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COLUMNISTS
TODAY'S STORIES
01.02.2008
Harry and Louise -- They're Back!

A quick follow-up on last night's debate over health care reform -- and then a new development.

1. A substantial group of 80 intellectuals have signed a letter arguing that the mandate debate is overblown and that "There is simply no factual basis for the assertion that an individual mandate, by itself, would result in coverage for 15 million more Americans than would robust efforts to make health care more affordable and accessible."  And while not everybody on the list qualifies as a heatlh care scholars -- I'd love to see Harvard Law Professor Laurence Tribe on the Supreme Court, but when did he start studying insurance mandates? -- it includes a lot of people I know and respect, including Henry Aaron from Brookings, Stuart Altman at Brandeis, and Ted Marmor at Yale.  I'm also a fan of the University of Chicago's Harold Pollack, who posted the letter at Huffington Post -- where you can read it

Read what they have to say; take it seriously.  Since I've certialy had my say on this, and then some, I'll give only a very brief response.

Last night, I concluded my item by saying "about the policy question asked during the debate -- whether this mandates make a difference -- the overwhelming consensus among experts is that they do."  This was overstated.  What I should have written was that it's the overwhelming consensus among economists who model these propoals -- i.e., people who have worked closely with the actual available data on this and projected the impact of various policy levers.  (Whether or not you put faith in that judgment, it's worth mentioning that, when it's time to actually pass legislation, everybody will have to go by the estimates of the Congressional Budget Office. And CBO will use a similar model for making its estimates.)

I'll also point out that, as proof of their point, the letter-signers reference a paper by Sherry Glied, a Columbia University economist.  It's the right place to look for answers -- she's very well-respected and has looked at this issue closely.  I know, because I consulted that paper, too.  And then, to go more deeply on this issue, I contacted Glied herself.  I wrote about that in one of my original articles, which you can read here.

(For more on this specific dispute, see another Huffington Post entry -- this one by Clinton campaign advisor Gene Sperling, who is also a senior fellow at the Center for American Progress.)***

The letter also makes a broader point: That the similarities between Clinton and Obama -- and the relative difference between them and the Republicans -- are far more impotant than the mandate dispute.  I agree.   As I've written many times, I think Obama's support for health care reform is genuine and that, overall, his plan is still very good.  And there are aspects of this mandate issue, particularly the political elements of it, that are open to genuine debate.  On the other hand, I continue to think that Clinton (and John Edwards before her) have been bolder, at least on paper, when it comes to health care.

Of course, that doens't mean I like the way Obama and his campaign have sold his plan lately.  Which brings me to this...

2. Like Ezra Klein, my inbox this morning contained all sorts of mail from folks about this new Obama mailer on mandates. 

Ad

And Ezra says pretty much everything I would say about it.  It's one thing for Obama to defend his position, which (I believe) he genuinely prefers to Clinton's.  And in the heat of the campaign, it's hard to avoid saying things that might ultimately come back to hurt your opponent if he or she becomes the nominee.  So I'm happy to cut some slack there, particularly since he's been on the receiving end of all sorts of campaign trash lately.

But a presidential candidate who believes in a reform has to avoid making statements that could undermine that reform down the road.  And that's precisely what Obama has done here.  Even he has admitted, in some instances, that a mandate might be necessary in order to get everybody into a universal health care system.  (And he already has one for kids.)  But this mailer -- with all of its unmistakble echoes of Harry and Louise -- makes that task much harder. 

--Jonathan Cohn

*** This item has been corrected.  Due to an inadvertent cut-and-paste, the item originally identified Gene Sperling as part of the Congressional Budget Office. 

Posted: Friday, February 01, 2008 1:25 PM with 16 comment(s)

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Robert Powell said:

Best pay attention to Harry and Louise. When you combine Hillary's absolutism on mandates (with the consequences for resisting them left ominously vague), with the appalling idea of a government-mandated freeze on interest rates, you get the whiff of that ol' kneejerk socialism that's Hil's Achilles heel.

