Sherry Glied, who's done a lot of the best academic work on health care mandates, has a column on the subject in the latest New England Journal of Medicine. She's honest about the difficulties facing the implementation of any mandate, but arrives, I think, at the right conclusion. "Perhaps the most important benefit of mandates is symbolic," she writes. "By mandating the purchase of health insurance, governments signal to their citizens that coverage is critical. For many uninsured people as well as their families, communities, and elected representatives, this public commitment to coverage may lead to a reassessment of priorities. Although making mandates functional will be demanding, just passing a mandate may serve an important purpose by moving health insurance higher on the agendas of all these constituencies." Glied's point reminds me of Tony Blair's pledge to eliminate child poverty by 2020. It's unlikely, to say the least, that come 2020, not a single child in Britain will be impoverished. But by setting the goal, Blair kicked off a massive government effort to reduce the number of children in poverty, which has actually been quite successful. And even if the efforts fall short, now there's something to measure success and progress against. So too with universal health care. It's one thing to have 47 million uninsured in a country that neither guarantees nor works towards universal coverage. It's quite another when universality is official government policy. When uninsurance becomes a policy problem rather than a political argument, it radically changes the nature of the debate.
