The worst thing that a journalist can do is to present opinion as fact—especially when talking about something important. To do it on Super Tuesday is particularly irresponsible.
Yet that is exactly what conservative columnist David Brooks has done in today’s New York Times.
Responding to what Paul Krugman wrote yesterday (see my post below, “But There Is A Difference Between Obama and Clinton on Healthcare”), Brooks attacks Hillary Clinton for insisting that if we want universal healthcare, we are going to have to ask everyone to get into the pool. Rich and poor, young and old, healthy and sick—everyone will need to contribute to the national healthcare fund by signing up for insurance. Otherwise, we won’t be able to afford the subsidies that low-income and working class families will need to enroll in the plan. Hillary’s mandate is much like the mandate that we all contribute to Social Security or Medicare.
As Brooks sees it, the issue “is over whether to use government to coerce people into getting coverage. The Clintonites argue that without coercion, there will be free-riders on the system.”
In other words, the Clintonites are concerned that young, healthy people who earn too much to qualify for subsidies may not sign up—especially since, under healthcare reform, they will know that once they do get sick, insurers will be required to cover them and will not be allowed to charge them more than they charge everyone else. Thus, while older, sicker people pay into the pool, younger healthier people will get a “free ride”—until they need insurance.
“They’ve got a point,” Brooks admits briefly, referring to Clinton’s position. It’s really rather hard to argue with common sense. “But,” he adds, “there are serious health care economists on both sides of the issue.”
Who exactly does he have in mind? Brooks doesn’t say.
Yesterday, Krugman quoted a serious health care economist, at length,
providing facts and evidence to buttress his point that if we want
“guaranteed issue” (which means that insurers cannot refuse to cover
you if you are sick, and cannot charge you more) we have to have
mandates. (Again, see Krugman’s argument below in my post “But There Is A
Difference . . .)
By contrast, Brooks blithely refers to unknown “serious health care
economists” who, he claims, agree with him. Why doesn’t he name them?
Why doesn’t he cite their work?
Perhaps because they don’t exist (I honestly can’t think of who has in
mind.) Or, if they do exist, perhaps their arguments aren’t very
persuasive. Where is the evidence?
Brooks is simply presenting his own opinion here, while gesturing
vaguely in the direction of ghostly experts who would back him up if he
cared to name them. He is trusting that we will be naive enough to
believe that “if Brooks says so—and prints it in The New York Times—it
must be true.”
Meanwhile, he goes on to quote one of Clinton’s political opponents
(who, by the way, is not an economist, serious or otherwise)
characterizing her call for mandates as so “absolutist, draconian and
intolerant” as to constitute a “political death knell.”
One knows, from past columns, that David Brooks would like to see
Barack Obama win the Democratic nomination. Cynics say that this is
because he believes that a Republican candidate will have an easier
time beating Obama than he would if forced to tussle with Hillary.
Maybe so. I don’t know.
But what I do know is then he talks about “coercive health care plans”
Brooks fails to mention that while Obama’s plan doesn’t have a mandate
forcing individuals to sign up for insurance, it does have a mandate
“coercing” small employers who do not now offer insurance to
“contribute a percentage of their payroll toward the costs of the
national plan.” The only possible exception mentioned in some of
Obama’s press releases: small employers whose revenue falls under an
unspecified threshold.
Clinton, by contrast, would exempt “most small employers” from making a
contribution while simultaneously offering them a tax credit as an
incentive to provide coverage.
Who would be most likely to be hurt by Obama’s mandate on small
employers? The people who work for small employers—mainly low-income
workers—who might find that, if their employer cannot afford Obama’s
mandate, he has to lay them off.
Who would be most likely to dislike Hillary’s mandate? Relatively
affluent young singles and childless couples who earn too much for
subsidies, are healthy, don’t feel they need insurance, and don’t
particularly want to contribute to an insurance fund that covers older
sicker people, or families with children to worry about. In other
words, the 20-something and 30-something, well-educated, relatively
elite voters who count among Obama’s most loyal supports. Perhaps that
is why he would rather “coerce” someone else.
Thanks for your efforts to add clarity to this issue Maggie. I feel like I’m in opposite land where a Democrat is using the same misleading campaign tactics and co-opting progressive language towards regressive ends. On health care, Obama sounds like Dubya.
