Please Obama supporters, please just be honest and say this is wrong.  It doesn't mean people should vote for Hillary.  It doesn't mean your guy doesn't support expanding health care.  Now that Edwards is out I'm undecided, but the spite vote for Hillary is definitely in play if Ithe double standard Michael refers to continues.

I don't like it. If for no other reason than selfish ones: I think he has little to lose by sticking to the high ground whereas whatever fears he stokes with this mailer wouldn't compensate for the potential backlash. At least it's a policy difference, though.

come one, it is fair. Tha Hillary machine sent flyers to a bunch of women saying Obama was pro-life. She had to cry first mind you.

You can only make an argument that it "harms progressivism" if you assume that Obama's goal really is to mandate everyone. If that's not his goal, he's not harming the reaching of his goal. Maybe you think his view harms progressivism, but that's another argument. This ad doesn't do it.

Lymon, as an Obama supporter, I know you will call me an Obamaton, or an Obamaniac for saying this. And I tend to be anti-mandate, so to me, this makes a certain horse sense. Keep in mind, my strong support for Obama over Hillary really solidified after NH, so I wasn't blindly anti-Hillary. And I have to say, it is over-the-top for my taste. Not immoral, however. This seems a) much better than the Reagan endorsement, since it's not an overt lie, and b) not substantially different from when Hillary repeatedly says the Obama plan "leaves 15 million people out," which implies that his plan leaves some people in the cold who don't choose to be left in the cold.

If the ad clearly and fairly depicts the differences between their policy agendas, I don't get what's wrong with it. Now, if it's distorting her position or misrepresenting his own, then I do have a problem with it.

The idea that it is destructive to progressivism - whatever that means - seem moot. His agenda is a certain approach to health care. Either you agree with it or you don't, but I don't see how him being blatant about his agenda is the problem.

As regards the references that the ad reflects the "Harry and Louise" ads, well, if her agenda is still the same, then the same criticism can apply. It would be strange process, indeed, if candidates couldn't criticize their opponents' positions because someone else had made that criticism before.

It would help if HRC actually had a response to this concern. A few weeks ago Cohn just dismissed this objection when we raised it on one of these threads: "I didn't say it wasn't enforceable..." Well, what's the enforcement mechanism? She wouldn't say last night.

Epicciuto -- let me first say I don't think the mailing is "immoral" -- I'll save that for some of the GOP positons in the general, and even then only for the most egregious.  I also won't argue that it's as bad as the Clintons' spin on the Reagan comment (though as Michael noted, this one doesn't hurt a political rival, it hurts the public).

The problem with the ad isn't even about mandates, it's the blatant invoking of Harry and Louise.  The frightened young couple who need to be saved from Big Government and "ruining the world's finest health care system."  This wasn't just an attack on HRC 1992-93, it was an attack on progressives.  

While I take Krugman's point that it hurts the eventual policy argument Obama may have to make if, after he's built it and subsidized and still finds that he has to add some kind of mandate, just to socialize the risk pool and keep it both affordable for everybody and profitable for the insurance companies.......in the context of the current campaign arguments, and as a rebuttal to the demogogic assertion by the Hillary side that he "leaves out 15 million people", it is the perfect rejoinder.  No, he doesn't leave anybody out who wants insurance, he just doesn't force anybody in who doesn't.  She started this particuar give and take, and his point (problematic as it may in the future) has the advantage of being true.

If her response is "we have subsidies for those who cannot afford it," then her plan is no different from his in substance (because he does too), the mandate debate is irrelevant, and Krugman's/Cohn's objections reduce to handwringing hysteria. The beauty of the no mandate plan is that it circumvents this effective criticism.

Basically...Obama has no choice here. He's got to hit back, because Hillary is hitting him with the 15 million uninsured number - which is not even true (since he has a mandate for children - that number is for completely unmandated plans).

At any rate - this issue is way to sophisticated for any actual swing voters to grasp...

PS: Many Obama supporters agree with Hillary's plan, but disagree with the politics/fault her for failing before. Doesn't any mention of Harry and Louise just remind people of Hillary's failure?

