This is the smartest defense of Barack Obama's health care plan that I've seen. But I don't agree with it. I have to run, but the short version is that you can't actually have this wonderful system everyone's talking about without full buy-in. The insurance industry really can't offer community rating -- which is to say, they can't offer health care coverage at flat rates, disregarding preexisting conditions and the like -- if individuals don't have to participate in the system. In that world, they really will get nailed by adverse selection, as healthier folks forego insurance and sicker types sign up in droves. Universality isn't just a nice moral decision, it's part of the bargain with the insurers -- and you can't force them into community rating without it.
Then comes the question of whether mandates work. Barack Obama believes they do. He's got one for children. Surely he doesn't mean to say that "Americans aren't going without health care because they don't want it, it's because they can't afford it. But the reason their kids are going without health care is that their parents don't want to give it to them."
The third point is a bit airier: Universality should simply be a non-negotiable bottom line. I made this argument at greater length yesterday, but the idea that we're all in this together is key to progressivism, and if you can't even sell something with the obvious rhetorical advantages of medical coverage for everybody, you may as well pack up your toys and go home. It's just an absurd place to pull up on the reins -- bad policy, yes, but my hunch is, a huge political error. You'll lose support on the left, won't gain any on the right, and will give opponents an easy way to attack your plan. "We're spending all this and we're still leaving 20 million uninsured? Typical liberal efficiency, I guess."
And fourth, the rhetoric he's using will, later, be turned on progressive reformers. He's constructing an argument, that will be attributed to leading liberal Barack Obama, that battles against universality. The way he's engaging on this issue is actually, so far as I can tell, setting back the cause of reform. That's bad in the particulars, of course, but it also suggests, to me, that Obama hasn't spent much time thinking abut how to achieve universal health care reform.
