In today’s political casualty report from the health-insurance-mandate front, Paul Krugman once again attacks the man who is likely to carry the Democratic standard into battle, if not now then eight years from now, while Hillary Clinton gets mousetrapped by a reporter into mentioning wage garnishment as a mandate-enforcement mechanism. At this rate, what ought to be a huge Democratic advantage on health care could easily be neutralized.
This is not an issue worth making a headline argument about. Both Democratic candidates support making health coverage available and affordable to anyone who wants it. John McCain opposes making health coverage available and affordable to anyone who wants it. The rest is commentary.
Since HRC has never actually defined an enforcement mechanism for mandates, I don’t know how Jonathan Gruber or anyone else can reliably estimate how many people would defy or neglect a mandate and wind up uncovered as a result. (The willingness to assume a can-opener is an occupational disease of economists.) And of course no plan that omits 12 million illegal aliens could actually cover “essentially all” the currently uninsured.
Surely Krugman is simply wrong when he says that opposition to mandates makes the passage of a comprehensive health care reform impossible. Why not pass a no-mandate policy first and go after the free riders when free-ridership is a demonstrated problem rather than a theory? Calling the financial disincentives for non-enrollment “back premiums” rather than “penalties” strikes me as mostly a quibble, not a policy difference.
(No, I’m not an expert on health care policy. But lots of real heavyweights in the field — the names that leap out at me are Henry Aaron, Stuart Altman, David Blumenthal, Ted Marmor, and Mark Schlesinger, in addition to the RBC’s own Harold Pollack — have reached more or less the same conclusion.)
Footnote The convention that requires Democratic (but not Republican) Presidential candidates to issue detailed policy documents as part of their campaigns is enormously destructive and should be ended, preferably by a treaty among the candidates the next time there are contested primaries.