On the subject of health care, did anyone notice that Obama said in last night's debate that anyone who hadn't signed up for health insurance and then got sick could be penalized by paying the back insurance premiums at the point they needed the health care? Whaaaaaaat?? Maybe I could also do that with my car insurance and only pay my premiums if and when I get into an accident.

But seriously, the fact that Obama would say such a silly thing under the pressure if a debate (the whole point of insurance is that you share risk prior to the certainty that you need it, a la John Rawls) indicates how superficial his understanding of the health care issue really is.

Anyway, more recent than Gallup, the newest Fox poll, taken in the evenings on Wednesday and Thursday, has Hillary up by 10 points. The EMK endorsement may either be fading or not worth what it's cracked up to be.

PPS: Yes, Lymon, I disagree with Obama's plan (though I'm starting to be more sold), but if that's his plan, then this is an honest attack. I don't think it hurts the progressive cause as much as it hurts a few scattered healthcare wonks.

the ad harms progressivism? that is ridiculous. So it is, agree with me means supporting progressivism and disagree is anti-liberal. Well, that ad is freaking right.

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.

I guarantee, this debate is one that Hillary will lose. I am a freaking liberal Democrat and cringe at the word "mandate"

But I suppose progressivism means supporting policies that will never be adopted.

I am just tired of these numbers being thrown about. Obama will leave 15 million uninsured, without a discussion of just who these 15 million people are and why they won't be insured. If 13 million of these are not entitled due to legality, leaving 2 million young, relatively affluent people uninsured because they feel they can't be bothered by buying insurance than what is the fuss? Hospitals are certainly in the position to go after payment from this group. Years ago, when I was between jobs I broke my foot and went to the hospital, I arranged a payment schedule with them and took care of it.

Come on, I will take on anyone on this issue.

come on pccostello, I will debate you on healthcare and eat you for lunch. bring it on baby. Hillary care is a bad idea, as is the insane statement she will freeze interest rates for 5 years. Hell, they don't even do that in Commie China.

not to hijack the thread, but that 5 year interest rate thing is about the stupidest and most pandering statement to come out of any politicians mouth in decades. I ranks up there with Ford and his Poland is not part of the Warsaw pact in 76. But at least Ford misspoke. Trust me, she will get buried with this later on if she wins the nomination, and she will then say she was misquoted. But anyway, she has already put out a lot of really dumb ideas, like give every child 5,000, and such I am not sure the Republicans can even go through them all.

Politically, Obama is simply right on this issue. The problem with American health care is not that the government hasn't made it a crime _not_ to have health insurance. The problem is that decent health insurance -- or, heck, plain old pay-as-you-go care -- is too expensive. That's what tens of millions of Americans experience every year, not the lack of the government fining us for lack of coverage, but doctor's visits and prescriptions that cost too much.

Now, the best way to bring down costs is single-payer. But that's not on offer this year from either candidate. So Obama's plan speaks directly to what everyone knows is the problem, with what feels like an American-style market approach that uses the government to empower individual opportunity, not to force people to spend money they don't have.

When it comes down to it, Hillary's plan will never pass a Congress with 41 or more Republicans. Obama's plan might. Once his plan is in place, mandating coverage for the small minority who don't opt in will be a minor reform, not a radical policy revolution.

Some numbers and why Hillary care is not Universal. American citizens -- especially native-born citizens -- are much more likely to have health insurance than immigrants are. In 2005, about 13 percent of native-born citizens lacked health insurance, while 43 percent of noncitizens did, according to the census bureau.

Even that estimate might be too low because it's hard for census-takers to find undocumented workers willing to answer survey questions. More than 11 million immigrants in the United States were uninsured in 2006, accounting for 26.6 percent of all uninsured individuals in the country. With exceptions, those needing emergency care and refugees, all legal immigrants who arrive in the United States after August 1996 are barred from participation in public health insurance programs (Medicaid and SCHIP) for their first five years in this country. This prohibition adds to the discrepancy in insurance rates between the native and foreign-born populations.

So lets see, Hillary care excludes 11 million legal immigrants, and untold illegal immigrants, and she dares call it Universal. Bullshit. I am tired of Hillary distorting the truth. Hillarycare will not cover more people than Obama's plan, which seeks to make insurance affordable for all, citizen and non citizen alike. Who's plan is more progressive?

