As the scorecard in Iowa is tallied, add insurance companies to the loser camp along with the disgraceful, rhetorical sham that forcing individuals to buy insurance is universal healthcare.
Individual mandate, the policy wonk lingo for requiring the uninsured to purchase private insurance premiums, was the key talking point of Sen. Hillary Clinton's attack on Sen. Barack Obama in Iowa.
In speech after speech Clinton lambasted Obama for "leaving out" millions because his health plan does not include individual mandate. In the final days leading up to the caucuses, Iowans were barraged with robo calls reinforcing that theme.
While many Iowans, like other Americans yearn for genuine, comprehensive healthcare reform, it's safe to conclude the tactic did not work. Volunteers on the ground report that healthcare was increasingly the main issue for many Iowans, and numerous voters echoed Obama's response, as noted in one of his ads opposing the proposal to "force those who can not afford health insurance to buy it, punishing those who don't fall in line."
Simply put, the mandate doesn't solve the problem; it just pads the pockets of insurance corporations who are not exactly scrapping for cash. Indentured servitude to the insurance pirates is hardly a humane or sound healthcare policy.
Clinton made individual mandate a national referendum in Iowa with a stance parroted by several national columnists and supposed healthcare experts who have also embraced it as the deceptive synonym for universal care. And Iowans responded.
It's not confined to Clinton, of course. Individual mandate is also the centerpiece of Sen. John Edwards' health plan, Mitt Romney's law in Massachusetts, and the bill proposed for California by Gov. Arnold Schwarzenegger and state Assembly Speaker Fabian Nunez. Thus the significance of the Iowa vote.
To be clear, Sen. Obama's health plan shares much in common with Clinton and Edwards in an ongoing reliance on private insurers, and a failure to crack down on insurance denials of care or price gouging.
But Obama deserves credit for not jumping on a bandwagon that plunged off a cliff in Iowa and whose wheels are already coming off in Massachusetts.
In Massachusetts the deadline in that state for buying insurance was December 31. According to national census figures only 44 percent of the state's uninsured had purchased the mandated policies. And most of those who have enrolled - 79 percent - get full or public subsidies; in other words, the state is using public money to enrich the insurance industry.
But Massachusetts officials are apparently also ignoring the evidence. Their response was to quadruple the tax penalties for those who fail to buy insurance, even while acknowledging that premiums may go up as much as 14 percent next year.
In his election night speech, Edwards described the poignant case of Nataline Sarkisyan, the 17-year old California teenager who died in late December after her insurer, CIGNA, denied a liver transplant until it was too late, even though the transplant had been recommended by her doctors. CIGNA, which like all insurers terms payments for care a "medical loss ratio," only changed its stance after public humiliation prompted by protests largely organized by the California Nurses Association/National Nurses Organizing Committee.
Los Angeles Times columnist Steve Lopez this week told the story of 10-year-old Preston afflicted with cystic fibrosis whose insurer Blue Cross has just raised his bills for vital medication he needs to keep breathing from $30 a month to $784.
These are the corporations we want to reward by giving them tens of millions of new customers marched into their offices under threat of tax penalties, or as proposed in California, garnishing their wages?
It's long past time to wrench control of our health out of the hands of CIGNA and Blue Cross and return it to where it belongs, to the medical professionals at the bedside in consultation with patients and their families.
There's only one way to accomplish that, with a fundamental overhaul that gets insurance companies out of the way. The day of the Iowa vote, columnist Robert Novak, of all people, reported in the Washington Post that "one longtime Democratic consultant, not involved in any campaign this time, suggested that Clinton propose a genuine universal health-care scheme" which Novak conceded was "a simplified, though far-reaching, health-care plan" - having "everybody covered by Medicare."
Clinton and her advisers rejected that advice. In the wake of Iowa, she might want to re-consider. There is such a proposal now in Congress, HR 676. All the leading candidates should endorse it. In the meantime, let's heed the call of Iowa, discard the notion of forced mandates, and tear off the yoke of the insurance industry once and for all.