Wednesday, December 12, 2007

On Mandates

Paul Krugman is being attacked by Obama supporters (such as here on Daily Kos) because he believes "mandates" are necessary.

What are mandates?

Well, they're simple. They say that you have to have some kind of health insurance. Public, private, whatever, you have to have one. Edwards' and Clinton's plans have them, Obama's doesn't.

Krugman, rightly, points this out as a problem. If someone doesn't have to pay for something they don't immediately need, they probably won't. They might be too poor, or they might be too poor because they're buying something else, but they'll find a reason not to pay. Unfortunately, that means that the system really doesn't work: healthy people subsidize unhealthy people in any insurance system, and those healthy people who become suddenly sick and end up in emergency will end up bleeding the system dry, especially in situations where inexpensive preventative care is ignored because it's "too expensive", leading to far more expensive work later.

Obama's supporters are yelling about this, because they say that people without a whole lot of expendable income can't afford the insurance. I'm sympathetic to this, and I'm sure Paul is too. But let's be honest: health care costs have to come from SOMEWHERE. He's in favor of single payer, and you better believe I am too, but the only way to get to single payer is if EVERYBODY is in the system. That's the whole reason why single-payer works; "single-payer" could just as easily be called "everybody-payer".

And, yes, that will cost money. Taxes in, say, Canada are a little higher than they are in the U.S., principally because of socialized health insurance. Whether or not it comes from taxes or mandates, universal health care will have to be universally paid for, just like private insurance. It isn't a free lunch, and shouldn't be sold as such- it's just cheaper per capita than privatized insurance is.

And, no, you can't dodge around this simple point like Daily Kos diarist Eugene does here. Yes, private insurance doesn't cover everything and is often a hassle. So is socialized insurance; no system is perfect. Eugene pulls out this endless wankery about "neoliberalism", when it has nothing to do with that, and everything to do with the problem of programs costing money, and the bog-standard game theory problem that is the tragedy of the commons. That Krugman pointed this out makes perfect sense: he didn't stop being an economist when he started his NY Times column, and it doesn't make you a "neoliberal" to know what the hell a tragedy of the commons is.

I mean, look at this:

Finally, there is an economic argument against these subsidies - they're wasteful and ineffecient. Wouldn't those subsidies be better spent by government paying for low-income folks' health care itself, instead of giving subsidies to health insurers in the hopes that those insurers will, against all evidence, actually spend it on patient care?
And government money comes from where? Taxes! And what are taxes? MANDATORY.

And look at this:

Look, the point of a mandate isn’t to dictate how people should live their lives — it’s to prevent some people from gaming the system. Under the Obama plan, healthy people could choose not to buy insurance, then sign up for it if they developed health problems later. This would lead to higher premiums for everyone else. It would reward the irresponsible, while punishing those who did the right thing and bought insurance while they were healthy.

Krugman is saying here that we who cannot afford insurance but are "healthy" (I am 28 and uninsured) are "gaming the system." He's calling us cheats! He's engaging in classic conservative rhetoric by ignoring the financial problems causing us to forego insurance and then castigating us for daring to need public assistance when we do get sick. I find this to be a personally offensive statement right there - and if you recall the fact that health insurance is no guarantee of health care, this part of Krugman's column becomes totally indefensible.
Let's leave aside that nonsense about "health insurance isn't health care", because it's irrelevant to the question of how to pay for said health care. Yes, if you don't pay for insurance and then benefit from it later (presumably by hitting the ER when something bad happens), you ARE a drain on the system. This isn't "conservative rhetoric", it's a basic problem with the American system. They aren't going to leave you dying on the street because they aren't monsters, but you're still going to get that care, even if you aren't paying for it. Under a UHC system, you ARE paying for it. Whether you can "afford it" or not. If you are advocating UHC...and eugene is... then you are advocating everybody paying for it. As I said, taxes are mandatory.

But, I should point out, there's a difference between being irresponsible and being a "cheat". Irresponsible people will convince themselves that they cannot do something that they really should. A cheat knows what he's doing. Nobody is saying that eugene is a cheat. People ARE saying that some people (perhaps not eugene) will find a way to convince themselves that they can't or shouldn't pay for health insurance. Again, that's exactly why public health care is "universal": because everybody pays in.

(He goes on to castigate "market" rhetoric. Socialized health care is not "market" in any way, shape or form. That's the strength. I'm not even sure what he's about there.)

I like Obama. I like a lot of Obama supporters. But I'm sorry, guys, Krugman has a point here. "Universal" doesn't mean "free".

Edit: By the way, Krugman advocates single-payer as the best solution. I don't disagree, which is why I'm a little frustrated by the Obama people talking about how Krugman seems to be all market-oriented. He's not: what they don't get is that Krugman is using economic arguments in favor of something OTHER than raw capitalism. That's pretty rare, I know, but it does exist, and it certainly does here.

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