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Friday, November 30, 2007

And this is the problem with Barack Obama
Posted by Jill | 6:20 AM
I'll defend Barack Obama against those who are trying to brand him as some sort of terrorist mole because his father was Muslim. I won't, however, defend him against what's increasingly evident -- his alarming tendency to adopt "bipartisanship" by framing policy in right-wing talking point terms. We've seen what "reaching across the aisle" does when dealing with an intractable, rigid Republican party with a sense of entitlement. I've been concerned about Obama's alarming tendency towards conciliation-by-capitulation ever since his mentorship by Joe Lieberman during the first months of his terms. And now, after buying the Republican frame that Social Security is in crisis, he's now buying their frame on universal health care.

I'm not crazy about the idea of mandatory purchase of health insurance either -- at least not as insurance is currently structured, where insurance is provided by for-profit entities with a greater responsiblity to keep costs in check and provide profits for stockholders than to provide coverage for medical expenses. Americans who receive insurance coverage as an employment benefit are largely insulated from the actual cost of such insurance -- until they lose their jobs and get stuck with the entire premium under COBRA. My own excellent plan, which has a sizable network of quality physicians and an 80% out-of-network reimbursement after a reasonable deductible of $350 per year per person, costs my employer over $13,000/year, of which I pay about a third. Premiums are on a sliding scale based on salary -- a method which caused much hue and cry when first implemented this year, but which I think is eminently fair. If I lose my job, however, then we go to Mr. Brilliant's plan, which uses the HMO "primary care doctor" model in which you must have a referral to see a specialist. But if we had to spend five figures for health coverage, we, like most Americans, would balk.

The mandate is troublesome in both the Clinton and Edwards plans, but the Edwards plan's nonprofit Health Care Markets (assuming the concept works) at least has a built-in element of risk-sharing, which is of course how insurance is supposed to work; along with a "public plan", which is a first step towards universal, single-payer health care coverage. The one question mark, of course, is just how much this health coverage will cost, and how families with little money left over after paying for rent/mortgage, car insurance, food, clothing, and spiralling utility costs, will be able to pay for such coverage.

But Barack Obama insists on playing nice with Republicans by adopting their framing, as Paul Krugman notes today:

The central question is whether there should be a health insurance “mandate” — a requirement that everyone sign up for health insurance, even if they don’t think they need it. The Edwards and Clinton plans have mandates; the Obama plan has one for children, but not for adults.

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.

Here’s why: under the Obama plan, as it now stands, healthy people could choose not to buy insurance — then sign up for it if they developed health problems later. Insurance companies couldn’t turn them away, because Mr. Obama’s plan, like those of his rivals, requires that insurers offer the same policy to everyone.

As a result, people who did the right thing and bought insurance when they were healthy would end up subsidizing those who didn’t sign up for insurance until or unless they needed medical care.

In other words, when Mr. Obama declares that “the reason people don’t have health insurance isn’t because they don’t want it, it’s because they can’t afford it,” he’s saying something that is mostly true now — but wouldn’t be true under his plan.

Mr. Obama, then, is wrong on policy. Worse yet, the words he uses to defend his position make him sound like Rudy Giuliani inveighing against “socialized medicine”: he doesn’t want the government to “force” people to have insurance, to “penalize” people who don’t participate.


I recently castigated Mr. Obama for adopting right-wing talking points about a Social Security “crisis.” Now he’s echoing right-wing talking points on health care.

What seems to have happened is that Mr. Obama’s caution, his reluctance to stake out a clearly partisan position, led him to propose a relatively weak, incomplete health care plan. Although he declared, in his speech announcing the plan, that “my plan begins by covering every American,” it didn’t — and he shied away from doing what was necessary to make his claim true.

Now, in the effort to defend his plan’s weakness, he’s attacking his Democratic opponents from the right — and in so doing giving aid and comfort to the enemies of reform.

Obama may regard this adoption of right-wing framing as a gesture of "conciliation". But he's mistaken if he doesn't think the opposition will use this as a cudgel with which to beat him senseless if he is the eventual nominee.

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