The Debate On Healthcare: Mandates

The question of the competing health care plans has been one of the major differences between Hillary Clinton and John Edwards on one hand, and Barack Obama on the other. Clinton and Edwards favor mandates, which would require everyone to have health insurance (while providing subsisides to those who can not afford it). Obama opposes mandates. Last night it was discussed again. Here is a key exchange:

OBAMA: With respect to universal coverage, understand what this debate is about. And this is a legitimate policy debate. And I respect the positions that John and Hillary have taken. They have decided that we should mandate coverage for all adults. I believe that the problem -- and understand what that means. A mandate means that, in some fashion, everybody will be forced to buy health insurance. Now, John has been honest that that may mean taking money out of people's paychecks in order to make sure that they're covered. Senator Clinton has not been clear about how that mandate would be enforced. But I believe the problem is not that folks are trying to avoid getting health care; the problem is they can't afford it. (APPLAUSE) And that's why my plan emphasizes lowering costs, not only setting up a government plan so that people who don't have health insurance can buy into it and will get subsidized, but also making sure that those who have health insurance -- because, keep in mind, we've got millions of Americans all across the country who have health insurance, but are struggling with rising co-payments, deductibles, premiums. Under George Bush, families are paying 78 percent more on health care than they were previously -- let me just finish, because this is an important policy point. We put in a catastrophic re-insurance plan that will help reduce those premiums for families by an average of about $2,500 per year. But the last point that I think is worth making, every expert that's looked at this has said there is not a single person out there who's going to want health care who will not get it under my plan. And it's true that some people could game the system by just waiting until they get sick and then they show up. But keep in mind that my plan also says children will be able to stay on the parents' plan up until the age of 25. And so I don't believe that there are a whole bunch of folks out there that will not get coverage. And, John, both you and Hillary have a hardship exemption, where, if people can't afford to buy health care, you exempt them, so that you sort of don't count them.

EDWARDS: But we would cover them. We cover them, Barack.

OBAMA: But you don't cover them.

EDWARDS: Yes, we do.

CLINTON: Yes, we do.

EDWARDS: Yes, we do. It's not true, Barack.


CLINTON: That is not true.

EDWARDS: No, no. Here's the problem. The problem with this argument is you can make exactly the same argument about Social Security. I mean, you think about the analogy. What George Bush says is he wants people to be able to get out of the Social Security system, choose, elect to get out of the Social Security system. Well, that's exactly what this argument is.


EDWARDS: This argument is you shouldn't have to have health care. If you choose not to have health care, you shouldn't have to have it. And that is a threshold question. It is a judgment. It's a fair policy debate. There's nothing wrong with us arguing about this, but I believe that there is not a single man, woman, and child in America who's not worthy of health care. Everybody should get health care.


CLINTON: Well, first of all, if you don't start out trying to get universal health care, we know -- and our members of Congress know -- you'll never get there.

If a Democrat doesn't stand for universal health care that includes every single American, you can see the consequences of what that will mean. I think it is imperative that we have plans, as both John and I do, that from the very beginning say, "You know what? Everybody has got to be covered."

There's only three ways of doing it. You can have a single-payer system, you can require employers, or you can have individual responsibility. My plan combines employers and individual responsibility, while maintaining Medicare and Medicaid.

I think that the whole idea of universal health care is such a core Democratic principle that I am willing to go to the mat for it. I've been there before. I will be there again. I am not giving in; I am not giving up; and I'm not going to start out leaving 15 million Americans out of health care.

Secondly, we have seen once again a kind of evolution here. When Senator Obama ran for the Senate, he was for single-payer and said he was for single-payer if we could get a Democratic president and Democratic Congress. As time went on, the last four or so years...

CLINTON: As time went on, the last four or so years, he said he was for single payer in principle, then he was for universal health care. And then his policy is not, it is not universal. And this is kind of like the present vote thing, because the Chicago Tribune, his hometown paper, said that all of those present votes was taking a pass. It was for political reasons.

