies like Mrs. Clinton's would enroll about half to two-thirds of the uninsured, less for a voluntary plan and subsidies alone. But such guesswork is pointless without the basic enforcement assumptions, which Mrs. Clinton refuses to provide. She's more interested in wielding what she calls "a core Democratic principle" against Mr. Obama. "My opponent will not commit to universal health care," she said Saturday.

The logic of Mr. Obama's approach is that policy makers should target those who are priced out of coverage. The Census Bureau says 38% of the uninsured earned more than $50,000 in 2006, 19% above $75,000. They aren't a major public policy problem -- except that a big reason they lack coverage is because it is more expensive than it needs to be thanks to government market interference. And 29% earn under $25,000, which means they probably qualify for existing subsidy programs like Medicaid or Schip but haven't enrolled.

The news here is that all of this is being exposed now, and by a fellow Democrat. Many Americans are uncomfortable with the coercion of the mandate -- and not all of them are Republicans. The California health-care overhaul was recently done in by liberals concerned about its consequences for the working poor.

The political lesson that Mrs. Clinton learned in 1994 wasn't about compromise or market forces. It was that a government health-care takeover can only be achieved gradually and by stealth. Her individual mandate is an attempt to force everyone to buy into a highly regulated and price-controlled system where government redistributes income and dictates coverage. We assume the McCain campaign is paying attention.