Edwards Explains His Mandate

by: Matt Stoller

Thu Nov 29, 2007 at 16:26


And here's Ezra Klein on how Edwards will force everyone to enroll in universal health care.
Matt Stoller :: Edwards Explains His Mandate
Later today, John Edwards will announce the specifics of how his mandate works. And they're quite good. Whenever you come into contact with the health care system, or whenever you pay your taxes, you will be asked to provide proof of insurance, presumably a policy number or some similar identifier. If you cannot, you will automatically be enrolled in either a public plan that you qualify for (like Medicaid or S-CHIP) or the cheapest plan offered by his Health Insurance Market. Bills will then get sent out, and if they're not paid, will be collected just like the government collects on student loan debts, or taxes, or anything else, using tools up to and including collection agencies and wage garnishment. (It's notable, here, that Edwards doesn't shy away from saying what his stick will be.)

So at the end of the day, if you don't have health care, your wages will be garnished or your credit will be damaged because a collection agency will see to it that you buy your insurance.  You might even go bankrupt!  And since it's called a mandate, we'll need a new IRS-like bureaucracy to handle all of this, but it won't be the IRS since a mandate is not a tax, it's just a required fee you pay to a private company.

Ezra likes this stuff a whole lot, and has a bunch of posts praising the policies.  Oddly enough, I can't find polling on individual mandates, only employer mandates, which the public likes.  This data, the public is on board with having a government program to compete with private insurance by 76-24 margin.  The public opposes more taxes to pay for an expansion of Medicare/Medicaid by an equally large 24-76 margin.

Politically, this is a very attractive situation for the health care industry.  If the industry can simply prevent the government entity from existing while retaining a universal mandate in the final plan, what they will essentially be creating will be a privatized tax system that moves money from individuals to insurance companies from the current crop of the uninsured by government fiat.

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Edwards Explains His Mandate | 35 comments
Versus Obama. (0.00 / 0)
In both plans, they use the opportunity when an individual comes into contact with the Health Care system to get that person into the system.  Under Obama's plan, the health care professionals would give the patient information and they could immediately enroll in one of the private or National plans since there would be no exclusions.  It would basically be the same as bringing in someone with a pre-existing condition.  The fact that the person could be saving money rather than paying full price for treatment would be an incentive to come forward.  Under the Edward plan, the same person would be penalized for not coming forward sooner and depending on how long he delayed, the worse it would be for him.  This is the opposite of what we want for this class of fools who can afford health insurance but don't get it and put off seeing their doctors.
Edwards (0.00 / 0)
Under the Edward plan, the same person would be penalized for not coming forward sooner and depending on how long he delayed, the worse it would be for him.

It's hard to understand what you are talking about here since you are not very specific. Did you know that Edwards' plan eliminates discrimination based on preexisting conditions? Are you saying that automatically signing someone up for a "Health Care Market" Plan makes the problem worse for someone? Remember that a person or family will get a refundable tax credit to purchase the health care plan.

I you want health care, work hard. If you want universal health care, vote for liberals.
[ Parent ]
Clarification (0.00 / 0)
We are talking about the idiot who can afford health insurance but doesn't pay for it because he's healthy.  And I would add cheap.  The objection to the Obama plan is when this guy gets sick, he goes to the hospital, buys into a plan, and places a strain on the system since he didn't pay in during the time he was healthy and not using it.  Under Edwards plan, the same guy comes forward goes into a plan, but Edward fines him and makes him pay retroactively.  What I'm saying is the effect of that will be that this cheap idiot will really think twice before coming in to get treated, and that's not really what we want.  Under Obama, at the first sign of trouble, he may come in and then weigh the costs of insurance vs. the cost of treatment and for the first time in his life really think seriously about the decision he is making.  Under Edwards, he will avoid medical care like the plague - until he actually has the plague.  Now of course, I'm only talking about this ship of fools who don't want affordable health care, but that's the only group who are affected by the differences in plans.
[ Parent ]
I think its pretty clear (0.00 / 0)
That that is not what Edwards plan would do.  It would sign him up for a plan, and then he'd be sent a yearly bill just like everyone else.

I support John McCain because children are too healthy anyway.
[ Parent ]
I don't believe that is the case. (0.00 / 0)
If so then there is no teeth to the mandate and the only difference is that under Obama's plan this person would have the option of paying for the treatment himself, placing no burden on the system, where Edwards automatically places a burden since that person hasn't paid up to that point.  I don't believe that is Edwards plan.
[ Parent ]
I think (0.00 / 0)
the teeth come in when the person doesn't pay the bill that they were supposed to pay...  But when you come into contact with the system, say by getting sick, you get enrolled, not fined.

