In the post above I quote Harvard professor of health policy and political analysis at Harvard’s Kennedy School of Government Bob Blendon as saying that voters perceive little difference between Obama and Clinton on healthcare reform. And I think he’s right. But that’s because most voters haven’t honed in on the fine points of their plans.
Those who have scrutinized the plans, and understand the economics of healthcare reform, see important differences—differences that could be deal-breakers.
In today’s New York Times, Princeton economist Paul Krugman argues that because Obama’s plan does not require everyone to sign up for insurance, it would be more expensive—and thus less likely to pass Congress. Without a mandate, Obama’s plan “would face the problem of healthy people who decide to take their chances or don’t sign up until they develop medical problems, thereby raising premiums for everyone else,” Krugman points out. He acknowledges that “Mr. Obama, contradicting his earlier assertions that affordability is the only bar to coverage, is now talking about penalizing those who delay signing up — but it’s not clear how this would work.”
Writing on The American Prospect today, economist Dean Baker from the Center for Economic and Policy Research responds to Krugman, saying that he knows how penalties would work:
“Obama has suggested that we can have a system of default enrollment, whereby people are signed up for a plan at their workplace.
“People would then have the option to say that they do not want insurance, so they are not being forced to buy it. However, they will then face a late enrollment penalty if they try to play the ‘healthy person’ game. When they do opt to join the system, at some future point, they will have to pay 50 percent more for their insurance, or some comparable penalty for trying to game the system. “
What Baker doesn’t say is what we will do with families who cannot afford to pay such stiff penalties when they finally decide they need insurance. Would we subsidize the penalties?
If not, and if everyone believed that the penalty would enforced, then
how is this different from a mandate? Everyone knows that,
eventually, they will need healthcare. And only the very wealthy could
afford to pay that 50 percent more than everyone else. So threatening
free riders with a steep penalty is, in effect, putting a gun to their
heads. It’s a mandate by another name.
Krugman, by contrast, assumes that Obama is genuinely committed to
letting enrollment be voluntary, at least at first. As a result,
Krugman points out “the Obama plan would leave more people uninsured
than the Clinton plan.” How many people? Here he points to a new
paper by M.I.T. healthcare economist Jonathan Gruber:
“Mr. Gruber finds that a plan without mandates, broadly resembling the
Obama plan, would cover 23 million of those currently uninsured, at a
taxpayer cost of $102 billion per year. An otherwise identical plan
with mandates would cover 45 million of the uninsured — essentially
everyone — at a taxpayer cost of $124 billion. Over all, the Obama-type
plan would cost $4,400 per newly insured person, the Clinton-type plan
only $2,700.”
The difference in cost is tied to the fact that, without mandates,
healthy young people who earn too much to qualify for subsidies might
decide not to enroll, while poorer people (who qualify for subsidies)
would be almost certain to sign up (as they have in Massachusetts),
along with people who are older, sicker and generally more expensive to
insure. Quite simply, if younger, healthier people don’t contribute
their share to the pool, it will be left to taxpayers to make up the
difference.
And that is why Krugman fears that Congress would never agree to
Obama’s more expensive plan. But what if Obama included the penalties
Dean Baker describes, in essence forcing everyone to sign up?
Trouble is, “the Obama campaign has demonized the idea of mandates,”
says Krugman—“ most recently in a scare-tactics mailer sent to voters
that bears a striking resemblance to the ‘Harry and Louise’ ads run by
the insurance lobby in 1993, ads that helped undermine our last chance
at getting universal health care.
“If Mr. Obama gets to the White House and tries to achieve universal
coverage, he’ll find that it can’t be done without mandates — but if he
tries to institute mandates, the enemies of reform will use his own
words against him.
“If you combine the economic analysis with these political realities,
here’s what I think it says: If Mrs. Clinton gets the Democratic
nomination, there is some chance — nobody knows how big — that we’ll
get universal health care in the next administration. If Mr. Obama gets
the nomination, it just won’t happen.”
