Krugman Gets Stupid On Health Care Mandates

Paul Krugman takes Barack Obama to task for his campaign rhetoric on health care reform, but had to get either stupid or disingenuous to do it.  Away we go:

From the beginning, advocates of universal health care were troubled by the incompleteness of Barack Obama’s plan, which unlike those of his Democratic rivals wouldn’t cover everyone. But they were willing to cut Mr. Obama slack on the issue, assuming that in the end he would do the right thing.

...

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.

Well, yes - *if* insurance companies are not allowed to turn people away on the basis of pre-existing conditions, then only a fool would sign up for insurance before actually getting sick.  The plans offered by Hillary Clinton and John Edwards try to sidestep this by obliging everyone to sign up or else.  But as the Times pointed out recently, Massachusetts has now reached the "or else" portion of Gov. Romney's state-wide "sign-up or else" health care reform.  And folks in Massachusetts are providing a live demonstration of the problem for which Barack Obama has criticized his rivals - not everyone wants to sign up and the penalties for non-compliance are not enough to sway them. 

Now, for perfectly sensible reasons, Hillary is disinclined to describe the "or else" stick she might be prepared to swing.   Hence Barack's criticism - Hillary calls her plan "universal" because everyone is obliged to sign up, even though we have no idea how serious her proposed enforcement will be.  (Hmm - perhaps some Dem can offer a universal Don't Worry Be Happy plan, where we will all be happy because otherwise... well, otherwise nothing, but so what?  And don't forget the pony.) 

But a plan isn't universal simply because Hillary says it is; it is "universal" if there is complete (or near-complete) participation, and since she has provided no information on prospective enforcement we have no way of guessing how close HillaryCare might come to achieving that goal.

So how does the Earnest Prof tackle this?

Second, Mr. Obama claims that mandates won’t work, pointing out that many people don’t have car insurance despite state requirements that all drivers be insured. Um, is he saying that states shouldn’t require that drivers have insurance? If not, what’s his point?

Look, law enforcement is sometimes imperfect. That doesn’t mean we shouldn’t have laws.

Kidding?  I think there is broad agreement that we should not pass laws that can't or won't be enforced.  We were all a nation of law-breakers when the national speed limit was 55 MPH, which hardly promoted a respect for traffic laws.  If HillaryCare amounts to requiring people to sign up for insurance they would not otherwise choose but imposes no penalties on the free riders who ignore her commands, then the law-abiding citizens will feel like suckers.  Because that's what they will have been.

Krugman continues:

Third, and most troubling, Mr. Obama accuses his rivals of not explaining how they would enforce mandates, and suggests that the mandate would require some kind of nasty, punitive enforcement: “Their essential argument,” he says, “is the only way to get everybody covered is if the government forces you to buy health insurance. If you don’t buy it, then you’ll be penalized in some way.”

Well, John Edwards has just called Mr. Obama’s bluff, by proposing that individuals be required to show proof of insurance when filing income taxes or receiving health care. If they don’t have insurance, they won’t be penalized — they’ll be automatically enrolled in an insurance plan.

That’s actually a terrific idea — not only would it prevent people from gaming the system, it would have the side benefit of enrolling people who qualify for S-chip and other government programs, but don’t know it.

The IRS is going to enforce the Edwards' plan?  Excellent - I assume it is in some other speech that Edwards decries tax cheats and the non-tax-compliant among us; for purposes of health care reform, IRS compliance is not only 100%, but the folks who are not even required to file with the IRS already have health insurance.  Of course this is nonsense, as presumably Edwards' and Krugman realize; back in reality, the immediate impact of the Edwards' scheme would be to provide yet one more incentive for participants in the underground economy to remain underground.

Kevin Drum and Mattt Yglesias bash the Edwards idea with more gusto, so let me add this - Edwards at least demonstrated why it has been shrewd of Ms. Clinton to keep mum on this point.  But Krugman's real worry - that the points being made by Obama today will be made by Republicans next fall - won't go away if Obama just pipes down.

Comments

[MayBee]

How would this work with illegal aliens? I wonder.

[MayBee]

Well, yes - *if* insurance companies are not allowed to turn people away on the basis of pre-existing conditions, then only a fool would sign up for insurance before actually getting sick.

That observation is brilliant in light of this:
Well, John Edwards has just called Mr. Obama’s bluff, by proposing that individuals be required to show proof of insurance when filing income taxes or receiving health care. If they don’t have insurance, they won’t be penalized — they’ll be automatically enrolled in an insurance plan.

So if you go to an ER, you get treatment and a brand new insurance plan. I'm assuming they won't charge you a penalty before they treat you. So basically, you can get catastrophic coverage even if you've never paid any premiums.
Then, what happens if you let the policy they put you in lapse by refusing to pay your premiums? Next time you need health care you'll get it, right? Or does the insurance company you've dropped have to inform the government?

[Annoying Old Guy]

One could also pile on the driver's license analogy by pointing out that

1) Punishment: States are willing to remove the right to drive or even impose jail time for not obeying — let's see someone propose anything like that for not having health care.
2) One can chose to not drive and avoid the mandate legally. Such an action isn't free loading, unlike health care.

But, time spent pointing out obvious deficiencies in Krugman columns is time wasted.

[clarice]

If you jail people for not getting health insurance, taxpayers will still have to provide it.
What a plan!

[Jor]

This is Krugman's 2nd or 3rd column against some Obama plan. My own take is that lefty bloggers and columnists are much more lukewarm to Obama, and looking to nit-pick than readers of their blogs/column. The only reason I can think of is because Obama is trying to position himself as post-politics, which is very appealing to basically everyone except people too invested in politics (including bloggers, etc.).

On the republican side, the only equivalent I can think of is Huckabee. Even though I don't think I agree with him on any social issue he just seems 1000x saner than and less of a politician than the other candidates (excluding Ron Paul).

Least politician-like is probably my deciding citeria.

[Paul Zrimsek]

I've found that the best way to avoid appearing politician-like is not to run for office.

[JohnD]

Australia has a tax for this, 2.5% of your income to pay for universal insurance, and you opt out of it only if you have private insurance. If people don't pay income tax then they get the insurance anyway, so everyone is covered.

[Jor]

Paul, somebody has to do it. I rather it just not be someone who is going to make a career out of it. Which is what the current system is out to reward. Politicians are like prostitutes -- you can probably be a whore for a few years and still be a good person, but after 20 years of being a whore, you're rotten to the core.

[Jor]

Lincoln had one term in congress before becoming president and was well aware that politics is a disease that will slowly eat your morality and any sense of decency you have.

[MikeNC]

Krugman "gets stupid"? As if that is a new phenomenon.