Come on lymon, let me eat you for lunch. You are wrong, wrong, wrong, and I got the facts and figures to prove it. So please be honest and admit it, instead of just spouting your opinion, give me facts to refute what I am saying.

Blackton, get out the plate, but first tell me what we're debating.  Whether the ad conjures Harry and Louise?  Whether Harry and Louise had a message beyond "mandates"?  Whether mandates are necessary for universal health care?  Whether mandates are bad politically?  Whether Obama's plan is better than Hillary's?  What?  Be forewarned I may not get to respond to everything you write tonight -- I'm in the middle of an office move and things are a bit chaotic.

I'm an Obama supporter.  This is wrong.  My man needs to stay on the moral high ground, and frankly, maybe even move his proud mind a little in Clinton's direction on this question.  Universal health care needs to be universal, and Obama needs to articulate how his no-mandate plan accomplishes that, not attach Clinton's mandates in this way.

While I tend to believe this well beyond the boundaries of appropriate tone between fellow Democrats, reading that thesis from Krugman after his staunch defense of the the Obama=Regan ad is a little bit much.

lymon, the ad is not out of bounds because it is true. Affordability is in the eye of the beholder tis true, but subsidies kick in for only low income people, middle income people, such as a married friend of mine, no kids, who is an adjunct professor-good wage per class but no benefits, who lives in northern New Jersey and pays $1,200 a month for rent, in addition to two car payments and daily cost of living. He and his wife are also in very good health. He definitely wants to buy insurance but he also wants to eat, Now he is holding out for tenure with the benefits, but until then does want to buy meaningful and affordable insurance. Hillarycare does neither. It is this group of people who live in high expense areas who will be hurt by the mandate.

sdemuth: blackton is right. This ad is not at all low-ground. It's completely valid criticism. "Universal coverage" can mean that everyone can afford health insurance, and it does not have to mean that everyone is forced to purchase health insurance at the risk of criminal penalty.

And why should Obama move toward a plan he genuinely doesn' t agree with? Why is he not allowed to attack that plan? You are free to prefer Clinton's plan, but it's not an abandonment of the high ground for Obama to disagree with you and Clinton.

I waiver between Obama's and HRC's proposals (more often than not I lean towards hers), but this is not at all an out-of-bounds criticism. Remember that he's not just attacking Hillary's plan, but he's punctuating doubts about Hillary's ability to get the job done. Here's Brad Delong's take on Hillary:

"My two cents' worth--and I think it is the two cents' worth of everybody who worked for the Clinton Administration health care reform effort of 1993-1994--is that Hillary Rodham Clinton needs to be kept very far away from the White House for the rest of her life. Heading up health-care reform was the only major administrative job she has ever tried to do. And she was a complete flop at it. She had neither the grasp of policy substance, the managerial skills, nor the political smarts to do the job she was then given. And she wasn't smart enough to realize that she was in over her head and had to get out of the Health Care Czar role quickly."

www.j-bradford-delong.net/.../001600.html

I would find Krugman, Cohn, and Klein more convincing if they could just tell me substantively WHY this argument isn't true rather than just decrying it as unfair. OK, so HRC offers subsidies too. What if the subsidies aren't enough for some families? Would they STILL have to buy health insurance? And what's the enforcement mechanism if they don't? And finally why should liberals sweat so much over the means -- is the plan "universal" or not -- rather than focus on the ends -- are people who want health insurance going to be able to afford it?

Just as a follow-up to Jon Cohn's comments, which posted while I was writing mine above...

I don't find the "Trust me, Hillary won't sign an unaffordable mandate" argument very convincing... mainly for the reasons that she herself laid out. Even if she starts the process budgeting enough money to reasonably assume that the goal of affordability has been met, what about when it comes out of committee in Congress? Or conference committee? It certainly won't be the same bill that went in, but unless Congress flat out guts the bill, I can't help but see Hillary, saddled with the baggage of Hillarycare's defeat, signing it. But the danger doesn't stop there. What about when the GOP is (inevitably) in power again, either in Congress or the White House, and is looking for social spending to cut? Can we really rest our hopes on the premise that Hillarycare will be so popular as to be untouchable?