“’There are serious health care economists on both sides of the issue.’ Who exactly does he have in mind? Brooks doesn’t say.”
Surely you’re not suggesting that there are no economists who object to mandates. Greg Mankiw, Arnold Kling, and Glen Whitman are three that immediately come to mind. Any of these guys has more credibility than the increasingly ridiculous Krugman.
Mike C and Catron–
Mike C–
thanks for the support.
Catron–
As I’m sure you know, none of the people you name are health care economists.
They are conservative economists–with little background in healthcare– and, as such, are opposed to universal coverage.
P.S. Catron–
As for your comment about Krugman being “increasingly ridculous” –this is also what people said when, in the run-up to the war in Iraq, Krugman repeatedly warned that going to war in Iraq would be a huge mistake, that there was no clear evidence that Saddam had weapons of mass destruction ..
People ridiculed Krugman then, but he insisted on telling the truth.
And that is what he is doing now.
It’s interesting, Maggie, that you dismiss respected economists on a frivolous technicality while suggesting that a has-been economist is an expert on foreign policy.
Krugman’s Iraq predictions were just the cocktail party canards that all faux-progressives were parroting at the time. To pretend that he was uniquely prescient is … well … ridiculous.
GOLDSMITH ON MANDATES
Respected health care analyst Jeff Goldsmith has a great post over at The Health Care Blog, in which he makes the following point about mandated universal coverage:
To simply assume that extending coverage to the 47 million uninsured somehow assures ac…
I am one of those thirty something elite, educated people who do not want to pay for mandates, but not for the reasons you say. I would love to pitch in to a pool that supports health care for all, sick/poor/health/rich. What I don’t want to do is to be forced to give any, not a single cent, of my hard earned income to support the profits of insurance companies who have been one of the major players in our current health care mess!!!!!!! I doubt I am alone on this point.
Dr. Matt–
As I’m sure you know, neither Clinton’s nor Edward’s proposals for mandates would force you to give a single penny to a private insurer.
Both would give you the option of signing up for a non-profit government plan roughly equivalent to “Medicare for All”
My guess is that the govt.
plan would be able to give you better coverage for less–for reasons we have discussed on this blog in the past. And, over time,
many, of not all of the private insurance options might well “wither away.” They just wouldn’t be able to compete successfully with Medicare for all.
But the majority of Americans who have private insurance want to hold onto what they have. We have to respect that choice. (If we don’t, we will not get national health reform for a long, long time.)
Dr. Matt–
As I’m sure you know, neither Clinton’s nor Edward’s proposals for mandates would force you to give a single penny to a private insurer.
Both would give you the option of signing up for a non-profit government plan roughly equivalent to “Medicare for All”
My guess is that the govt.
plan would be able to give you better coverage for less–for reasons we have discussed on this blog in the past. And, over time,
many, of not all of the private insurance options might well “wither away.” They just wouldn’t be able to compete successfully with Medicare for all.
But the majority of Americans who have private insurance want to hold onto what they have. We have to respect that choice. (If we don’t, we will not get national health reform for a long, long time.)
A brief preface to my below comment:
Please see WSJ OpEd piece Jan 31 08
“SAYING NO TO COERCIVE CARE”
Then proceed to a response statement to the article:
“Screw Gruber and his greedy & stupid friends.”
that was sent from an older colleague in New York who, for many years, helped to run one of the country’s early non profit HMO’s before that model – and the rest of U.S. healthcare – was taken over by profit-driven interests that push health interests to the side, or down the toilet.
My further comment-
RE: “As I’m sure you know, neither Clinton’s nor Edward’s proposals for mandates would force you to give a single penny to a private insurer. Both would give you the option of signing up for a non-profit government plan roughly equivalent to “Medicare for All”. My guess is that the govt. plan would…”
First Point – Note Maggie’s appropriate use of the words “guess” and “would”. All of the “Plans” are just that, plans constructed of words on a page and words coming out of people’s mouths.
A hell of a lot of political action would be required before ANY element of ANY plan would reach full implementation. And this means that major policy elements of each plan would likely be subject to change.
