THE BLOG
12/03/2007 09:59 am ET Updated May 25, 2011

Why Not Single Payer? Part 3: The Clinton/Obama/Edwards Individual Mandates Represent a Losing Political Strategy

Hillary Clinton is busy in Iowa bashing Barack Obama for offering a health care plan that doesn't punish uninsured people who won't pony up their own money out of their own pockets to buy their own health insurance. She points out (rightfully) that if, under Obama's plan, the Federal government doesn't force everyone to buy health insurance, millions of uninsured people may decide not to pay for their health insurance and remain uninsured--Thus, Hillary charges, Obama's plan fails to provide for Universal Health Insurance for all Americans.

Meanwhile, John Edwards criticizes Hillary's plan on the same grounds. Her plan is vague and elusive on the details, calling for a Federal Mandate, but not specifying what the penalty will be on uninsured citizens who ignore the Mandate. If there's no penalty, or the penalty is small (under Massachusett's Universal Mandate plan the penalty is currently $295 per year) then Hillary's plan doesn't guarantee Universal Health Insurance either. In addition, Hillary's plan does not cover 12-15 million illegal immigrants who will continue to flood emergency rooms, driving up premiums for everyone else. Even one of Hillary's principal health care advisers, MIT economic professor Jonathan Gruber, acknowledges that Hillary's plan will not include everybody, stating that "Any system that does not have a single payer will not have 100 percent coverage."

At least John Edwards has the political courage to put some teeth into his plan for the federal government to force the uninsured to buy their own health insurance: Citizens will have to provide proof of health insurance when they seek care or file their Federal tax returns. If they don't have health insurance, the Federal government will sign them up for a minimum basic plan and take the premiums out of their taxes or garnish their wages. However, Edwards, Obama, and Clinton all avoid spelling out what a minimum plan would cover, what the deductibles and co-pays would be, how much the premiums would cost, and how poor you will have to be for your premiums to be subsidized by the government.

The whole dust-up among Clinton, Obama and Edwards makes clear why Individual Mandate plans--far from being more politically pragmatic than Single Payer/"Medicare For All" plans--are likely to end up being as big a political disaster as Hillary's 1994 health reform fiasco.

When the Republican Presidential candidate starts attacking the Democratic nominee for trying to compel middle class Americans to buy health insurance that they can't afford, the Democrat's poll numbers may start to dive. "If you're a family making over $40,000 a year so you aren't poor enough for subsidies and you don't have health insurance, the Democrats will force you to sign up and keep your tax return or garnish your wages for thousands of dollars, since the average policy costs $10,000 for a family of four." This is what the Washington consultants think is smart, pragmatic politics for Democrats? The health care issue, which should be a big Democratic advantage on the '08 elections, could suddenly turn into liability.

Even if a Democrat wins the Presidency, when it comes time to get a specific proposal through Congress, it will become clear to the voters either that their plan only pretends to cover all the uninsured but doesn't, or it represents a massive backdoor tax on the uninsured middle class who will be forced by the Federal government to pony up thousands of dollars which they can't afford to buy their own individual insurance policies. The most affordable of these policies, which realistically will still cost thousands of dollars a year, will of necessity have high deductibles and co-pays. This will force policyholders to forego preventive care and delay going to the doctor until they are really sick and may need major and expensive care. It may even lead to their early death from conditions like breast and prostate cancer that could have been treated if diagnosed earlier. (For some of the other serious problems with Universal Mandate plans as social policy, see Part 2 of this series on the Huffington Post.

Getting major health care reform through Congress (particularly the Senate, with 60 votes needed to end a filibuster) will require a massive popular mobilization. If history proves anything, it's that Washington only enacts major social change if prodded by large scale social movements such as the union movement, the civil rights movement, and the anti-war movement. Without such movements, there would be no social security, no Civil Rights Act, and we might still be fighting in Vietnam. Why should progressives put such an effort into organizing a mass movement around Universal Mandate plans that will prove unpopular, will not really offer Universal Health Care, will put a huge financial burden on the uninsured middle class, and subsidize the private insurance industry? If we're going to organize the kind of massive mobilization that will be necessary to really change the health care system in America, then let's do it for a progressive plan that really works.

