[Woolhandler (co-founder and one of the presiding geniuses over Physicians for a National Health Plan) basically says, contra Krugman, don't make it your dealbreaker on who to vote for. More commentary by me afterwards.]
http://www.pnhp.org/news/2008/february/clinton_vs_obama_on.php
STEFFIE WOOLHANDLER, M.D.,
QUENTIN YOUNG, M.D., via Todd Main, (312) 782-6006, (708) 738-7365, todd at pnhp.org, http://www.pnhp.org
Woolhandler is professor of medicine at Harvard University and a co-founder of Physicians for a National Health Program. She said today: "Hillary and Obama are both right. Hillary's individual mandates would, as Obama charges, financially punish uninsured families. Obama's plan contains no individual mandate, but would, as Hillary charges, fail to cover 15 million or more Americans. In Massachusetts, where the individual mandates' high fines on the uninsured will not kick in until the end of the year, few of the state's quarter million middle-income uninsured have yet purchased coverage.
"Hillary's, Obama's and Massachusetts' mandate model health plans leave the private insurance industry in charge. Hence, the plans will continue to waste nearly one of every three health dollars on the overhead and paperwork that private insurers generate.
"Covering everyone in a non-profit single-payer national health insurance plan could cut health administrative costs in half, freeing up enough money to cover all of the uninsured with no increase in costs. Until politicians embrace the single payer model, they will have to choose between unaffordable costs (on one hand) or leaving millions of Americans uninsured (on the other) -- a choice that is all the more bitter because it is completely unnecessary."
Young, national coordinator of Physicians for a National Health Program, said today: "Any reform based on the private health industry will fail. Experience has proven that private insurers can neither control costs nor assure universal coverage; they are simply too bureaucratic and expensive. The administrative overhead in the current private-based system is 31 percent. Single-payer systems have overheads that are only about half that."
<end news release>
<Resume commentary by me>
Specifically on the mandate question, Steffie was on Doug's radio show a year ago, discussing Arniecare & Masscare:
http://www.leftbusinessobserver.com/Radio.html#070111
and she specifically discussed the madness of mandates in minutes 8:30-13:25.
Essentially in both the California and the Masscare plans what it means in round numbers is demanding that poor people spend $5,000/yr, or you'll fine them $2,000 (out of their taxes).
It's true that the vague plan that Clinton promises could possibly be different. But these seem to be the real world models that her plan is based on; she often alludes to them as such; and due to the underlying economics (the plans that are now on offer through the market, the bare bones plans that states have tried to create to fill the bottom gap) it's hard to imagine how her plan could be much different.
And when you look at it this way -- that mandate plans are cruel hoaxes that can't work -- Obama being against them doesn't have to be interpreted the way Krugman interprets it: that he's against single payer on principle. On the contrary, it could also be interpreted that he thinks mandates are a cruel hoax -- which seems to be what he's saying and, based on all current real world models, seems to be true.
In which case, this policy difference can't be used as evidence that Obama is constitutionally any farther from the idea than Clinton is.
Woolhandler also argues vociferously (here and elsewhere), and I think persuasively, that, contra the Krugman/Clinton camp, the mandate plan doesn't get us one iota closer to a single payer plan than a non-mandate plan. Single payer means changing the guts of the system to throw out insurance companies and replace a market commodity with a government service. Neither plan does that one bit. Neither gets us any closer to that goal.
So we're left back in the beginning. The only way national health care is going to work is single payer. And the only way we are going to get it with either one of these characters is if they throw their campaign plank on this issue completely overboard and do something completely new.
Therefore the only thing we really get from either candidate is a target to lobby -- and an advocate to sell it to the nation in the unlikely (but greatly to be desired) event that we win the battle that will be begin the day after they get elected.
Michael