I won’t go quite that far. But I do know that, unless everyone signs
up for health insurance, there is no way to fund national health
reform. As Paul Berwick suggested in last week’s post,
“we’re not going to achieve universal coverage by encouraging everyone
to “pursue his or her own individual self-interest.” We need to begin
to think collectively, about what’s best for everyone.
Obama has painted himself into a corner. So disappointing.
But hey, my company makes a ton of money off how fragmented the health care system is, so Vote Obama ’08!
I generally agree and personally favor mandates, except that Clinton has not spelled out any sort of penalty for not enrolling. While, theoretically, she has more wiggle room to offer an enforcement mechanism later on than Obama–who more or less can’t use a mandate–it would take an enormous amount of political capital, especially for clinton, who is associated with a previous health care debacle, to actually convince Congress to enact a sufficiently harsh penalty to make a mandate work.
Again, I’m pro mandate. But I don’t see how she gets a serious mandate through–and if that’s the case, you’re pretty much left with duplicate health reform proposals.
Obama’s one big experience dealing with “mandates” vs “no mandates” came in the form of legislation that would “require” nuclear plant opertors to report “all” leaks at their plants to the nuclear regulatory commission. According to the NYT, Obama boasted on the campaign trail that this was the only nuclear legislation that he passed in the Senate. The only problem was that Obama rewrote his bill to reflect changes sought by Senate Republicans, Exelon and nuclear regulators. His new bill removed language “mandating” prompt reporting and simply offered guidance to regulators. His revised bill was never taken up in the full Senate and shelved before the 2006 session ended.
I’m not saying that something like this is beyond Hillary, but the history of the bill showed 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, and on the other was Exelon, the country’s largest nuclear plant operator and one of Obama’s largest sources of campaign money. When push came to shove, Obama was shoved.
Hey, Greg P –
This post is about 2 different plans for fundamental health system reform – not the issue of nuclear industry regulation. And don’t try to defend your absurd stretch of “well, both issues include the word mandate” as an excuse to bring up an issue so you can say negative things about Obama. Stick to health care, please.
Back to the topic of this post – Words cannot express how grateful thousands of people here in Massachusetts are for the fact that Obama “Gets it”, on the inherent flaws of an individual mandate scheme.
We’re also thrilled that Obama is telling lots of other people across the entire U.S. about the harmful effects of an individual mandate that forces the uninsured to buy their own health insurance and punishes them if they can’t. It’s perverted.
Forcing people to buy individual policy insurance in a largely privately controlled profit-driven insurance market that is within the larger dysfunctional health care system IS A TERRIBLE IDEA AND WILL NOT WORK.
I am a nurse and health reform activist in Massachusetts and have in my possession reams of state documents that reveal how badly the mandate plan is going here in Massachusetts. Yes, 250k new people have insurance under our law but they have FULLY SUBSIDIZED or heavily subsidized coverage.
Only 4.14% of the newly insured in MA after this law was implemented have purchased insurance paying the entire cost themselves. And 75% of this group bought the crappy insurance with high deductibles ($2,000 to 4,000) and steep co-pays. Not because they were eager to buy crappy insurance, but because it is all most of them can afford.
I work as a nurse with this moderate income population and I know the cost of living in this state and I know this mandate is creating a real hardship for a huge segment of our population. The cruel irony is that many of the people who responded to the threat of the mandate will not be able to afford to use their new insurance, due to the deductible and co-pays!!! But the private HMO’s will keep collecting their monthly premiums. Like I said, it’s perverted.
The state is planning to use the dept. of revenue to execute the mandate penalties – up to almost $1,000 annually – simply because these individuals cannot afford to comply with the mandate and they are not eligible for a waiver.
