An Open Letter to Paul Krugman
Dear Professor Krugman,
I think you are a terrific economist and a terrific writer. Over the years, I have made hundreds of students buy your microeconomics textbook.
We have some disagreements about health policy. You have been lambasting Senator Obama for months now because he fails to propose an individual mandate. I support Senator Obama, though I in no way represent the Obama campaign.
In your view, the Obama plan will fall far short of universal coverage. In fact, both the Obama and Clinton plans will leave some millions of Americans uncovered, though both plans will cover many of the 47 million people who are now uninsured. Both plans will also address many serious failures and human tragedies that arise within our current healthcare system, and would put us miles ahead of where we are now.
No one can say how close these plans will come to universal coverage, because the devil is in the political and administrative details--details likely to be set by a future Congress negotiating with the next president.
In this morning's column, you cite a new working paper by Jonathan Gruber which supports the mandate concept. Anything that Professor Gruber writes deserves to be taken very seriously. It is, however, important to clarify that he does not specifically examine either the Obama or (especially) the Clinton plan.
In his policy simulations, Professor Gruber writes: "In particular I assume that 95% of those who would not voluntarily choose to insure are forced to insure through the mandate." This is not the Clinton plan. It is not even a "Clinton-type plan," as you prefer to say. Almost by definition, a near-perfect mandate will increase the number of people covered under any proposed health plan. Whether this nation actually would support such stringent policies is another matter. Here you presume precisely what is most in doubt.
Today's Times notes that "Massachusetts, the only state with an insurance mandate, has thus far failed to enroll nearly half of its uninsured despite imposing a modest first-year tax penalty of $219." Massachusetts will probably do better this year, because the penalties have stiffened. As I understand it, individuals are liable for half the premiums even if they are uninsured. Massachusetts provides a remarkably favorable political, economic, and administrative environment to attempt such a mandate. This is the best-case scenario, and it is not easy.
As a volunteer for the Obama campaign, I have called many primary voters. They sometimes ask about the mandate issue. Whatever health policy researchers believe, my sense from these conversations is that even core Democratic party voters don't much like mandates.
Senator Clinton's own equivocation illustrates the political dilemma. In criticizing Senator Obama, she happily takes credit for high levels of coverage. Yet she is wary in describing how she would bring this about. Today's New York Times has a story entitled "In Health Debate, Clinton Remains Vague on Penalties." It is certainly unclear that her proposed health plan comes anywhere near the near-perfect takeup and enforcement presumed by Professor Gruber, or that legislators and voters would support such policies. If Senator Clinton is nominated, Republicans will press this argument hard come November and beyond.
You are on more solid ground regarding the limitations of subsidies in achieving universal coverage. Professor Gruber notes that an important group of people--some but not all of low-income--will resist buying subsidized coverage. In the last debate, Senator Obama noted strategies to deter free-riding. This certainly merits debate, and merits comparison with what Senator Clinton actually proposes rather than a 95% perfect hypothetical plan.
More generally, you assert that Senator Obama is a less progressive candidate than Hillary Clinton because he has stopped short of imposing the individual mandate. This is a very sweeping judgment based on one political and policy calculation.
Your assessment makes an odd fit with Mr. Obama's policy view on Iraq and many other things. It runs counter to the thinking of many progressive organizations and people who have endorsed Senator Obama: MoveOn.org, Teddy Kennedy, and others. It runs counter to most tabulations of his legislative record, which often identify him as more progressive than Senator Clinton. It ignores many, many years of conscious, sometimes-justified triangulation by both Clintons regarding many social concerns.
I am puzzled by the shrillness of your columns about Obama, and your rather exclusive focus on individual mandates as the litmus test for a progressive politician.
Let's suppose, for the sake of argument, that everything you say is right. President Obama gets himself elected. He successfully enacts health reform, but he leaves out an individual mandate. Indeed, let's suppose that we later discover that too many people fail to buy insurance coverage or try to free-ride. We would have to address these problems.
In the meanwhile, all we will have accomplished would be:
1. to bar insurers from denying coverage based on preexisting conditions;
2. to provide significant financial subsidies to millions of low-income people to help them buy coverage;
3. to prevent people from losing their homes because they are diagnosed with cancer;
4. to cover all children;
5. to make safety-net providers (and the local governments that run them) more financially secure because they no longer bear the burden of treating 47 million uninsured people.
