There is something that has been getting at me lately, and that is how some progressives choose to attack the health care reform bill. One of those principal routes is by attacking the mandate as "forcing people to buy insurance they don't want". Here's the first reason on Jane Hamsher's 10 reasons to kill the Senate bill:
Top 10 Reasons to Kill Senate Health Care Bill
1. Forces you to pay up to 8% of your income to private insurance corporations - whether you want to or not.
PCCC/DFA has a poll out asking "Would you favor or oppose requiring all Americans to buy health insurance -- the so-called mandate -- even if they find insurance too expensive or do not want it?" with the results of 51% oppose, 38% favor.
Now, I have enormous respect and appreciation for the work Jane, FDL, PCCC and DFA have done on health care reform, and respect arguments on the basis of affordability, which is one part of this poll question. But this business about "whether you want it or not" is one step too far.
I explain why on the flip.
|In the first place, the messaging comes right out of the right-wing playbook. Conservative libertarian types have argued for years against mandatory participation in programs like Social Security on the basis of "the government is going to take part of your paycheck- whether you want it to or not! Tell the liberals you can make your own choices!" Making the same arguments on health care is echoing right-wing frames.
In the second, I don't care if people don't want health insurance. Do I care when people- young people just getting their first paychecks, libertarians, etc.- complain about being forced to pay into Social Security and Medicare when they don't want to? No. Pay up, folks.
Why do I say that? Because social insurance programs do not work without mandates. There are ten thousand pages worth of academic and policy economic literature on this issue. If you argue against the economic logic of mandates, or do polling just to demonstrate how much Americans hate mandates, you, as a progressive, really have no leg to stand on when arguing for compulsory Social Security, Medicare, Medicaid, worker's compensation, and so forth. None of those programs would work without a mandate.
In the third, Americans "don't want" a lot of things. I mean, I get that good people are trying to do anything they can to defeat the bill. And I no doubt have, or will, done or ignored polling results that fit my goal. For example, if we had 70% against the public option, no doubt progressive activists would be saying Americans just don't understand health care markets, and still push it anyway. Such is politics.
But one thing I can't deal with is polling Americans on academic policy concepts they don't understand, like health care mandates, and pretending like they have any clue what they're talking about. Hell, if I ran the question "Would you favor or oppose the government, without your consent, automatically deducting money from your paycheck- the so-called "Medicaid" proposal- to give to the poor, even if those receiving money do nothing to help themselves?" at the time of legislative passage, what kind of results do you think I would get? Americans don't understand concepts like risk pooling, adverse selection, moral hazard, information asymmetry, the health insurance death spiral, which are essential to understanding health care markets and the importance of a mandate. Hell, I only understand them myself because my boyfriend is a health economist. So I am certainly not going to honestly point to a poll result and say Americans know what's best for themselves when they seriously don't understand the background of the policy.
And frankly, if this were a wonderful bill with a public option and cost controls and good affordability, I would throw down money to bet a lot of progressive activists would tell conservatives opposed to the mandate, "tough shit, it makes economic sense!".
Now, that doesn't mean you can't attack a mandate. If you want to attack a mandate based on progressive principles, by all means. Talk about how Americans shouldn't have to buy insurance they can't afford. Do what Jim Dean did and talk about forcing people into the arms of the criminal insurance companies, and how that's different than a mandate for Social Security or Medicare. There are better ways to defeat the bill than using right-wing frames on choice or pretending the American public has any clue about health insurance markets.