Many uninsured residents are in a panic over the mandate penalty situation, and I know a number of them who have called their state legislators and the Governor’s office for help. Mostly what they get is “It’s the Law” but one woman was told to consider getting another job, maybe at Starbucks because they provide health insurance plus she would get free coffee every month. Another was told that she could default on her mortgage payment and then use the paperwork to apply for a “hardship waiver” to the mandate. Seriously.
Individual mandate schemes open the door to all kinds of negative results for the very people who need affordable health care.
The one group that is assured to do well under a individual mandate plan is the insurance industry.
Thank heavens Obama gets it.
Let’s move beyond the mandate mess and make plans to demand – whoever is the next president and congress – a program of improved Medicare For All, cradle to grave in every state, and eliminate the “Part C Medicare” (the private HMO’s game the system and reap huge profits) and reform “Part D” so it actually works in the interest of Medicare beneficiaries.
The US has some of the best doctors and best medical technology in the world, but there are too many other fingers in the pie. Many private health insurance plans easily consume up to 20% of total costs and limit patient treatments where they shouldn’t. For-profit HMOs and hospitals are by law required to put profits and shareholders above all else, and the first to suffer is quantity and quality of staffing. The next is fewer tests and fewer hospital days. The result is poorer health care.
The healthcare system is not the only one where there is such a huge gulf between the “image” and the “reality.” To many times special interests have neutered mandates. Promoting voluntary compliance over mandates will never help solve the health care crisis. We actually do need real leadership that will stand up to these special interests, or all the cards will remain in the hands of the stakeholders with the real power. If the country is to solve the health care problem, it needs to make it possible for the working poor and middle class to afford insurance. You increase the economies of scale by increasing the insurance pool, thus lowering costs. Mandating will help to do the job, voluntary compliance won’t.
Thank you Ann for your post regarding the realities of a mandate in Massachusetts. Oh, and I see that the Boston Globe endorsed Obama!
Everyone talks about a right to healthcare…..but doesn’t a mandate to get insurance infringe upon our right to personal freedom?
Universal healthcare could be funded in other ways, without resorting to mandates, such as the value-added tax proposal along with the issuance of vouchers (as proposed by Ezekiel Emanuel and Victor Fuchs).
The question I have is whether either of the Democrat candidates’ plans would outlaw private insurance? I’m guessing that, at least in practice, the current concept of private insurance would be defunct, if not outright outlawed but so far I haven’t seen this issue directly addressed.
Greg – I agree w/ many of the points made in your second comment below, but I must take issue with a line of thinking that points us in the wrong direction for reforms that will actually benefit ordinary people in the U.S..
You say: “The healthcare system is not the only one where there is such a huge gulf between the “image” and the “reality.” To many times special interests have neutered mandates. Promoting voluntary compliance over mandates will never help solve the health care crisis.”
I’d ask that you consider re-calibrating your thinking on system reform aimed to achieve quality universal coverage and healthcare for all, and shift it from “How do we MANDATE that individuals purchase an insurance product?” to “How do we GUARANTEE quality affordable health care for all?”
And yes, it’s gotta get paid for, and I agree that everyone should have a responsibility to pay in on a sliding scale, but let’s cut out the middlemen who mostly just waste huge sums of money and muck up the system creating huge problems with access and quality, while driving costs through the roof. Put in place program standards and oversight for QA to reduce unnecessary, profit-driven/reimbursement-driven care by providers.
Here’s how to do this:
Move beyond the mandate mess, and other system tinkering that’s doomed to fail, toward a program of improved Medicare For All, cradle to grave in every state, and eliminate the “Part C Medicare” (the private HMO’s that game the system and reap huge profits) and reform “Part D” so it actually works in the interest of Medicare beneficiaries.
A key – and thus far, missing – ingredient for this is exactly what you say: “We actually do need real leadership that will stand up to these special interests…”
What we might have here is a situation of “The people must lead and then the leaders will follow” – and eventually these leaders will begin to lead as well!
