Progressives who have turned against the individual mandate in health care reform may want to highlight their one-time ally in that fight: President Barack Obama. Throughout the 2008 primary campaign, the mandate was one of the bigger debates between Obama and Hillary Clinton. Obama won the election but Clinton arguably won that debate, since the President took up the mandate in his health care plan. But he was pretty adamant about why he didn’t think a mandate was useful in the past. Perhaps the best distillation of that comes in this interview to CNN from Febuary 2008:

OBAMA: Let’s break down what she really means by a mandate. What’s meant by a mandate is that the government is forcing people to buy health insurance and so she’s suggesting a parent is not going to buy health insurance for themselves if they can afford it. Now, my belief is that most parents will choose to get health care for themselves and we make it affordable.

Here’s the concern. If you haven’t made it affordable, how are you going to enforce a mandate. I mean, if a mandate was the solution, we can try that to solve homelessness by mandating everybody to buy a house. The reason they don’t buy a house is they don’t have the money. And so, our focus has been on reducing costs, making it available. I am confident if people have a chance to buy high-quality health care that is affordable, they will do so. That’s what our plan does and nobody disputes that.

The problem that people resisting the mandate seem to be having is that the health care offered through the Senate bill is not completely affordable, particularly to those in the middle class, and more important, it’s not of high quality.  As Ian Welsh notes today, the Senate bill does not have annual caps for insurance companies and has on the aggregate a 70% actuarial value, and even lower for certain key groups. Welsh notes, “100 billion in subsidies doesn’t mean squat if they come tied to an expense people can’t afford, making them buy insurance which is not particularly useful.”

The individual mandate makes sense if it locks in health care coverage that is actually worthwhile. There are compelling arguments that the coverage that can be offered in this bill does not meet that test. This is a policy dispute, and those who prefer passing the bill want to marginalize it by demonizing it as purely emotionally based and childish. But it’s not. People who have done serious work looking at the bill don’t think that it mandates quality health coverage, and if that’s the case, they think forcing people to buy it is misguided.

And they have support from then-candidate Barack Obama. If you follow his logic – that if people have a chance to buy high-quality health care that is affordable, they will do so – then it holds that if people see the coverage as neither high-quality or affordable, they wouldn’t buy it. But under his plan, they are being forced to do it.

David Dayen

David Dayen