Of course, Obama's plan is susceptible to budget politics as well. But at least if Obamacare underwent periods of underfunding, there wouldn't be a mandate in place forcing people to buy undersubsidized insurance. They'd at least have the freedom to take the most economically-rational path.

Plus -- and Jon Cohn does give credence to this argument -- I just think Obama would be a more effective advocate for health care reform in this country. No baggage from past mistakes. Wisdom from his past successes in Illinois. Support from old guard health care warriors like Ted Kennedy. And the ability to win support from the center and even right-of-center.

blackton -- I'm still not sure if we're arguing the Harry/Louise aspect of the ad or the policy, but I think it's the latter.  

Let's start your analogy from the end.  Ok, let's look at the example of your friend.  First, some numbers: I have a friend who has an individual blue cross/blue shield policy, living in Chicago, for about $100/mo.  The deductable is $2500, it's HMO, he's in his 30s and is in good health.   So let's say the "mandate" cost for your couple is $300/month, part to cover their insurance, part to fund the system (which presumably is going to offer less services and be less "premium brand" than blue cross/blue shield).  Your argument is that your friends should be allowed to make the choice "to eat."  But what are we losing in exchange?  First, there's the cost of their decision to society: if either, say, is in a car accident and need emergency surgery(ies), that would cost tens to hundreds of thousands in care that the public hospital wil provide (or the private hospital will spread to consumers).

Speaking of car accidents, couldn't you make the same argument against mandatory car insurance?  That they are willing to risk not getting into a car accident and risk whatever assets they have?  The obvious retort is that the mandatory insurance is the situation where the uninsured is at fault and the victim is left helpless (especially if they too are uninsured) , but health insurancei is only different in that it's society that suffers.

Now consider the tradeoff from the Nannystate that you're protesting: your friends will have to change their life -- move to the boonies where the rents are lower or get by with one car and public transportation, or give up on the position the prof is seeking and go to a less desireable but better paying job.  That's awfu, I agree.  But so is having millions of uninsured people.  It's trading legions of limited-negative-impacts to prevent a lesser number of unlimited-negative-impacts.

Finally, yes, I do trust the political process to force an "affordable" mandate -- what I think will be cut will be the scope of "public care" but I can live with that.

Jonathan, I'd like to hear a longer response to Rhubarb's point above.  Let me try to make the point even more sharply.

I think that the argument over which health care plan is better is kind of missing the point.  Even if Clinton's health care plan IS better (and for what it's worth, I think that the numbers suggest that eventually there will have to be mandates), it hardly matters if it can never be implemented.  

Clinton claims to be tough, claims to vetted, claims to be able to take the tough attacks that are coming, and then something like this happens, and it seems that her only response is "Hey, that's not nice!"  

Well, if she's the nominee, she shouldn't expect "Harry and Louise" to show up in a few mailings; she should expect the Republicans to saturate the airwaves with non-stop advertisements talking about people without health insurance being arrested.  And something tells me, "Hey, that's not fair!" isn't going to cut it as a response.  So if she has a politically viable response (I can't imagine one), let's hear it now.

The smart strategy, by the way, is the one Obama is leaving open to himself.  Pass a health care plan without individual mandates that people will like.  Then when it becomes expensive, turn and attack "freeloaders".  Then people will get the connection to car insurance and mandates will become popular.

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

thank you jonathan, again my greatest criticism is the politics of mandates. McCain will go in front of a college crowd and say Hillary will make you buy insurance, regardless of your financial situation (many young people in the NE or California will likely earn too much to qualify for subsidies, and will have a 6 month waiting period before company policies kick in, and will be burdened by college loans, rent, etc) and Hillary will come out in front of that group and say, yes you have to pay but it is for your own good. At the end, who will the crowd applaud? As to the rest, I agree with Clifton. Paternalism seldom wins votes.