Please find out what is happening in your state to build a winning movement for Medicare For All at http://www.HealthCare-Now.org
Ann:
Would it be a fair characterization to say that your plan is: From each according to his ability, and to each according to his need?
Seems like it. Sound familiar?
What does that even mean? Medicare for all? Does it mean that 25% of the people also have Medicaid as is true of traditional Medicare?
The problem is that Obama has already said that for his plan to work, he’d have to have a penalty for people who try to “game” the system by not enrolling until they become sick. Well, if you put in a penalty, that penalty starts looking an awful lot like a mandate. Do you read the posts before responding to them?
The point of all of this is that Obama is being disingenuous, and his words will wind up being used by those who oppose univeral insurance. He’s already selling progressives up the river on health care and he hasn’t even made it through the primary yet!
Mike C., Brad,
Thanks for your comments.
Mike C–I hope you’re not right. But I’m afraid we’re less likely to get hc reform under Obama–in part because it is not his top priority.
Brad– Hillary doesn’t propose fining people who don’t sign up.
If they don’t pick a plan, she would just sign them up automatically in the public sector plan. (This was also what Edwards proposed.)
The mandate would work like Medicare. If you don’t pick a Medicare Advantage private sector plan, you are automatically enrolled in traditional Medicare.
Any payments due are taken out of your Social Security check.
I’m not sure how Hillary plans to collect payments–probably the least expensive way would be to take it out of paychecks the pay we now pay FICA taxes for Medicare.
How do we collect from the unemployed? In many cases, they wouldn’t owe anything but would qualify for a full subsidy.
HOw about the self-employed? Perhaps they would be billed on their income tax the way they now pay for Medicare.
Gregory– very interesting parallel.
Obama has portrayed himself as a compromiser and I worry about what part of healthcare reform he might be willing to give away.
Of course Clinton is also very pragmatic. But we know that healthcare reform is very near and dear to her heart. And that she understands all of the Dartmouth reserach about overtreatment. So she knows how to fund it.
Ann–
The Mass plan is very, very differnt from Clinton’s plan.
A major problem in the mass plan is that private insuers are allowed to charge older (say 55-year-old) citizens twice what they charge a 30-year=old for the same policy.
This means that some older people who earn too much for a subsidy still can’t afford insurance.
Secondly, Hillary’s plan requires that insurers compete on a level playing field with her public sector plan (a version of medicare for all). They would have to offer an insurance package that was at least as comprehensive as the public sector plan.
They would not be able to discriminate against people who are elderly or sick.
I very much doubt that she would allow high deductible plans that, as you say, middle-class people then can’t afford to use.
She promises to cap how much anyone pays to 5% of income.
More importantly, she has studied the numbers and knows what she is talking about–in detail.
Cradle-to-grave Medicare for all is a great idea but there are two problems:
First, even if the Democrats have a landslide victory, there are not enough votes in Congress to get it. And demanding that legislators do something isn’t going to work. Have you noticed–we’re still in Iraq. We don’t have expanded SCHIP.
And, on this issue, the majority of voters do not want single payer–by a wide margin. They like the employer-based insurance they have and don’t want to change.
Secondly, if we went directly to Medicare for all, people would blame everything they didn’t like on “socialized medicine” or “the government.”
For instance, if we’re going to cover everyone, we cannot continue to cover over-priced, ineffective or unncessary tests, and treatments and pills.
Many people will be unahppy to find that if they want the latest magic pill advertised on TV, they have to pay for it themselves.
If we had single-payer they would blame “the government” for rationing care.
If private insuers are competing with a public plan, they too will have to refuse to cover over-priced ineffective procedures, followng Medicare’s lead. (Or else the private insurers’ premiums will be too high and they won’t be able to compete with Medicare for all)
Thus people won’t be able to blame the new rules on “socialized medicine” or “the government.”
Gregory, I agree– we just won’t have enough money to cover low-income and lower-middle income families–giving them the subsidies they need to sign up–unless everyone is in the pool
Under all of the Democrats’ reform plans insuers will no longer be able to refuse to cover sick people. And they won’t be able to charge people more if they are sick.