I'd be pretty darned happy with this outcome--although I (like you) would ultimately prefer "Medicare for All" or some other version of a single-payer system.
Obama and Clinton supporters disagree on tactics and policy details. Politics and human nature being what they are, each side is angry because the other has thrown some fouls.
It's a tough campaign because there are two excellent candidates with similar policy views, and there can be only one winner. I suppose Obama people should not send mailings that attack mandates. I suppose Clinton people should not send mailings that say Obama will impose a $1 trillion tax increase on working families by raising the Social Security earnings cap. I suppose Bill Clinton should be quieter and stay out of trouble.
Hopefully this fight will burnish the eventual nominee and unite the Democratic Party. The fact is: We share the same values and ultimate goals. Whoever is nominated, we will need each other to win the general election and to enact Democratic proposals into law. So let's fight now, but let's tone things down a bit, too. We'll be on the same side a few months from now, or maybe sooner.
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His universal health care plan, her universal health care plan. What I find lacking in all of the ivory tower analysis is the basic tenet that the health care system in this country is broken.
As long as hospitals keep charging $19 for an aspirin while the insurance companies and malpractice attornies reap millions - adding more individuals to the rolls whether voluntarily or by mandate will only put a bandaid on an inherently flawed system. A $75 bandaid.
Thank you. This is the most reasoned response to the Hillary/Krugman talking points that I've seen. The press has done nothing more than parrot whatever Hillary has said about her healthcare plan (or what she has said about Obama's).
Mandates without a stated enforcement mechanism are nothing but a dishonest gimmick. We really don't benefit from tricking ourselves into believing we have a health care system that we do not have. Cluttering up the law books with laws that have no penalty or enforcement mechanism, is at best, a waste of legislative time, and at worst, deliberatley misleading and a potential source of litigation.
Obama's plan will be more policially feasible and will help us get a handle on what else will need to be done.
A pox on both your medical reform policies. The way to pay for a real universal medical care program is to by-pass the unnecessary, expensive, inefficient, medical services distorting, for profit, private, corporate insurance companies. Such a policy will be able to move more than $300 billion of insurance premiums from overhead to the privision of medical care. Needless to say this will be a hard job. Ms C failed at it once and Mr O seems to shy away from this side of the issue like it was the kiss of death. I agree this will be a difficult job - but hey - we need some political leadership! Neither Mr. O nor Ms C will come out assertively for this type of a program. Please note that Mr. Edwards' idea to set up a Medicare for all program to compete with the terrible commercial plans invented a politically feasable approach to evolve to universal government single payer program. What I take away from the surviving candidates' health care differences is that both candidates are weak in the knees.
Paul Krugman, HBR, Rob Reiner, etc, are never wrong. Just ask them. They and the rest of the Party Olde Guard represent the kind of reflexive, top-down, I-know- (and I'll mandate)-w
The Krugmans, Clintons, Reiners, et al have fought back with "best of intentions". But their tit-for-tat "mental model" left the Democratic Party with no coherent vision of governance, formulating policies and programs instead on the basis of a vague and amorphous kind of humanism (the problem, to be sure, is not with "humanism" but with being vague and amorphous) leaving the party “waffling” about notions of individual responsibility, unable to come to terms with the idea of capitalism as the driver (if not the architect) of economic growth, or “fuzzy” on national defense: issues of deep and ongoing concern to the American people.
Krugman's shrill, incessant tone, HBR's uninspiring schoolmarm didacticism, R. Reiner's delusions of self-righteousness: all are symptoms they share in full with their ideological [sic] adversaries due to the same root cause: a hidebound inability to admit that they just might be wrong--about (virtually) anything.
Consequently I welcome the overdue shift from the "me" to the "we" generation, and I am proud to join this ageless generation in support of Barack Obama—a generation that recognizes that this election is less about "policy points" than about how to transcend them; that while progress may be measured incrementally, our vision of the future cannot be. And they know it is a vision that demands inclusion, respect, transparency and inspiration, not patronage, antipathy and continued old school parsing and “triangulation”.
It's due time, Mr. Krugman, to revise your own "mental model". Modernity calls.
I live in Germany, which has the oldest universal healthcare system in the world. It has been around since the end of the 19th century, when Bismarck brought it into existence as a way to discourage rising Marxist sentiment in Germany.
