Splitting the Difference on Mandates

Splitting the Difference on Mandates

Jacob Hacker wades into the great mandate debate this morning in the LA Times. He argues that the sturm und drang over mandates is overblown:

Still, I do not believe that the individual mandate is essential to healthcare reform, as its supporters suggest. That’s because Obama and Clinton have rightly rejected reform based on the individual purchase of insurance, choosing instead to allow most people to obtain subsidized coverage through their employers. By emphasizing the individual mandate, Clinton is shifting attention from this fundamental and popular feature of her (and Obama’s) approach and actually may be hurting the cause she cares so deeply about.

The cornerstone of both Clinton’s and Obama’s plans is the same: Employers must provide coverage to their workers or enroll them in a new, publicly overseen insurance pool. People in this pool could choose either a public plan modeled after Medicare or from regulated private plans. Both candidates have promised help for middle- and lower-income Americans, and both have said they will cut costs through administrative streamlining, prevention and quality improvement.

Copy Link
Facebook
X (Twitter)
Bluesky
Pocket
Email

Jacob Hacker wades into the great mandate debate this morning in the LA Times. He argues that the sturm und drang over mandates is overblown:

Still, I do not believe that the individual mandate is essential to healthcare reform, as its supporters suggest. That’s because Obama and Clinton have rightly rejected reform based on the individual purchase of insurance, choosing instead to allow most people to obtain subsidized coverage through their employers. By emphasizing the individual mandate, Clinton is shifting attention from this fundamental and popular feature of her (and Obama’s) approach and actually may be hurting the cause she cares so deeply about.

The cornerstone of both Clinton’s and Obama’s plans is the same: Employers must provide coverage to their workers or enroll them in a new, publicly overseen insurance pool. People in this pool could choose either a public plan modeled after Medicare or from regulated private plans. Both candidates have promised help for middle- and lower-income Americans, and both have said they will cut costs through administrative streamlining, prevention and quality improvement.

The Obama and Clinton plans, by contrast, get most of their mileage out of requiring that employers provide good coverage or help pay for publicly sponsored insurance. As a result, they can sign up most people — the 95% or so of nonelderly Americans who have some tie to the workforce — automatically at their place of work.

If enrollment is automatic for virtually all Americans, the big question is whether premiums can be kept low enough that people will want to keep the coverage (or, in the case of Clinton’s plan, won’t be forced to pay too much). This in turn depends on the generosity of federal subsidies. The federal price tag for Clinton’s plan is usually cited as $110 billion a year; for Obama’s plan, $50 billion to $65 billion. But the Clinton campaign estimates that her plan will save the federal government $56 billion, so she proposes almost the same amount of new federal spending as Obama does.

This syncs up with some of what I’ve been reading and hearing on the issue. On a slightly different note, during a recent episode of Bloggingheads Ezra Klein and I discussed the case against mandates from the left.

Support independent journalism that does not fall in line

Even before February 28, the reasons for Donald Trump’s imploding approval rating were abundantly clear: untrammeled corruption and personal enrichment to the tune of billions of dollars during an affordability crisis, a foreign policy guided only by his own derelict sense of morality, and the deployment of a murderous campaign of occupation, detention, and deportation on American streets. 

Now an undeclared, unauthorized, unpopular, and unconstitutional war of aggression against Iran has spread like wildfire through the region and into Europe. A new “forever war”—with an ever-increasing likelihood of American troops on the ground—may very well be upon us.  

As we’ve seen over and over, this administration uses lies, misdirection, and attempts to flood the zone to justify its abuses of power at home and abroad. Just as Trump, Marco Rubio, and Pete Hegseth offer erratic and contradictory rationales for the attacks on Iran, the administration is also spreading the lie that the upcoming midterm elections are under threat from noncitizens on voter rolls. When these lies go unchecked, they become the basis for further authoritarian encroachment and war. 

In these dark times, independent journalism is uniquely able to uncover the falsehoods that threaten our republic—and civilians around the world—and shine a bright light on the truth. 

The Nation’s experienced team of writers, editors, and fact-checkers understands the scale of what we’re up against and the urgency with which we have to act. That’s why we’re publishing critical reporting and analysis of the war on Iran, ICE violence at home, new forms of voter suppression emerging in the courts, and much more. 

But this journalism is possible only with your support.

This March, The Nation needs to raise $50,000 to ensure that we have the resources for reporting and analysis that sets the record straight and empowers people of conscience to organize. Will you donate today?

Ad Policy
x