So why would an relativelyl affluent, healthy young person sign up for insurance? He could wait until he gets older, has children, or is sick, and then decide to enroll, secure in the knowledge that the insurer would have to take him and couldn’t charge him more.
We need those young healthy people in the pool.
jms– Do you feel that the mandate that you contribute to Medicare, or to Social Security impinges on your right to personal freedom?
This is essentially the same thing. Many people have decided that we want to guarntee healthcare for everyone, not just peole over 65, and to do that we need to have everyone pay into the system, according to their income, as they do with SS and Medicare.
Trust me-I know the numbers. There is no way that we can afford universal coverage unless everyone signs on. And many young healthy people will not sign on volutnarily. See my response to Gregory and Ann above. A value-added tax won’t do it–the dollars aren’t there.
I’ll be back later this evening to respond to the rest of you
cheers, mm
Tom Ann, Mike C–
Tom– None of the Democrats has proposed eliminating private insurers.
They are all very explicit that everyone can choose between a private insurer and a public sector alternative that would be much like Medicare-for-all.
People who have private insurance through their employer could keep that insurance. And it is expected that, at least at first, many people would do just that–waiting and watching to see how the public sector alternative works out.
If, as I suspect, the government can offer more coverage at a lower price, people may begin switching to the public plan, but this will be purely an individual choice.
Mike C–I’m afraid you are right. Obama is being disingenous about this. Telling people that if they don’t sign up know they will have to pay 50 percent more when they do sign up is, in essence, a mandate.
And what this show is that, when Obama thinks about it, he realizes that we cannot afford to cover everyone unless we have a mandate. He knows many young, healthy relatively affluent people won’t sign up voluntarily. Why would they if they know that under heatlh reform, insurers will have to take them when they get sick–and can’t charge them more.
And that has to be part of national health reform. We don’t want private insurers to be able to “cherry-pick” healthy patients while shunning the sick. IF that happens, all of the sick people would wind up in the public plan, and it would be unaffordable.
I wish Obama had just come forward and said: “I was wrong. We do need to make sure that everyone signs up.
Maggie – I pretty much know all the ground you covered in your reply to me, but thanks b/c we all learn by repetition so hearing some of it again is useful to me, and maybe it’s the first time hearing these details (of the policy AND the politics of healthcare reform) for others.
One reason I post about Medicare-for-all is to generate a discussion about the general concept, what a model for a national insurance program might look like and how it would function. In a similar comment I put up on Ezra’s blog I added that MCare-for-all would need to include QA standards and effective oversight to reduce the appalling amount of unnecessary care that is profit-driven/ fee-for-service-driven and is now so widespread that some analytical estimates are that 50% of all care provided is unnecessary (and carries with it undue risks)!
Since I’m a nurse who’s trained to think about health in a holistic way, in contrast to the medical model that’s more dz and tx-focused, I get excited thinking about eventually achieving MCare-for-all (or something like it) and what it would allow us to do if we actually had a functional nat’l health program. We could make great strides in putting resources and best practices programming into the largely neglected areas of health promotion and dz prevention.
This leads us to the elephant in the parlor – the politics of it all.
Policy is only half the equation, and maybe not even half!
I appreciate’s Maggie’s pointing out the likely votes in Congress – or lack thereof – and the data we have on where the “American Public’s” head and heart are at on this issue.
Fear is a mighty motivator and easy to use, as you point out – look at the results Bush got with it! But anger is a mighty motivator as well. And lots of other motivators are being analyzed through the work of The Herndon Alliance over the past 3 years http://www.herndonalliance.org
So, in the very real political context of hc reform, what I and other hc activists are trying to be a part of is building a groundswell public movement for fundamental improvements in our health care system. This movement building is a hugely difficult thing to accomplish that will require passionate outspoken strategic indefatigable MLK type leaders across the country.
