Matt Zeitlin

Shockingly, Paul Krugman thinks that Obama’s mandate-less health care plan isn’t all that great. He cites this hot Jonathan Gruber research claiming that Obama would only be able to cover half of the uninsured that Clinton could cover. The basics behind this assertion are solid — healthy, young people are unlikely to buy health insurance, no matter how cheap it is. But as Mark Kleiman points out, we don’t know what Hillary’s enforcement mechanism is, so it’s pretty hard to evaluate how universal her program would actually be. Unless she proposes automatic enrollment a la social security, I find claims that her plan will have signifigant enrollment advantages unconvincing, especially in light of plenty of respected health wonks saying that the diffrences between Obama and Clinton are only marginal.

Krugman is especially unconvincing on the political end of his discussion. He says that ” 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.” While I’m not happy with Obama’s demonization of mandates, Krugman misses a crucial distinction. The crutch of Obama’s health thinking is that the primary problem is that people who want health insurance can’t afford it. He thinks that until subsidies and price control measures are enacted, it’s irresponsible to have a mandate. After all, even Clinton’s mandate would include provisions for those who can’t afford coverage. So Obama could probably enact a mandate later, if free-ridership is demonstrated to be a problem even after his cost-lowering measures are enacted. So Krugman is being overly negative when he claims that only with Clinton do we have a chance of universal coverage. Under both Clinton and Obama, significantly more people who want insurance and don’t have it will be covered at a lower cost than they would otherwise. The differences are small, especially compared to McCain…