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Cover Me

February 2nd, 2008

One of the biggest knocks on Obama from the left, is that he doesn’t offer a health care plan that requires all Americans to purchase coverage.

Paul Krugman and Ezra Klein are infinitely more qualified to discuss the merits of mandates than I am. But while they have convinced me that mandates are hugely important in terms of strategy — because you have to guarantee universal coverage at the outset to prevent Republicans from whittling away at the number of insured — in terms of actual policy, they seem quite problematic.

Massachusetts, the state I live in, is a perfect example.

If you are dirt poor, you are wholly subsidized when purchasing health care. Good, good. If you fit somewhere below 300 percent of the poverty level (which is 62k for a family of four), you will receive some assistance in paying for health care. If you don’t have health care and don’t qualify for subsidies, the government will assist you in purchasing a low-cost plan from a private insurer. If you didn’t do this by the end of 2007, you will lose the $219 from your tax return, and more in subsequent years.

Because people living above the “poverty level” are often, in fact, still very poor, some folks will still not find it economically feasible to get insured. I think there are decent arguments to be made on both sides about whether the number of folks getting screwed is acceptably low. But the important thing to remember is that Massachusetts is a very liberal state with an abundance of good hospitals, and university-funded medical programs.

It’s quite likely that any kind of national plan would squeeze the shit out of people who make just enough to be on their own in terms of subsidies, but not nearly enough to afford health care, and I think the percentage of people who would fall into that unenvied category would be much bigger, because let’s face it, Massachusetts is not that representative of the rest of the nation.

So, to oversimplify the debate, it comes down to forcing some people to pay for what they can’t afford and leaving them out until there are more inexpensive options. Ultimately, I prefer mandates, but I think much more important is the amount of money any plan secures to provide the neediest with coverage, and to offer quality, inexpensive health care to all Americans.

Entry Filed under: Politics