Which brings me to this Second Point – For the above stated reasons, there exists an ethical obligation to not propose a hc policy plan that starts off with an individual mandate. Take that piece out and go with the rest.
What if the hoped for “gov’t plan”component ends up being stripped down coverage or has other significant weaknesses but the ind. mandate piece still exists.
Here in MA approx. 290,000 uninsured state residents are living this very nightmare (a worse nightmare, really, b/c there was no attempt to create a gov’t option, so the only plans available are private HMO’s – that’s why Romney was so proud).
These ~290,000 uninsured can’t afford the available insurance, even the crappy “more affordable” policies that have high deductibles and steep co-pays, and some include 20% co-insurance even after the deductible is paid!), and they don’t quality for a state waiver to be exempt from the mandate, so these ~290,000 people are facing fines of up to $920.00 annually for the pleasure of remaining uninsured.
Back to nat’l stage, how can we/ why should we, have any confidence that any element of any proposed plan will make it to the finish line and full implementation.
Which brings me to the final point, which is this:
First, do no harm. Reject the individual mandate on the national stage and block its implementation in Massachusetts.
Nurse Ann hits the nail on the head.
A government “mandate” is just a tax wearing a fancy dress.
If you want a government health care system, the financing mechanism will have to be the same as the general income tax, i.e. progressive with a steep indexing as the taxpayer’s income increases. In general, the bottom 50% of the income group would pay nothing, the top 10% of income earners would pay about 90% of the cost, with the remaining 10% of cost distributed through the top 20 through 40 percentiles.
This could be an add-on to the general tax rate or a separate add-on to the payroll tax.
The other side of this coin is finding MDs, RNs, etc. to play in such a system. Gov’t would have to come up with bait. The most likely one: Forgiveness of student loans. In return for a low base salary, the State would eat the cost of college.
Would this fly? Only if the tax were roughly equal to or less than the private sector premiums.
Unless, of course, a new President used his/her Executive Orders perogitive and simply mandated it….
BobMan–
YOu are right, a mandate that everyone buy insurance is a tax–just like the Medicare tax.
Medicare says that to make sure that everyone over 65 has healthcare, we all must pay a certain percentage of our income into a national fund.
Clinton’s plan says that in order to make sure that Everyone –has healthcare, we must all either buy insurance or contribute to a national healthcare fund (by joining the public-sector plan)
Anne–
I realize that the Mass plan is a mess–and to a fair degree, it reflects Romney’s values, which as you know, are not mine.
But you should realize that an op-ed in the WSJ about “coercive care” is put there by the conservative forces in the country who do not want national health care reform of any kind,
They want the people making the profits on the $2.1 trillion that we spend so wastefully to keep on making those profits–drug-makers, device-makers, some hospitals, some surgeons . .
And they do not believe that heatlhcare is a right.
See my recent blog showing Stan Greenberg’s polls on what Republicans and Independents believe.
Also, if you don’t have a mandate that requires affluent people under 40 to contribute–just as they contribute to medicare–then where exactly do you get the money lower-income people need for subsidies??
The economics of health care is something that I studied for 3 years writing my book. It will take a lot of money to get universal coverage.
And this country is entering a deep recession. Sure, we should let the Bush tax cuts for the rich expire–but they were set to expire anyway. That’s not found money.
Sure you could raise taxes on the rich–but by only so much.
I’ve read the studies that do the numbers. We’re going to have to do things–get everyone into the pool, as we did with SS and Medicare–and cut the wasteful, unncessary, unproven overpriced tests, products treatments.
Sure, in the course of going through Congress, the plans will change to some degree. But the fact that the 3 Democratic plans are so close–and that they are so close to what the Medicare Payment Advisory Commission has been saying for a number of years–means that progressives have come to a real consensus as to what needs to be done.
And people like Clinton completely understand that if you start compromising on key parts of the plan, we won’t be able to afford it. We’ll just end up with a “poor plan for the poor.”
Some people wanted Johnson to restrict Medicare to older people below a certain income level. He refused–he knew that everyone had to be part of Medicare. Otherwise, they wouldn’t care about it.
BobMan–
YOu are right, a mandate that everyone buy insurance is a tax–just like the Medicare tax.
Medicare says that to make sure that everyone over 65 has healthcare, we all must pay a certain percentage of our income into a national fund.