I support John McCain because children are too healthy anyway.
[ Parent ]
If that's the case (0.00 / 0)
and you aren't forced to pay the equivalent of back taxes, then there's little difference between him and Obama.
[ Parent ]
Obama (0.00 / 0)
doesn't make you enroll.  You get sick, you get emergency care, and then you continue to have health insurance.  If you get signed up automatically and don't pay, you're still without health insurance.


I support John McCain because children are too healthy anyway.
[ Parent ]
Disagree (0.00 / 0)
This chap would have already been signed up for the plan way before this would happen if he or she has ever submitted a tax return. That would pretty much exclude any rich guy from your outlined scenario. How many people are there who can afford health care on their own but don't buy it and have never been to the doctor and have never filed taxes? That's like the proverbial 40-year-old virgin.

I you want health care, work hard. If you want universal health care, vote for liberals.
[ Parent ]
grossly mistaken (0.00 / 0)
"Edward plan, the same person would be penalized for not coming forward sooner and depending on how long he delayed, the worse it would be for him."

Uh, no. If you're 18 years old and haven't had a job yet and then you get a job and start paying social security taxes, are you penalized for not paying social security taxes since you were 16? I don't think so. It's the same concept here.

All Edwards does is widen the net to catch people who are not signed up so that everyone actually is signed up.

Stoller: What the hell is your problem? You're sounding like a damn libertarian. There aren't going to be gestapo coming to your door to beat you up if you don't have health insurance. You know, taxes can be construed as a coercive government action too (enter Ron Paul wingnuts), but since we're, you know, progressives, we actually believe in things like government mandates. You don't get to skip out on paying for social security (or defense spending) and you don't get to skip out on paying (at an extremely discounted rate, and lots of times not at all) for health insurance.

[ Parent ]
Absolutely (4.00 / 2)
The Edwards plan includes generous subsidies that are phased out up until 100,000 dollars in income.  Families are far, far more likely to go bankrupt if they have a medical crisis and don't have medical coverage. 

Also, once again Krugman is right on the scene and cuts to the chase on the importance for the overall prgram:

Why have a mandate? The whole point of a universal health insurance system is that everyone pays in, even if they're currently healthy, and in return everyone has insurance coverage if and when they need it.

And it's not just a matter of principle. As a practical matter, letting people opt out if they don't feel like buying insurance would make insurance substantially more expensive for everyone else.



[ Parent ]
Obama's plan is a step toward single payer (4.00 / 2)
Sometimes I feel like Obama is the only Democrat who can see more than one move ahead on the chess board. He has expressed his support for single-payer in the past as the best solution,  but has said it's not a politically feasible solution at this time.

His plan is much more of a step toward single payer than the others for one main reason that Matt is identifying: it doesn't involve the creation of (and presumably, eventual dismantling of) a huge invasive bureaucracy to "mandate" health care on individuals.

Ezra says in his piece he wishes Obama would just advocate for collective responsibility by having the government pay for everyone's health care. I see his plan as getting much closer to that than Hillary's or Edwards'.

Politics is a strong and slow boring of hard boards.

In (4.00 / 2)
What way does Obama's plan move us closer?  Edwards makes everyone sign up, with a public option.  If public health care works better, which I believe it will, people will choose that instead.

By not mandating you leave healthy out of the system, causing prices to rise.  That's a major problem that I just don't think he's dealt with.

I support John McCain because children are too healthy anyway.

[ Parent ]
I'm healthy, (0.00 / 0)
I have insurance. By lowering the price, the healthy will buy in, not opt out.  This whole debate has been blown out of proportion because it really only concerns the foolish who can afford now cheaper and better insurance but willfully decide not to buy it.  And those concerns need to be weighed against the political risks of trying to get a mandate passed.  My guess is the individual mandate will be the first thing thrown out the window when the real discussions begin.  Obama is being more transparent and realistic.
[ Parent ]
Good government = Obama (0.00 / 0)
I believe you, but Obama better start providing a simple explanation on why his plan makes more sense or else HRC is going to end up winning this war of words.
[ Parent ]
Obama (4.00 / 1)
What you see as seeing more than one move ahead, I see as bargaining two steps ahead before the other side has even made an offer!

His plan will not cover everyone and I believe it will not provide as affordable coverage as the Edwards plan.