Well, when you come up with a universal health care plan and you don't have any wiggle room left, you know that you're going to draw a lot of political heat. I am not running for president to put Band- Aids on our problems. I want to get to universal health care for every single American.


BLITZER: I have to let Senator Obama respond.

But try to be brief, 30 seconds, if possible.

OBAMA: Here's the policy question: if, in fact, we are not making it affordable enough, which is what's happening right now, and you mandate on families to buy health insurance that they can't afford and if they don't buy it you fine them or in some other way take money for them -- this is what's happening...

EDWARDS: But, Barack, you're ignoring that we subsidize...

OBAMA: John, I haven't finished. John, let me finish.

EDWARDS: OK, all right, go ahead.

OBAMA: Now, what is happening in Massachusetts right now -- there are articles being written about it -- which is that folks are having to pay fines and they don't have health care. They'd rather go ahead and take the fine because they can't afford the coverage.

My core belief is that people desperately want coverage. They desperately want it, and my plan provides those same subsidies. And if they are provided those subsidies and they have good, quality care that's available, then they will purchase it. That is my belief.

Now, it's fine for us to have a debate about how the best way to get there is, but to suggest somehow that I'm not interested in having anybody covered, or to suggest, as Hillary just did, that I was in favor of single payer -- I never said that we should try to go ahead and get single payer. What I said was that if I were starting from scratch, if we didn't have a system in which employers had typically provided health care, I would probably go with a single-payer system.

What's evolved, Hillary, is your presentation of my positions, which is what's happened frequently during the course of this campaign.

(APPLAUSE) BLITZER: Thank you, Senator.

This was a good exchange.

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  • Display: Sort:
    It was good (5.00 / 1) (#1)
    by andgarden on Tue Jan 22, 2008 at 08:15:35 AM EST
    and I think Edwards/Clinton got the better of the argument. Edwards's tying it to social security was very effective, as was Clinton's presentation of UHC as a core Democratic value.

    Obama lost much of the ground he had gained (5.00 / 2) (#2)
    by Molly Bloom on Tue Jan 22, 2008 at 08:32:52 AM EST
    with me after Iowa and NH- even with his new found willingness to fight. I think he would be an effective VP candidate.

    VP of a small company near Chicago (none / 0) (#4)
    by koshembos on Tue Jan 22, 2008 at 09:19:20 AM EST
    This guy scares almost as much as Guiliani does. Reagan, social security, health care lite, vouchers, war in Pakistan sound Republican.

    owner of a small company here (none / 0) (#5)
    by hellothere on Tue Jan 22, 2008 at 09:38:53 AM EST
    i spend more on health insurance than my mortgage. so obama's invitation even before winning the election to bring insurance companies in did not sit well with me.

    krugman has written several good pieces on health care.


    The healthcare discussion (none / 0) (#3)
    by Bob In Pacifica on Tue Jan 22, 2008 at 08:52:43 AM EST
    made me wish that Kucinich was there. Single-payer is the most efficient, most widespread.

    yup, kucinich has made some (none / 0) (#6)
    by hellothere on Tue Jan 22, 2008 at 09:41:10 AM EST
    very good points about insurance.

    Mandates are Outrageous (none / 0) (#7)
    by JHFarr on Tue Jan 22, 2008 at 09:47:50 AM EST
    Why? Because no one else can tell me what I can or can't afford! And I guarantee you that for someone like me, over 60 but in perfect health, being forced to buy the lowest-rung health insurance policy will only take money from me and give it to the insurance companies.

    The only "mandate" I will accept is declaring the Congressional health plan open (and free) to all Americans. The irony is that we could actually afford this, if we weren't spending trillions of dollars to kill brown people all over the world.

    That wouldn't be free either. (none / 0) (#8)
    by Teresa on Tue Jan 22, 2008 at 10:16:36 AM EST
    You'd be paying it out of your taxes.