I think Krugman has bought the premise that the insurance companies can't be defeated in a straight-out fight for single payer, so he's willing to entertain the possibility of a wonkish squaring of the circle: don't cut out the insurance companies, find a technocratic design that will limit the damage they do, and hope that they won't defeat you anyway. Maybe, more charitably, he's simply accepted that both Clinton and Obama have taken that route, so he's willing to accept it as the working premise of his argument.
On the mandate issue, I think his argument relies on "adverse selection." If you don't mandate universal coverage, then a certain number of robustly healthy and risk-tolerant people will decide not to get health insurance. There will be two results. (1) Some of those who choose to take that risk will nonetheless require high-cost medical care which will end up being paid for by third parties. (2) Those who do pay for health insurance will be, on average, less healthy. Therefore, the cost of insuring them - and of premiums - will be higher per person than in a mandated system. So, in the mythical world where either Clinton or Obama could enact their current proposal by fiat, Krugman believes that Clinton's plan would be superior. (Obama's plan would, however, ameliorate the current adverse selection problem somewhat. Right now, very high risk people often find themselves in an "adverse selection death spiral," able to purchase health insurance only in a risk pool with other very high risk people, thus inflating the premiums far out of the reach of anyone you or I know).
But yeah, this is all straining at gnats. Insurance companies (and big pharma) will do their best to kill either plan, and will very probably succeed. The only way to deal with these folks is to beat them down: put the insurance companies out of business and fundamentally change the IPR regime for pharmaceuticals.
Michael McIntyre
On Tuesday, February 05, 2008, at 12:12PM, <JBrown72073 at cs.com> wrote:
>CG wrote:
>
>>So, I asked myself this morning, what the fuck am I going to do
>tonight after work? The posting yesterday by Krugman on the
>differences between Hilary and Ob was seriously convincing. I
>understand exactly the difference between mandated and optional.
>
>Really? I found Krugman's article muddy and mysterious. Why is he wimping out now when he could be arguing forcefully for standing up to the insurance companies?
>
>How is forcing people to pay for private insurance that may or may not cover you and improvement over not doing so? I mean, it's great for the insurance companies, but what about for the average citizen? Are they going to insist I can afford coverage because I have savings? (Like Medicaid basically requires you to have no assets?) And what about this assertion:
>"After all, we already have programs that make health insurance free or very cheap to many low-income Americans, without requiring that they sign up. And many of those eligible fail, for whatever reason, to enroll." If they don't have to sign up, how could they fail to enroll? What programs is he referring to? I found this impenetrable.
>
>In general, both Clinton and Obama's plans are fatally flawed because they don't attack insurance company power. They'll be vulnerable to McCain saying it's government reaching into your pocket, forcing to you purchase insurance (in Clinton's case everyone, in Obama's case parents only).
>
>What did you find convincing about it?
>
>Jenny Brown
>in Florida, voted pointlessly for Edwards before he dropped out
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