[ Parent ]
Obama and Mandates (4.00 / 1)
There is an excellent interview with Obama conducted by Guy MacMillan of the Keene Sentinel in New Hampshire that gives Obama a chance to answer questions about that exact issue in some depth.  It is well worth checking out.

http://www.youtube.c...

and the issue is... (4.00 / 4)
If you can't pay for insurance, Edwards would enroll you in a public plan.  He's included his own public plan inside the system that would compete with the private plans.  This is a government mandate, and by the way, so is single-payer health care.

I agree wholeheartedly that you cannot have an individual mandate without a public/private competition option, and the health care industry will certainly try to work to eliminate it.  But don't you think progressives would be JUST as successful by saying "the health care folks want to take away your Medicare"?

Bad universal systems like that in Massachusetts or the one proposed in California are forced markets for the insurance companies.  Edwards' system couldn't be further from that. 

Insert shameless blog promotion here.

a public plan (0.00 / 0)
"or the cheapest offered by his Private Insurance Market." I don't like that at all, because I can't imagine that the insurance industry would let the government take their business. And I think they are a lot more organized than the government, frankly.

I also think this debate needs a better assessment of just where progressives are in terms of our ability to influence public opinion at this point in time. We kind of don't know our asses from our elbows right now. We aren't yet in a position where we can just "say" anything, because we don't even have a communication channel for our movement, and the right wing has a total lock on the corporate media.

Politics is a strong and slow boring of hard boards.

[ Parent ]
Health plan (4.00 / 1)
"I don't like that at all, because I can't imagine that the insurance industry would let the government take their business. "

So? They would be forced to provide as good a health care plan as the government option (which will be about as good as the very best PRIVATE plan out there today) at a minimum. If they can do that and do it cheaper than the government, then more power to them. Something tells me though that with 20% overhead costs (read Profit) compared to 3% for Medicare, the government is going to win that fight.

[ Parent ]
public plans will be more expensive and tax-subsidized (0.00 / 0)
Two factors will overwhelm profit margins in terms of cost.  I have a few other observations, so hear me out.  Here's what I think will be the differences between public and private.

#1: we should expect the private plans to be reluctant to take on old, high risk, sickly individuals.  The government plan, however, won't be able to say no.  Those with disabilities, regular medical needs, high risk for expensive surgical procedures, or have higher medical costs due to age will default to the government plans.  The difference in aggregate risk for the private plans and the public plans will more than wipe out advantages to be gained by elimination of "overhead."  [b]Considering high risk individuals use 100 times more health care than the average healthy individual, we should expect the government plan to be much more expensive.[/b]

#2: the insurance companies have a sophisticated mechanism for denying care reimbursement to their customers.  These mechanisms hassle the customer and sometimes deny care, but these tactics do cut costs to the insurance company.  The government won't be doing this.  We should expect the government plan to have lower administrative costs, but incur more costs for more health care dispensed.  This is going to be a modest increase in costs.

#3: the insurance companies exert their economic power over hospitals and clinics and negotiate for lower prices.  Sometimes these prices are so low that the doctors or hospitals will refuse to service those insurance plans.  The insurance companies will also hassle the doctor for lots of paperwork to justify the health care dispensed.  The government will not require the same amount of paperwork for health care justification.  It will have more negotiating power than the insurance companies, but may not utilize its full negotiating power against clinics and hospitals.  This could drive government plan costs up or down.  It's unclear.

#4: quality of care may not be top notch.  I expect the government will pay a uniform fee for the same type of procedure regardless of the quality of the doctor, clinic, or hospital.  (This is why I say government won't use its full negotiating power.)  If members of the government plan are allowed to choose and switch doctors, doctors will have an economic incentive to provide good care.  None will really provide excellent care.  The top quality doctors will probably exclusively service the high end private plans.  If members of the government plan aren't allowed to choose and switch doctors, then the quality will be disastrous.  Doctors will still perform adequately since they are ethically bound to do so, but the extra effort may not be there.

#5: preventative care in the government program will be mandatory.  It may even be mandatory in private plans.  Someone negligent in catching cancer in its early stages would cost the government a lot of money.  The government will seek to prevent this scenario, and its policy would require its members get preventative care.  This may be applicable to private plans too.  The government won't want to pick up the tab for the negligence of someone that was previously on a private plan.  This is the reason behind Edwards's "You don't have a choice." comments.  Indeed we won't have a choice.  Smoking is probably out of the question, too.  Smokers will have to quit.  This is going to be a severe cost cutting measure if applicable to the private plans as well.  It's rather tyrannical.  (hmm, what about proper diet and exercise?  Going down this path, leads to some horrifying propositions.)

#6: because of the increase in costs primarily because of the first two observations, we'll put the full ticket of government plan out of reach of some individuals.  Subsidization will be required to help those individuals pay for the government health insurance.  We'll pay for the balance through our taxes.