I think I agree that far-reaching fundamental reform policies shouldn’t be proposed to be undertaken in one fell swoop – that would be felt by many of the public as taking something away from them. I guess human nature is that people will stick with the devil they know rather than supporting a change to the untested and unproven, that’s why using the concept/vision of MCare-for-all makes sense b/c most people kinda understand it and support it. (Although Bush and Co. are doing their best to destroy the program and the public’s confidence in it).
As much as the policy details do matter, candidates and people like me who are ardent advocates for fundamental system improvements have to be saavy about the politics of reform. That brings us to the very real challenge of not only what vision to put out there, but what words to use to begin to articulate that vision to mobilize supporters, allay their fears, and hold them with you when your vision comes under fierce attack.
This leads a very ugly, but, as you know, a very very very real aspect of the politics of health reform. That is the need for us advocates to be constantly launching offensives toward the opposition, rather than mostly fending off the onslaught of attacks by special interests who have huge sums of money to spend (our “healthcare dollars”). For as we have seen, these special interests and their operatives will stoop to the lowest of depths to protect their current undeserved share of the healthcare spending pie.
I think Obama has shown political wisdom in not bringing up the individual mandate as a leading edge of his vision for reform. Clinton attacked him for that so he hit back.
I think Obama’s got a lot more than Clinton does of what it will take to mobilize the public around a vision for reform (let’s face it, charisma and oratory skills can make a big difference in politics and are essential for movement building).
On the specifics of the ind. mandate piece, yes, I know our situation here in MA where the uninsured are being forced to purchase private policies without community rating is not what the Clinton plan has put forward. Which leads to a final political point, for now. Both Obama and Clinton’s plans are just that, plans. Words on paper and coming out of their mouths (and ours). There’s so much that would have to be accomplished to get those plans passed in Congress and then fully implemented which means it’s likely (practically a given) that many plan details will change along the way. That’s why I don’t think it’s wise, and could even be harmful, to include an individual mandate up front.
And yes, the 25% who receive MCaid supplements to pay for their MCare part B premiums would need to be addressed as we move the reform ball down the field.
Maggie,
So, as of right now they don’t want to get rid of private insurance. From what I gather, though, opting out of insurance (the so called free rider proglem) would either be illegal or penalized (making you contribute anyway). Let me repeat, that’s what they want now. Based on past experience, does anyone honestly believe that they’ll stop there? The term ‘mission creep’ comes to mind. I cannot think of a single government program that has maintained its original purpose, let alone gotten smaller. Government programs, with very few exceptions, expand over time. I predict that if we pass Communist-style health care we will see it become illegal (or against regulations, with severe punishments, which amounts to the same thing) to go outside the system.
Tom–
You wrote: “I cannot think of a single government program that has maintained its original purpose . . .”
Medicare, Social Security . . . .
You also refer to what “they” are going to force us to do. Presumably “they” are the
“Communists” embedded in our government?
I’m afraid you’re about 55 years late with that theory. McCarthy’s dead; the cold war is over.
I’m happy to say that I’m an American who now lives permanently in Canada — where I can enjoy and good (and the bad) of a single-payer system. My wife and I collectively pay $96 a month for our insurance (on a sliding scale — we have a good income, so we pay the top amount). When we need medical assistance, we go to our physician, show our card, and that’s it. The physicians handle the administrative issues with the government payment system. What could be easier?
Granted, there are “waiting lists” for certain procedures (ones which do not involve life-threatening or emergency situations). In the US, your insurance might cover those, or might not. Even if covered, you would certainly have to wait, too.
I really disagree with the US candidates, which insist on integrating a public system with the structure of private insurers. Why? It is those insurers which increase the administrative costs of the US system — and those costs have been estimated at 16% of total cost, 4 times higher than the Canadian.
Mike–
Thanks for your comment.
