The Mandates Are the Message

The Cleveland debate ends, and presto, the MSNBC boys pop up to discuss "who won." Chris Matthews complains of "a lot of back and forth about health care, which I find almost absurd given the fact that we don't have a national health care plan."

That's right, Chris. We don't have national health care in America. That's why the candidates wasted 16 minutes of your precious time arguing about it — time you and Keith Olbermann could have spent throwing out more football metaphors.

Oops, my TV screen went blank.

Let's talk about health care.

Hillary Clinton and Barack Obama were fighting "around the edges" of a health-care plan, Matthews beefed. No, these weren't edges. They were very important details that could make all the difference between a government program that works and one that fails.

Clinton favors mandates requiring everyone to buy health insurance. Obama opposes them. On this matter, Clinton is right.

Obama has a problem with forcing people who don't want insurance to buy it. What will Clinton use as a stick, he asks.

Americans don't like sticks unless they're attached to lollipops. States force drivers to buy auto coverage, however. The penalties may include loss of driver's license and, in some states, jail time and a $5,000 fine. Guess what. Most drivers comply.

Obama insists that "the reason people don't have health insurance isn't because they don't want it, it's because they can't afford it." But if his plan would make insurance affordable — as he says it would — then why can't everyone afford it?

Being liberals, Clinton doesn't want to use the unflattering term "free riders," and Obama pretends they don't exist. But they do. A free rider is someone who can afford a health insurance policy but won't buy any.

Obama wants to give Americans the freedom to not buy insurance but the right to get government-subsidized coverage when they get sick.

There are 47 million uninsured people in the United States, and 16 percent have a family income above $75,000. Another 15 percent make between $50,000 and $75,000. Some no doubt have pre-existing medical conditions, and no private insurer will sell to them. Others prefer to spend their money on vacations.

Conservatives who pooh-pooh universal coverage say the free riders tend to be healthy and don't use much health care. Not quite true. About 16 percent of the patients who received "free" medical care in 2004 came from families making at least four times the federal poverty level, according to New American Foundation estimates. They racked up $5.8 billion in uncompensated care, which others had to pay for.

Thus, Clinton is somewhat misleading when she says that the Obama plan leaves 15 million people out. Many of the 15 million are free riders who will leave themselves out.

But she is correct that a government plan that lets hearty young people opt out is doomed to collapse. It would make more sense to skip all this reliance on private coverage — the heart of both the Clinton and Obama proposals — and go to a Medicare-style government plan paid for through taxes.

Back in the MSNBC studios, no one's fretting about insurance mandates. Olbermann is observing that for Clinton, "This looks like a bunch of field goals, not touchdowns."

To which Matthews responds: "I think we learned tonight why Americans like high-scoring sports. This was a low scoring game, perhaps like a hockey game."

Click.

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