HR 676, the "Medicare For All" bill introduced in Congress by Rep. John Conyers, already has 78 congressional co-sponsors. It would cover all Americans from birth until death for all medically necessary treatments and drugs, as well as preventive care. As with Medicare, people can chose their own doctor and determine the best course of care in conjunction with him or her. The 30% of the health care dollar--over $400 billion this year--that goes to pay administrative costs of insurance companies, doctors, and hospitals, as well as insurance company marketing cost, executive salaries and profits, would be reduced to less than 5%, which alone would be enough to cover all of the uninsured. Medicare For All would be paid for by taxes, but would cost most Americans less in the aggregate than they are already paying in premiums, deductibles, co-pays, and forgone wages that are used for employer-provided health care. Unlike Clinton's, Edward's and Obama's plans, it would be truly universal.

A mass movement has already begun to organize around Medicare-For-All. HR 676 has been endorsed by over 235 union organizations in 40 states, including 60 Central Labor Councils, as well as many citizens and religious organization. In California, SB 849, which would have provided for a single payer system for the State's 37 million citizens, passed both houses of the California Legislature, only to be vetoed by Gov. Schwarzennegger. It was backed by over 400 organizations and unions including the League of Women Voters, the Consumers Union, the California Catholic Conference, the California Nurses Association, the California Teachers Association, AFSCME and the SEIU, and numerous cities and counties. Many other states are building large coalitions favoring Medicare For All.

With a mass mobilization still in its infant stages, several polls show that a majority of Americans are ready to support Medicare For All. A CBS News poll on September 14-16, 2007 asked, "Which do you think would be better for the country: having one health insurance program covering all Americans that would be administered by the government and paid for by taxpayers, or keeping the current system where many people get their insurance from private employers and some have no insurance?" 55% chose "One Program For All" (up from 47% in February, 2007) and 29% chose the "Current System" (down from 38% in February). (Back in January, 2007, according to an NBC News/Wall Street Journal Poll, 53% said they would be willing to pay higher taxes so that everyone can have health insurance, while 40% disagreed.)

So why are the leading Democratic candidates afraid to support Medicare For All and are instead offering up inferior, and politically less viable, proposals for Universal Mandates? When it comes to health care, Andrew Sullivan's recent description of Hillary Clinton, unfortunately seems to apply to Barack Obama and John Edwards as well. "Her liberalism is warped by what you might call a Political Post-Traumatic Stress Syndrome. Reagan spooked people on the left, especially those, like Clinton, who were interested primarily in winning power. She has internalized what most Democrats of her generation have internalized: They suspect that the majority is not with them, and so some quotient of discretion, fear or plain deception is required to advance their objectives".

As the above polls suggest, the Democratic candidates need not be so fearful when it comes to Health Care. Even if they are, progressives do not need to follow them in their fear and timidity. Only a progressive grassroots movement has the power to help a Democratic President get meaningful health care reform through Congress, given the millions of dollars in campaign contributions and the arm twisting of corporate lobbyists that will be mobilized against real reform by the insurance and drug industries and other corporate special interests.

So here's the deal for our Democratic frontrunners: Run on your Universal Mandate plans if you must. You've probably gotten yourself so locked into them that it's hard to change course in the middle of a political campaign. At least you'll keep health care reform on the political front burner. We'll even give you money and work on your campaign, because the country and the planet cannot afford another 4 years of a Republican in the White House.

But if you're elected President, we're not going to lend the force of our progressive movement to supporting your Universal Mandate plans. We'll be organizing millions of people behind Single Payer Health Care/Medicare-For-All, the only type of plan that can actually guarantee quality, Universal Health Care to all Americans.

End of Part 3
Coming in Part 4: How Universal Mandates Originated in Republican and Corporate Democratic Think Tanks