My post on this subject last week sparked a lively and substantive discussion among our commenters. As promised, the New Republic’s Jonathan Cohn–whose writing, for my money, is must-read for anyone who really wants to understand both the policy and the politics of health care–has returned to the subject. He takes a look at Barack Obama’s contention that his plan, designed without an individual mandate, could actually cover more people than Hillary Clinton’s or John Edwards’, which do contain one. Cohn’s bottom line: Obama is wrong, not just on the substance, but on the politics of the issue. Cohn tells us:
If the significance of including a mandate as part of health care reform really came down to nothing more than the numbers, it would not be so important. Obama’s plan may not reach as many people as Clinton’s or Edwards’ would, but it would reach an awful lot of people–and, as such, do an awful lot of good. And, thankfully, Obama continues to say he wants to achieve universal coverage–that is, to make sure everybody has insurance. At least he has the right goal in mind. But achieving universal coverage is as much a political challenge as a policy one. And by talking down a mandate, he makes the political challenge that much harder. Among other things, the moderate Republicans and business groups willing to consider universal coverage will likely demand that a mandate be part of the package, because they see it as a way to reinforce personal responsibility. The insurance industry, meanwhile, will demand it because they think it essential to prevent an adverse selection death spiral. If the idea is to pass universal health care with bipartisan support, then a mandate may be essential.
(As I was getting ready to post this, I got an email from Jon saying: “I should add that, for the record, the Obama people object to my characterization that Clinton and Edwards are as good on affordability as they are.”)