Lymon, if my friend gets in a car accident, car insurance covers medical. And you car insurance analogy is weak. Buying a car is an option, if you don't want to have car insurance don't buy a car, take a bus. It is a conditional transaction, but the condition you lay out is simply being alive. If you don't want to buy health insurance kill yourself is not a good retort. Beyond that, why don't we also mandate everyone buy car insurance, even if they don't have a car because isn't it possible they can jaywalk and cause an accident? Or have everyone in the US buy Earthquake or flood insurance, regardless of need because theoretically it is possible you can have an earthquake or flood everywhere.

What bothers me about this is that this (a few young people gaming the system) is not the problem in our health care system. Our problem is the vast majority of low income people working for jobs that don't offer coverage being priced out of the market. Every Goddamn distraction from solving this issue, and Mandates are a distraction, detracts from the issue. Let us not forget, we are fighting for these people, and not against a few young people who are temporarily uninsured due to life circumstances or general stupidity. FIGHT FOR THE UNINSURED AND LET THE REPUBLICANS FIGHT AGAINST!

The ad, while technically true, does seem in bad taste.  A more positive approach would have been to stack the two plans up and compare them and let the reader make the conclusion - "Oh, Hillary's plan means that I HAVE to buy their health care, even if the government hasn't done it's part to make it affordable.  Wait, I don't like that!  I don't trust these bureaucrats!  Obama's plan keeps me in the drivers seat.  That's the one I want."  

Also, the element of government enforcement that Hillary still avoids answering head on would probably be a more potent angle.  Getting fined by the "Healthcare IRS" would probablly be a more effective ad, in addition to being more tasteful.

So because your friends have *mandated* insurance those emergency costs won't be paid by the public but it's wrong to extend that mandate to jaywalking accidents?  I'm not following -- to take another of your fanciful analogies, we do insure natural disasters *at a basic level* -- those Katrina FEMA payments and other public assitance for example.  If there were large economies of scale by requiring natural disaster insurance for everyone then it'd be worth considering (I think you'd need stipends for the higher-risk areas, but ykwim).

As to the main problem, while I'm all for exploring ways to cut the cost of insurance (ideas include allowing drug imports to edgier things like letting insurers outsource certain procedures to nations like India where they are done at a fraction of the cost), I don't think cost alone will cut it.  One of Obama's better ideas is the "opt-out 401(k)" where people are enrolled automatically -- Hillary just makes the 401(k) more attractive.  Similarly with health insurance, I think a lot of people would still use their income for more immediate purposes than buy health insurance even if it was less expensive.  The exact percentages I couldn't even guess.

In any event, I don't feel like lunch :-)

Gavriel, that would be fine for another ad. I just don't see how the above ad is in bad taste. Since when has truth been in bad taste? Now I can see if your argument is that it is not effective because it stinks of politics, even then I disagree. As negative ads go, these ain't much.

I do like the image of the Healthcare police, with cops stopping people on the road demanding to see their health insurance cards. A bit over the top, I agree, but something I can imagine the Republicans do.

lymon, as I said above, advocating a position which is far more of a political loser is just stupid. Let us keep the argument positive, Fight for and not against. We can argue forever about how to enforce mandates on a few recalcitrant people or we can work together on getting insurance for those that want it but can't afford it. Personally, I favor a Japanese style of health insurance which is Universal and far more cost effective than America's. Why we insist on reinventing the wheel is beyond me when there are practical and effective plans out there (that don't require people flying to India, I take it that part was a joke) is beyond me. I disagree, I know cost alone can cut it, but it requires more boldness than either candidate is giving us. Hillary's idea of bold, Mandates, will just piss off too many people. If she is going to be bold then she should be bold.

Year 2000 Organisation for Economic Co-operation and Development (OECD) figures show that Japan spends 7.6% of its GDP on health, compared to 9.2% for Canada  and 13.1% for the US. In 1998, Japan spent ¥29.8 trillion (US$280 billion) on healthcare, of which 53% was covered by insurance, 32.3% by the government, and 14.8% by patients' co-payments. Officially, the patients' co-payment rate is 20 to 30%, but with co-payments capped, the effective co-payment rate is 14.8%. The cap is at ¥63,600 (US$600) per month, with the average monthly disposable income being ¥561,000 (US$5,300); additionally, there is a low-income cap.

