My favorite New York Times columnist is Paul Krugman. My favorite presidential candidate is Barack Obama. Krugman doesn't like Obama much, mostly because of the lack of mandates in Obama's health care proposals. The politician Obama thinks (mostly intuitively) that it's wrong to penalize people who can't afford health care or to coerce them into buying it. The economist Krugman thinks that universal health care can't work without mandates, since people will fail to sign up and in the event of a catastrophe, will still wind up free-riding on the system. In other words, a reasoning of means versus a reasoning of ends.
Normally, this would be the sort of fun, shop-talky policy debate you and your liberal friends would get into, and you'd hash everything out and call each other a few names but have a drink afterwards and agree that the real thing to do is to try to get health care done. But in this case, it's nearly the only major policy difference between Obama and Clinton, so it's something that is being fought over like crazy, especially since Obama sent out a controversial mailer attacking Hillary on the issue.
I believe that universal health care has to be THE central item in a progressive agenda--not just because it’s the right thing to do, but because of its political economy implications. As I explain in Conscience of a Liberal, Republicans went all-out in 1993 to block health reform because they feared that success would reinvigorate the progressive agenda. And they were right...
Obama’s plan fell short — but I was initially willing to cut him slack, figuring that it could be improved. But then he began making the weakness of his plan a selling point, and attacking his rivals for getting it right. And in the process he has systematically trashed the prospects for actually achieving universal coverage.
Here's David Brooks:
[Jim] Cooper is one of the most thoughtful, cordial and well-prepared members of the House. In 1992, he came up with a health care reform plan that would go on to attract wide, bipartisan support. A later version had 58 co-sponsors in the House — 26 Republicans and 32 Democrats. It was sponsored in the Senate by Democrat John Breaux and embraced by Daniel Patrick Moynihan, among others.
But unlike the plan Hillary Clinton came up with then, the Cooper plan did not include employer mandates to force universal coverage.
On June 15, 1993, Cooper met with Clinton to discuss their differences. Clinton was “ice cold” at the meeting, Cooper recalls. “It was the coldest reception of my life. I was excoriated.”
Cooper told her that she was getting pulled too far to the left. He warned that her plan would never get through Congress. Clinton’s response, Cooper now says, was: “We’ll crush you. You’ll wish you never mentioned this to me.”
And via Andrew Sullivan, here's Josh Patashnik at TNR:
Imagine you're a Senate Republican. You think the health-care system is getting a bit out of control, and you find it unacceptable that 45 million Americans lack health insurance. So you're thinking about signing on to Ron Wyden's universal-coverage bill, as five of your GOP colleagues have already done. Then, along comes Krugman to tell you, oh, by the way, Kristol was right in 1993--if we get our foot in the door by passing health care, you can count on a broader Kucinichization of America. What are you gonna do? Chances are, you'll be a lot less likely to support the bill. Krugman continually insists Republicans will fight universal coverage tooth and nail at every turn, and then frames the issue in such a way as to ensure that they will...
It always surprised me that Karl Rove would constantly brag about how privatizing Social Security was the first step toward a piece-by-piece demolition of the social safety net--and then he proclaimed himself shocked, shocked when Democrats showed no interest in helping Bush partially privatize Social Security. It would be a bitter irony if universal health care were to elude our grasp again because liberals made the same mistake.
Krugman's identification of Obama's plan with the antiprogressive agenda feels shaky to me, because when conservatives attack mandates, they do it in order to scuttle health care reform. In part, it seems that Obama wants to take that objection off the table, to give the bill a better chance of passing. I don't think he's "systematically trashed" universal health care -- one flier does not make a trashing.
But it's bizarre that this policy disagreement has created a much broader frame of Obama as "attacking Clinton/Edwards from the right." Differences on immigration, on international politics, or on taxes (hey, just what are these candidates' tax proposals?) haven't done that. Only the health care debate has. Like Krugman, I think health care is crucial. But like Patashnik and others, I'm worried that the assumption that this is the only health care proposal that can possibly work (or even become a stepping stone to single-payer insurance) is likely to lead to another quixotic, distorted showdown on this issue. And it's too important for that.