Clinton’s plan says that in order to make sure that Everyone –has healthcare, we must all either buy insurance or contribute to a national healthcare fund (by joining the public-sector plan)
Anne–
I realize that the Mass plan is a mess–and to a fair degree, it reflects Romney’s values, which as you know, are not mine.
But you should realize that an op-ed in the WSJ about “coercive care” is put there by the conservative forces in the country who do not want national health care reform of any kind,
They want the people making the profits on the $2.1 trillion that we spend so wastefully to keep on making those profits–drug-makers, device-makers, some hospitals, some surgeons . .
And they do not believe that heatlhcare is a right.
See my recent blog showing Stan Greenberg’s polls on what Republicans and Independents believe.
Also, if you don’t have a mandate that requires affluent people under 40 to contribute–just as they contribute to medicare–then where exactly do you get the money lower-income people need for subsidies??
The economics of health care is something that I studied for 3 years writing my book. It will take a lot of money to get universal coverage.
And this country is entering a deep recession. Sure, we should let the Bush tax cuts for the rich expire–but they were set to expire anyway. That’s not found money.
Sure you could raise taxes on the rich–but by only so much.
I’ve read the studies that do the numbers. We’re going to have to do things–get everyone into the pool, as we did with SS and Medicare–and cut the wasteful, unncessary, unproven overpriced tests, products treatments.
Sure, in the course of going through Congress, the plans will change to some degree. But the fact that the 3 Democratic plans are so close–and that they are so close to what the Medicare Payment Advisory Commission has been saying for a number of years–means that progressives have come to a real consensus as to what needs to be done.
And people like Clinton completely understand that if you start compromising on key parts of the plan, we won’t be able to afford it. We’ll just end up with a “poor plan for the poor.”
Some people wanted Johnson to restrict Medicare to older people below a certain income level. He refused–he knew that everyone had to be part of Medicare. Otherwise, they wouldn’t care about it.
Maggie – I know about Reason’s ideology; when I first saw the WSJ Op-Ed “Coercive Care” a few days ago I googled Reason Foundation and learned of its “Free Market Free Minds” mantra; in fact, I included their mantra next to the author’s name when I emailed the article to activists around the country so they’d know it, too. But just b/c that ideology is where Reason’s argument is coming from, it doesn’t have to mean that some progressives (me and others who oppose the ind. mandate) cannot have an area of agreement with them on a specific element of public policy. Or does it, in your opinion?
The conservatives at Reason acknowledge that very dynamic, and state as much in the WSJ “Coercive Care” piece:
“It may be too much to hope that Mr. Obama would embrace market-oriented measures — such as deregulating insurance markets, giving patients more control over their health care dollars, and fixing the federal tax code to let individuals, like employers, buy health coverage with pre-tax dollars — to bring down insurance costs. But unlike Mrs. Clinton, he at least seems to understand the perverse side effects of an individual mandate.”
Maggie, I have an ethical and a professional obligation to try and stop harm being done to my patients and to my neighbors – or for that matter harm to anyone anywhere. And I do participate in many of those efforts on many fronts. This ind. mandate is happening NOW in Mass. and is causing real harm to many. You seem to know this. Do you have any idea why progressives aren’t trying to help us stop this harmful Romney/ Bush-driven policy?
The risk of causing the same harm to people on the nat’l level appears as an all too real possibility due to the current experience here in Mass.; so what’s a thoughtful, caring person to do? Is it a crazy response to try and stop the individual mandate here in Mass. and to stop it from spreading? I don’t think so, and lots of other progressives agree.
And please don’t overlook my previous extensive comments on Medicare-for-all, where I believe I am in strong agreement with you on most of the points you make here in your most recent reply.
But we’ll shoot ourselves in the foot politically if we lead off these reforms (which cannot happen all at once) with an ind. mandate requirement, b/c the reforms will be taking place within a healthcare landscape that is dominated by private insurance co’s., and within a political landscape that must build consensus (at least to some degree to get anything passed) among a wide variety of values and attitudes about healthcare and health policy that does indeed exist among various demographic groups in the U.S..
There’s an interesting and useful resource about the attitudes and values on healthcare and health reform held by Americans at http://www.HerndonAlliance.org
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