The Japanese healthcare system is highly regulated by the government and, as described by the OECD, "combines a mainly private provision of services with mandatory health insurance. (mandatory in this case being that insurance companies are mandated to provide coverage) Service providers are paid directly by insurers (the third payer system). Payments for outpatient care are predominantly on a fee for service basis, and inpatient care is paid through a mixture of per diem and fee for service. Fees for different medical services are set out in the Fee Schedule announced by the government and revised every two years. Between 20 and 30% of the fees are born by patients as co-payments. But with a ceiling (see below) the effective co-payment rate is about 14%."

The Japanese have the highest life expectancy in the world, and the Japanese economy is the second largest in the world with a dearth of natural resources.

The Japanese automakers benefit greatly from the UHC in Japan because their employee costs through benefit packages are much less. Forcing Companies in America to negotiate ad hoc with insurance companies eats at the heart of Capitalism by diverting employee resources into non productive activities. In Japan, people are assigned a health insurer according to their employment situation. Those who are employed at a company or office are insured by the Social Insurance System (SIS). This system is funded by the employers (who pay varyingly from 50 to 80% of the cost) and by premiums paid by the employees. Everyone else (the unemployed, elderly, and self-employed, including lawyers, doctors, etc.) is insured through the National Health Insurance (NHI) system. The NHI system is funded by the government and the employed members of the system.

About 63% of the population is covered by SIS plans, which is delivered by about 1,800 entities nationwide known as Health Insurance Societies. Premiums depend on the employee's annual income, but amount to approximately 8.5% of their salary. An insured person and their dependents must, in addition to contributing the cost of the premium, pay 20 to 30% of inpatient and outpatient costs and make an additional co-payment for prescription drugs.

What is there not to like here?

lymon, I got that from another thread, hence the ending. To be honest, I don't know if the Japanese form of Health insurance is feasible in the US, but I remember 20 some years ago Americans studying the manufacturing techniques in Japan, such as JIT (just in time) style of Inventory management. I get angry when Republicans bring up England, Canada, etc. single payer, and we argue on that basis, when Japan is far more effective a reply. That means Republicans are either racist (japanese people eat sushi, have yellow skin and are somehow not human like us?) stupid (for not knowing the japanese health care system) or disingenuous (by choosing to ignore the biggest hole in their argument.) or maybe it is all 3. It seems to me if Democrats had modelled our program after theirs we would have far more credibility with the American people than making up our own, or talking about the French. No Republican is going to yell that the Japanese are socialists.

Anyway, if we aren't going to be bold because of politics, than Obama's plan is better because it is based more on politics than Hellarycare. Which is what the Republicans call it.

Mandating healthcare coverage is a tax, and a highly regressive one.  In fact, it is comparable to social security in amount, essentially doubling the regressive tax on people.  Ok, before subsidies.  But there's no operative difference.  I have trouble with it in general  because there are times that people may have to make important decisions between options, and this will reduce their options.  At the extreme, we could mandate food purchases, housing purchases, clothing purchases, mandate a poor person's whole paycheck.

If you look at auto insurance, which is usually mandated, there alternatives like not driving, and the insurance is only to provide coverage for the damage you do to someone else (liability).  This is not the same thing by any means.

Some say look as SS.  Putting aside the regressivity of this tax (a mandate would be a highly regressive tax too), the argument is that there is a societal gain that outweighs the specific cost.  But that argument is risky if applied over an over to mandate a way of life...

Yes, strawman, but the point is where do you draw the line?  Obama's politics are a bit more libertarian tha many others, he's not a 'pure' progressive, but would prefer to make things possible and get out of the way of people choosing their own life.  That's what I like about him.  And this 'minor' policy difference is exactly that, the crucial difference in approach between the candidates.  I don't believe it is political expediency, I believe it is his libertarian streak.

The Nazis in Skokie analogy alludes to a famous SCOTUS case -- and is not overboard.  The reference to the case -- where Nazis sued to be able to march through an Orthodox Jewish neighborhood in Skokie, Ill. -- is apt here: Obama used the imagery NOT because he wanted to argue a point but because he wanted to make an offensive statement against the Clintons.

Come on, Crowley: I expect more from TNR fact-checker.