A few years ago when I was diagnosed with cancer, I received expedient, competent, and successful treatment. Although it means having a pre-existing condition that hinders my ability to return to the US, I am thankful every day that I got sick here. I am not convinced that I would be here to tell about it if I had been in the US.
No one here is foolish enough to believe that their system could work if it weren't mandatory, but they also understand what that mandate means. It is a contract between a government and its citizens. You are all of you fixated on the half of that contract that places a burden on the citizens, but shouldn't a government carry a mandate to provide its citizens with competent, fair, affordable healthcare?
Forget about the fault of Krugman's logic, what about the fact that "mandates" in the Republican lexicon translates as "socialism"?
What's the chance of Hillary passing legislation if she can't get elected?
Obma in '08
I am a Democrat who applauds the universal health care proposals, but stand scratching my head wondering:
(1) How do the candidates intend to eliminate our current $9 Trillion debt
(2) How are we going to pay for universal health care, regardless of who is elected ??
We are currently borrowing $1.4 Billion a day, that's $522 Billion a year from our entitlement programs (Social Security, Medicare, Medicaid) and foreign countries. That number is increasing yearly. If we continue as we are now, our current national debt of $9 Trillion will increase to $46-57 Trillion by 2040-2050.
We have two choices. Significantly increase taxes on all citizens or take money from one program to prop up another.
This is one Democrat who will NEVER be on the side of mandatory private health care. It's a stupid idea, and I will fight it to my grave. If Hillary wants a health care tax, let her propose one. Mandatory private health care is un-American.
Maybe this is why Krugman "is so shrill." From Sunday's Times:
"He (Obama) has boasted of it on the campaign trail, telling a crowd in Iowa in December that it was “the only nuclear legislation that I’ve passed.”
“I just did that last year,” he said, to murmurs of approval.
A close look at the path his legislation took tells a very different story. While he initially fought to advance his bill, even holding up a presidential nomination to try to force a hearing on it, Mr. Obama eventually rewrote it to reflect changes sought by Senate Republicans, Exelon and nuclear regulators. The new bill removed language mandating prompt reporting and simply offered guidance to regulators, whom it charged with addressing the issue of unreported leaks.
Those revisions propelled the bill through a crucial committee. But, contrary to Mr. Obama’s comments in Iowa, it ultimately died amid parliamentary wrangling in the full Senate.
“Senator Obama’s staff was sending us copies of the bill to review, and we could see it weakening with each successive draft,” said Joe Cosgrove, a park district director in Will County, Ill., where low-level radioactive runoff had turned up in groundwater. “The teeth were just taken out of it.”
The history of the bill shows Mr. Obama navigating a home-state controversy that pitted two important constituencies against each other and tested his skills as a legislative infighter. On one side were neighbors of several nuclear plants upset that low-level radioactive leaks had gone unreported for years; on the other was Exelon, the country’s largest nuclear plant operator and one of Mr. Obama’s largest sources of campaign money."
He talks the talk, and talks and talks and talks.
Paul Krugman understands that conservatives do not fight fair, and the very notion of compromise as the way to a solution on healthcare is flawed. The only real solution is a national health system, otherwise called single payer.
Thank you for this very well-written and thoughtful analysis of the clinton and Obama health care bills . . .and for slapping krugman ... like so many of the billary supporters he throws her voting record out the window . . .
I am soooo glad you wrote this column.
I too am quite annoyed with Krugman. His article seem to be very mean spirited.
I read Paul Krugman and I like him. I find very little in what he says as critical of Obama except in that Krugman is a questioning and thinking person and knows what a liberal is and is not. The fact that many obama have read so much criticism into Krugman and are so hypersensitive is so thin skinned. Wait until the likes of Rove and Republicans get unleashed on Obama.
Paul Krugman champions liberal causes and workers rights and I am saddened so many on Huffington Post don't delight in the fact that Krugman champions the middle class as he does.
Harold,
Get the stars out of your eyes and stop whining. This election is a non event.
It's the 21st Century version of the Circus Maximus; entertainment for the plebs.
Clinton is Bush in a skirt.
Obama is awash in corporate money. His record in the Senate is undistinguished. Every Democrat that has a populist agenda has been crushed by our distorted selection process and the corrupt Democratic Party.
Hundreds of millions of dollars are being spent to accomplish nothing.
Obama's plan has mandates for childrens health insurance.
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