It's not unsporting of Obama to use arguments that work because they've got a factual basis and, moreover, are going to be used effectively by Republicans if there is no adjustment by Democrats.

February 1, 2008 2:46 PM

virginiacentrist said:

Hillary = Nurse Ratchet.

February 1, 2008 3:00 PM

lymon1 said:

Didn't the "real" Harry and Louise (the actors) one day do a pro-health insurance reform commercial?  I'm not sure but that picture is stiring something in my memory.

February 1, 2008 3:03 PM

The Stump said:

I've mentioned before how the Clintonites feel that Obama pays a much lower price for attacking them

February 1, 2008 3:09 PM

blackton said:

oh right, like the Republicans would never have imagined an ad like that. I am a freaking liberal Democrat who thinks mandates are a bad idea, how can she sell it to the public at large? And, as I have said in other posts I want to know the breakdown of the uninsured, ie. how many are illegals and residents who will be ineligible for Hillary care? It is universal except when it is not. Beyond that, I keep hearing 15 million as the number of people in Obamas plan that won't be insured. How many of those fall into the category of illegal and residents?

Lets put forward a plan that will pass, and not say read my lips, type pledge when the Republicans will kill us with it.

February 1, 2008 3:19 PM

teplukhin2you said:

Intellectuals @ Huffington Post? wtf?

Why didn't they post this at the NYT? No $?

February 1, 2008 3:20 PM

blackton said:

Mandates expect people to buy insurance on their own, middle income young people will simply buy extremely restrictive, high deductible policies but very cheap policies to avoid a fine, but essentially only make the insurance companies rich without providing any kind of long term preventative care. Long term this will just breed resentment for the Republicans to exploit.

Beyond that, mandates are bad politically, because they will be distorted by the Republicans to mean that poor will have to buy overpriced insurance which has high deductibles and miserable care (crowded waiting rooms, etc.) when available. And I am afraid that in order for Hillary to get her "universality" she will throw the poor under the bus by simply buying out the insurance companies, with the poor essentially buying worthless coverage, in which case they will be worse off then when they started. At least the Seniors get the drugs under Bush.

Listen, I want everyone to be covered, the larger the pool the more the risk is spread out. But I want the coverage to be meaningful.

February 1, 2008 3:28 PM

lymon1 said:

"virginiacentrist said:

Hillary = Nurse Ratchet."

If Hillary Clinton could direct her target demographic to the TNR blog, she'd win by a landslide.

February 1, 2008 3:46 PM

psantillana said:

Is the ad true or isn't it? It's certainly relevant. If it's true, and relevant, it's not a smear.

February 1, 2008 3:54 PM

Jonathan Cohn said:

tep-

Beats me.

blackton and psantillana--

Mike Crowley has an item on The Stump about this same issue.  If I were more technologically adept, I could put in the link.  Anyhow, I wrote a long response in the comments section there.  It addresses some of the issues you raise.

Hope you find it helpful.  

February 1, 2008 11:27 PM

lesserliz said:

Hillary=Nurse Ratchet+Nurse Annie Wilkes(from the movie "Misery")

February 2, 2008 8:35 AM

The Stump said:

For the record, I agree with Mike on this : Obama's healthcare mailer wasn't quite as egregious

February 2, 2008 1:45 PM

The Plank said:

We're going to take a moment from the debate about individual mandates in health care reform -- a

February 4, 2008 1:17 PM

The Plank said:

It wouldn't be a primary night if I didn't say something specifically about health care. And

February 19, 2008 10:38 PM

The Plank said:

It wouldn't be a primary night if I didn't say something specifically about health care. And

February 19, 2008 11:02 PM

The Plank said:

As you may have heard, Hillary Clinton recently blasted Barack Obama over a piece of campaign literature

February 26, 2008 3:19 AM