Another Dem Debate Tonight? Another Chance to Go Round and Round on Health Care Mandates

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Another Democratic debate tonight? Enough already. Hillary Clinton has been pushing Barack Obama for more and more debates. But these debates have lost their utility. Do we really need to see the pair bicker once more over health care coverage mandates? That’s the only major current policy difference that the two have zeroed in on in their face-offs. They argue their points around and around in a circle like quarrelers in a bad marriage. And they’re kinda both right.

If you want to achieve universal coverage at the most efficient price point, then you need as big a pool as possible. That’s basic economics. So Hillary Clinton correctly notes that mandates are needed–especially to get into this pool those folks who may not need costly health care. Their premiums will help cover the cost of care for others. That’s how insurance works: the more, the merrier.

But Obama has a point when he says that it would not be fair to force people to buy insurance they cannot afford and that may not meet their needs. I recently met someone from Massachusetts–where there now is a health insurance mandate–who complained that she and her husband could not afford the insurance they are mandated to purchase. And, she added, they make just enough money to be beyond qualifying for a subsidy. This couple is considering moving out of the state. Maybe they’re over-reacting to the situation. But no one should be compelled to purchase substandard but costly coverage. Consequently, it seems fair to say, “Let’s see the policy, before we accept the mandate.” No doubt about it, Obama got somewhat trapped in all this. He put out a plan with limited mandates (only for parents regarding coverage for their kids) and was then raised (as in poker) by Clinton. At that point, Obama could not admit he had proposed an insufficient plan. He was forced into a corner–defending the absence of a comprehensive mandate in his plan–and this debate was born.

But there’s this: if either of these Democrats are elected, he or she will pull together roughly the same band of policy experts and craft a plan with congressional leaders that will likely not match exactly what they are proposing now. They may have to deal with health care reform in increments (depending on the composition and mood of Congress). And mandates may or may not be part of that process at the start. Would Hillary Clinton trade away mandates to get the rest of her plan through Congress? You betcha. (If you truly care about the details of this difference, check out NPR’s recent dissection here.)

So can we move on? Probably not. The candidates seem committed to pounding away on this point. In recent days, they have also tussled over NAFTA. Clinton has been endeavoring to back away from the trade accord that is unpopular in Democratic circles (particularly among blue-collar Dems). And while Obama has been reminding people of her past support, the Clinton camp has been trying to dredge up old Obama quotes showing he once had at least a mixed view on NAFTA. But on this front, Clinton, who is in second place, is in the weaker position. It’s not to her advantage to do battle over Nafta; her husband worked hard to pass it, after all. She seems to believe that the mandate issue offers her potent ammo. Blasting Obama on this topic hasn’t yet paid off. But her campaign advisers must feel that there’s no telling what will happen the 168th time she tries.


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