I really appreciate having someone who actually lives in Canada talking about the Canadian system.
Drug-makers and for-profit insurers in the U.S. have spread so many myths about Canadian healthcare.
Why are Democrats proposing a system that gives people a choice between a public sector plan and a for-profit plan?
Because 80 percent of Americans say that they like the insurance they have–this is usually employer-sponsored private insurance. And they want to keep it.
The idea of change–and being forced into a public-sector plan scares them. Particularly after all they have been told about the terrible things happening to people in places like Canada.
So Clinton, Edwards, et.al. quite reasonably decided: okay, we’ll give them a choice. They can keep what they have–or they can sign up for a public sector plan.
Because the private insuers have higher overhead (cost of marketing, advertising, exec salaries, profit for shareholders, etc.) it is almost certain that the public sector plan will offer more coverage at a lower price.
And the Democrat’s plans force the private insurers to complete on level playing field. They cannot turn down people who are sick and they cannot charge them more. They will have to offer an insurance package that is at least as comprehensive as the public sector plan. (No Swiss Cheese plans filled with holes.)
Once people see what the govt plan offers, many will switch into it. And over time, many, if not most private insurers are likely to “wither away.”
So Medicare and Social Security have both maintained their original purpose? Really?
Medicare was made law in 1965. In 1975 Medicare was expanded to cover disabled individuals under the age of 65. How’s that for maintaining its original purpose? (http://seniorjournal.com/NEWS/2000%20Files/Aug%2000/FTR-08-04-00MedCarHistry.htm)
When social security was first proposed ‘they’ promised the SSN would never be used as a national identification number. Have you ever tried to file a federal tax return without using your SSN? How’s that for maintaining the original extent of the law?
As for the ridicule I sense with the quotation of my “they”…are you suggesting that ‘they’ are not going to force me to do anything? Do you really expect me to believe that my fellow citizens (people on your side of the argument, actually), acting through the government, are not going to force me to take part in some attempt at Universal Medical System (or whatever ‘they’ end up calling it)? That’s what I see when I read about ‘mandates’ and the ‘free rider problem’. Please correct me if I’m wrong.
Tom–
You may be the only person I’ve ever met who objects to the fact that Medicare was expanded to
include the disabled.
Tom–
You may be the only person I’ve ever met who objects to the fact that Medicare was expanded to
include the disabled.
Wait. Did I object to Medicare’s expansion? No, I did not. That is another issue entirely.
What I did was point out the fact that Medicare has expanded. I suppose that I can take comfort in the fact that you, at least implicitly, admitted that you were in error when you pointed to Medicare as an example of a program that has not expanded.
Tom–
You’re right, I forgot that Medicare expanded to
include the disabled.
Though I don’t think many people saw this as a major deviation from Medicare’s original purpose–providing healthcare for people who are no longer working, either because they are older or because they are disabled. . .
Maggie,
Interesting. So you think that it’s ok for federal programs to expand (and you sort of seem to even not count it as true expansion) if you judge the change to be compatible with the ‘original purpose’ of the law? Can I extrapolate, then, to our current debate over Socialized Health Care? Would it be fair to say that the end of providing health care at no direct charge to every American citizen would justify any means necessary? For example, if a politician were to promise that there will be no mandate to participate in the program, and then after passing it into law we found out that was unworkable, then I suppose by your logic it would be perfectly fine to impose a mandate since it would further the ‘original purpose’ of the program.
I think you have nicely shown how the Statist’s mind works. You have a government, a goal and the will to use the coercive force of the former on all citizens to achieve the latter. While I am sure that your intentions are pure, your methods (using government power to force the populace to comply with the goals of a few) have been shown by history to lead to some of the most horrific acts ever visited upon human beings. That is why I will continue to work to keep the vision of the Founding Fathers alive. To do otherwise is to allow this great country to go down a path from which there may be no redemption. I just pray that we at least leave pieces large enough for our grandchildren to put back together.