09 October 2008

Well, fine then

I surprise myself in becoming more of a health policy wonk as time goes on. I actually took the time to read both candidate's health plans (actually, four of them, including Hillay's and Wyden's). Ok, they were pretty dull, and thin on some details. But I have acquired a good working knowledge of the plans as the candidates have proposed.

One of the criticisms I had of Obama's as compared to Hillary's was that it was not truly universal. It did not contain any sort of mandate or requirement for enrollment. Many others, including the NYT's Paul Krugman said the same. Hillary's plan did have a mandate, though she was vague as to how it would have been enforced.

So I was jolted out of my chair last night when McCain asserted the "remarkable" fact that Obama was intending to "fine" Americans who did not have health insurance.

"If you’re a small businessperson and you don’t insure your employees, Senator Obama will fine you. He'll fine you. That's remarkable. If you're a parent and you're struggling to get health insurance for your children, Senator Obama will fine you."
He also snarkily repeated himself after Obama's rebuttal.

Yes, that is remarkable. Remarkable in that I had never ever heard that before. In fact, surfing over to Obama's web site, I noted that the full text of the plan made no mention of fines (or any type of enforcement) for failing to sign up. In fact, there was no obligation to sign up at all for adults, and while children are required to have coverage, tax credits, expansion of SCHIP and connector plans would prevent this from being prohibitively expensive.

I wasn't the only one to notice McCain's remarkable claim. (His running mate also made a similar distortion of Obama's plan last week.) Interestingly, most of the fact-checkers missed the larger point. Obama's plan, they note, exempts small businesses from the requirement to provide health insurance to employees. Nowhere is there specified a "fine" for business who do not -- simply a choice of providing health care or contributing to the national plan. It is a distortion at best to characterize this as a "fine." McCain's more ambitious claim, however, was that Obama will fine families directly. There's absolutely nothing outside of McCain's fevered imagination to support that contention.

I would say that McCain told a "lie" with this mischaracterization of Obama's intentions; that's what we used to call a deliberate statement of an untruth. But the word "lie" has been bandied about so much with him that it's lost all meaning. I'll simply leave it as remarkable; McCain's word is quite apt.

It is remarkable that a man whose career was built on the concepts of personal honor and integrity should choose to so disgrace himself in a desperate struggle for the Presidency. Remarkable, and sad.


  1. An Interesting article from Rolling Stone Magazine. Honor forsooth.

  2. I can't believe anyone is actually arguing the merits of any of these so called plans. I remember the last time a Clinton tried to pass a health care plan and the total failure that was.

    The reality is that none of these plans has a hope of getting passed.

    The president doesn't just sign the thing into law. The president needs to convince the Congress and if you think that will happen without the ultimate plan being drastically different then the one proposed, well then I have a bridge to sell you.

    The best we can hope for is to allow anyone under 65 to join Medicare without any sort of means testings, but then we would have to figure out how to pay for it.

  3. Shadowfax,

    Fines are absolutely necessary in order for Obama's plan to work. According to Obama's position on prohibiting medical underwriting and having all members of an insurance plan to pay the same premium and having all applicants accepted regardless of pre-existing conditions, there is incredible incentive for individuals to apply for health insurance only when they need insurance benefits and to refuse to pay for premiums after they receive the benefits needed for their current treatment.

    Obama himself has admitted that mandates (and thus fines/punishment) for those who refuse to purchase health insurance are inevitable even though mandates are specifically not part of the plan.

    McCain is despicable in many regards and has a problem with being honest, but in response to your characterization of McCain's statement as a "lie" you are incorrect.

    There are other aspects of Obama's plan that are not specifically mentioned or outlined in his website because of political expediency. Another example is the fact that Obama plans on cutting primary care reimbursements by 30% in order to afford the mass increase in primary care visits as a result of insuring the uninsured, as revealed by one of Obama's close healthcare policy advisors. You don't hear about these things because it's unpopular for Obama to talk about them. It's far easier to talk about how those making more than $250,000 will have their take-home pay cut in half in order to pay for more entitlements.

  4. Peter,

    thanks for the on-topic response. If Obama has said in any venue that mandates and fines are inevitable, that would indeed be newsworthy and I will concede the point. Can you provide a citation? Also, understand that mandates do not require fines; there is a concept of automatic enrollment which gathered a lot of discussion last year. I recall that was more a feature of Edward's plan, though I could be wrong.

    I also have not heard about Obama's cutting primary care reimbursement. Again, a link or source would be helpful to support the point.

    Anon 5:41,
    Very true -- Congress will be making a lot of sausage if this is going to come to pass. However, all we have now is the plans the candidates put forth, and I don't think it's unfair to judge them on the basis of their stated intentions.
    And Medicare for all has its advocates, but that plan would be absolute poison in Congress, and has even less hope than Obama's plan.



  5. Where are they going to find the primary care docs to see all these newly insured patients when the primaries now in practice see 30-50 patients a session as it is?


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