Another note on Richard Eskow's interview with Obama health adviser David Cutler. In it, Cutler says, “It comes down to this: You’ll never get someone to buy something if it’s not affordable and not accessible. People just don’t do it...If there are free riders, Obama is open to mandates. But what he is saying is ‘Look, mandates seem like a panacea, but that’s not where the hard work needs to be done.’" That's all entirely reasonable, and I don't doubt the sincerity of the sentiment. But I'd challenge Cutler to think forward: Not to the day after Obama's reform, but to five years after his reforms. Here's the thing: The Obama plan does not make health insurance affordable. It does not arrest its growth. It does not even come close. Nor, it should be said, does Clinton's plan. But Clinton's plan, by establishing a universal health system, creates the pressures and incentives to retain and improve a universal health system -- otherwise, you have hordes of angry citizens caught between a mandate they can't evade and a plan they can't afford. Obama's plan makes some incremental improvements, but by not creating a universal system or having intense cost controls (and none of the plans do, as such controls are not politically palatable), it will simply return to a state of slow deterioration. So the difference between the plans is that in Clinton's case, we know the spur that will force her to continue reforming, improving, and pressuring the system: It's the mandate. With Obama, we don't know what that spur is, save for a generalized desire to improve the health care system. And I don't trust that as enough. Rather, I worry that attention will turn to other things, and though our system will be better for Obama's improvements, it will not be sufficiently changed, and it will definitely not be universal.