....  there are probably many more side-effects.  I can't foresee all of them, but they will be there...  As I said in #6, #1 and #2 will be the dominating factors in making the government plan more expensive.  #5 and its logical extensions are rather horrifying to think about.

[ Parent ]
Jenifer (0.00 / 0)
If we're in a position where this bill is seriously being offered, then John Edwards would be in the bully pulpit of the White House.  And you can bet that he'd make the progressive argument, and you can bet it would be reported.

Insert shameless blog promotion here.
[ Parent ]
The same goes for Obama (0.00 / 0)
Under Obama's plan if you can't pay for insurance, Obama would enroll you in the public plan.  There is no difference in the structure between them in that aspect or in the private/public competition.  Obama has a regulatory board that guarantees the Private plans at least match the Public plan in services and puts a restriction on price.  This goes along with an employer mandate to either offer private coverage or pay into the public plan.  How does Edwards handle that issue?
[ Parent ]
this isn't true (4.00 / 2)
And you keep repeating it. Obama would not enroll you in anything, necessarily. You might not even have the option of enrolling in the public plan.

Join us at the Missouri community blog Show Me Progress!
[ Parent ]
Okay let's reverse it. (0.00 / 0)
I keep repeating it because it is true.  The person we were talking about was someone who doesn't have insurance because they can't afford it, which in Obama's plan kicks in the subsidies of the National Plan.  The only reason why a person wouldn't be enrolled at that point was if they didn't want to, which is inconceivable because if they can't afford the insurance, they certainly couldn't afford the treatment.

But instead of repeating myself, please tell me where you get the idea they wouldn't have the option of enrolling in the public plan.

[ Parent ]
Where you're going wrong is that (4.00 / 1)
you keep saying that under Obama's plan, the public option would compete with the private plans. But that's not true, the public option is only for the self-employed, small businesses, and the uninsured. That's the opposite of placing the two in competition; that's walling off a segment of the population that's likely more costly. And if you don't have some sort of mandate, you tack the free rider issue on, to boot.

Join us at the Missouri community blog Show Me Progress!
[ Parent ]
public option (4.00 / 1)
Obama's public option is not allowed for everyone. Only for certain people. In the Edwards plan, anyone can choose the public option. It's much more progressive.
[ Parent ]
Edwards' Public Option (4.00 / 1)
The beauty of the competition between the private and public options is that the public option is more efficient, lacking the insurance bureaucracy, and over time will move us indirectly to a single-payer system that we could never achieve directly
Is there any difference? (0.00 / 0)
I know Obama has a public option.  Doesn't Clinton have one as well? 
[ Parent ]
Geez.. (4.00 / 1)
DD2...don't you have anything better to do all day than stalk the boards and be a pro-obama advocate?

Any slight criticism of your candidate and you freak out. You're part of the reason why reading the comment threads can be a pain in the ass. Concern Troll.

[ Parent ]
public option (4.00 / 1)
Obama's public option is not really an option for the public. Only certain groups are allowed to choose it, otherwise they are forced onto the private market. It's much more like the awful MA plan.
[ Parent ]
Reading through Obama's plan (0.00 / 0)
I do not see this group of people who are being forced onto the private market.  Who are they?
[ Parent ]
what about the indiv. mandate enforcement? (0.00 / 0)
I got the sense from the post Matt linked to that there would have to be a new IRS-like government agency trying to make sure everyone had coverage. That's the part I am worried about. It seems wasteful and intrusive.

Politics is a strong and slow boring of hard boards.
[ Parent ]
enforecement (4.00 / 1)
Gee, you'd think Matt was trying to obfuscate the issue wouldn't you!

No, the tools are already in place within the federal government. It would just be a matter of direction. And really, the main enforcement would just come from a single line on your tax form stating who your insurance is with and your policy number. Pretty simple and not intrusive at all.

[ Parent ]
WTF??????? (4.00 / 2)
Matt, are you going to make an announcement coming out of the closet as a Republican? Or maybe just a Hillary supporter? Probably the later judging from your comment about "I can't find polling on individual mandates, only employer mandates, which the public likes."

Poll-driven leadership, that's the ticket!

I have to assume that you know better than to really argue based on logic that mandating that everyone be covered is bad, right? I mean, you do know, don't you, that the whole concept of "insurance" is that everyone chips in to cover those who have health issues pop up, and that nobody wants to (see polls) pay when they are healthy but the best systematic way to share the risk of a serious health issue is to enroll everyone?

Of course you do.

So wtf are you trying to do here?

Edwards Explains His Mandate | 35 comments
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