Friday, February 08, 2008

Counterpoint! (Or, I Agree With Kleiman on Hillarycare vs. Obamacare)

by Tom Bozzo

Ken, you ignorant slut. [*]

In the post that riled Ken, Mark Kleiman wrote:

So we're back where we started: two plans, both with guaranteed availability of insurance regardless of health status, both with subsidies. One has a mandate with (as yet undefined) enforcement mechanisms. The other has no mandate but (as yet undefined) financial disincentives for free-riding. Until the two plans are better specified, there is no basis on which to estimate how many people will wind up not buying insurance under either plan, and therefore no basis for any firm estimate of costs to the taxpayer.

This is hardly justification for the holy war the Clinton campaign is waging on Obama on the mandate issue.

What's the big deal here? In evaluating would-be "mandates" to purchase health insurance, economists would be concerned mainly with the system of financial disincentives for free-riding, not with the directive per se. Clearly, a weakly-enforced commandment can be less effective than a set of incentives that isn't called a mandate but makes it pretty much worth everyone's while to act as the policymaker would like to dictate.

As it happens, I don't find mandates to buy something in the private market to be very progressive (see also Brian Weatherson with some useful gloss from the late Howard years in Australia), and HRC doesn't sell Hillarycare II to me by underscoring the mandate part of the plan. To the extent I'm mollified, it's by the presence of a public plan as an alternative.

Meanwhile, I find commentators who would criticize Obama for being all rhetoric, no substance should actually read the plan. (Indeed, actual attendees of Obama events have reported to me no dissatisfaction over a lack of policy specifics.) Among other things, the Obama campaign took the effort to include important if unsexy policy initiatives such as a federal reinsurance program. [**] The importance of this initiative was covered by Kash at Angry Bear 3-1/2 years ago, when this was an important but underheralded part of the Kerry health plan. A good bit of the premium-spiral problem can be laid at mostly missing markets for health care reinsurance, as plans otherwise are pushed to try to recoup their losses after the fact — making health "insurance" rather less insurance-like.

It looks like the narrative that will fulfill Lance Mannion's prediction should Obama be nominated is that those of us who support him are a bunch of cultish crazies who are blinded to his lack of substance. Let me point here and here (added: and especially here) by way of calling bullshit on that, and I hereby announce my intention do deal as harshly as I can with anyone who knows better and propagates the meme.

[*] See here in case you don't get the reference (I assume Ken does); for the record, I disapprove of rhetoric that questions the brains of those who might be our blog-allies and, except in extreme cases, even those who are not.

[**] I.e., the government would reimburse health plans for catastrophic losses.

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You would have to believe Kleiman's, er, interpretation; since the rest of his post belies that possibility, I'll demur for now and finish that post later (even if he hadn't described HRC as "Mark Penn's latest sock puppet").

Your links don't exactly refute the "lack of substance shown" argument:

Patrick's endorsement, as I noted before, is a pragmatist's attempt to either (1) at best, elect more Democrats or (2) more likely, elect more Ben Nelsons and hope for the best. Either way, the question becomes what you do with them, not just that they are.

De Long declared that he voted for Obama because Obama is a better speechmaker than HRC.

That is, they are both endorsing Obama because of his superior style, not his policies.

The other side is Taylor Marsh and James Wolcott. And the rest of us, still waiting for some substance that matches the occasionally-brilliant rhetorical flourishes.

Or at least something more noble than the case raised by Melissa's second point here:

Someone [was] speaking about Obama being the underdog, outsider candidate—which, by the way, once someone gets Democratic monument Ted Kennedy's and former nominee John Kerry's endorsements, is a meme that needs to die....The big problem is that the someone who said this is Barack Obama....I thought this campaign is supposed to be about hope and change and transcending the status quo and not playing politics as usual—but relying on misogyny is not hopeful nor original nor in any way new or transcendent. It sucks. And it makes me sad.

Obama has, so far, (1) "led" by withdrawing from the MI ballot, followed by his people complaining that people didn't get a chance to vote for him, (2) attacked mandates even as his HC advisor, David Cutler, says that they will use mandates w/h/e/n/ if the "financial disincentives" don't produce their expected 98-99% signup, and (3) made some nice speeches and inspired some hope, interspersed with several interview comments of the type Melissa noted above (which is why I tend to take, say, the "old white women" quote I posted a few days ago seriously—a campaign as well organized and grass-roots oriented as Obama's doesn't have someone say that as "a mistake" this late in the primary season.)

The Obama-Webb ticket, if/when it happens, will probably get my vote (not that it needs it), especially against the cancerous, war-mongering McCain. But it's steadily lowering my expectations.
Tom, sounds like you have a lot of anger there. Hmmm.
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