Tuesday, December 4, 2007

Health Insurance for All, Only if Everyone Pays?

Re “Mandates and Mudslinging” (column, Nov. 30):

Paul Krugman dismisses Senator Barack Obama’s points about health insurance mandates as “echoing right-wing talking points” on health care. Really?

It was two pragmatic Republican governors, Mitt Romney of Massachusetts and Arnold Schwarzenegger of California, who proposed mandates as cornerstones of their respective health reform plans.

In California, resistance to that approach has come primarily from unions and Democrats. Although I have favored the mandate component of Mr. Schwarzenegger’s plan, Mr. Obama raises valid points about the practicality of immediate mandates as the path to universality.

In California, there are real questions about whether the insurance that people would be required to buy and able to afford, even with subsidies, would be worth having. Massachusetts has already had to grant waivers to many.

In addressing this issue, carrots may prove more effective than heavy-handed sticks.

John Walkmeyer
San Ramon, Calif., Nov. 30, 2007



To the Editor:

How can Paul Krugman limit his discussion of health care reform to the competing Obama-Clinton-Edwards “universal coverage” plans with nary a mention of a single-payer system? As Mr. Krugman has noted in previous columns, having insurance does not always equate to being “covered” when needed care is prescribed.

Where all three “universal coverage” plans amount to subsidy schemes for the insurance industry, Representative Dennis J. Kucinich’s single-payer plan would eliminate the unnecessary middlemen — for-profit insurers and H.M.O.’s with their high profits and huge administrative costs.

Ernest A. Canning
Thousand Oaks, Calif., Nov. 30, 2007



To the Editor:

It is inconsistent for anyone to oppose an individual health insurance mandate and simultaneously support our current laws that require that emergency rooms provide care whether or not a patient is able to pay. Mandated emergency room care is ultimately what relieves individuals from having to buy insurance.

I doubt that Senator Barack Obama or any Republican candidate is prepared to advocate the repeal of these mandates.

We will never make progress on solving our health care crisis until Democrats accept the notion of a market-based solution and Republicans accept the notion that mandates will be required to optimize how the market operates.

Kim Davis
New York, Nov. 30, 2007



To the Editor:

As a devoted reader who agrees with Paul Krugman 99 percent of the time, I urge him to rethink his stand on health insurance mandates.

Consider:

¶We mandate car insurance because of the damage a half-ton of hurtling steel can do to others, but we don’t mandate that a car owner insure himself or herself.

¶If health insurance coverage were mandated, it would be like setting up a parallel taxation. While a single-payer system would be far more efficient, it now seems even more unattainable.

¶If Senator Barack Obama points out why Republicans will defeat the plans of Senator Hillary Rodham Clinton or John Edwards, he’s not “echoing right-wing talking points” but rather anticipating Republican criticisms.

We shouldn’t let the perfect be the enemy of the good, particularly when perfect will be defeated. Good policy is useless if it’s also bad politics.

Mr. Krugman’s policy recommendations may have some merit, but his political advice, in this case, is flawed.

Health Insurance for All, Only if Everyone Pays?

Re “Mandates and Mudslinging” (column, Nov. 30):

Paul Krugman dismisses Senator Barack Obama’s points about health insurance mandates as “echoing right-wing talking points” on health care. Really?

It was two pragmatic Republican governors, Mitt Romney of Massachusetts and Arnold Schwarzenegger of California, who proposed mandates as cornerstones of their respective health reform plans.

In California, resistance to that approach has come primarily from unions and Democrats. Although I have favored the mandate component of Mr. Schwarzenegger’s plan, Mr. Obama raises valid points about the practicality of immediate mandates as the path to universality.

In California, there are real questions about whether the insurance that people would be required to buy and able to afford, even with subsidies, would be worth having. Massachusetts has already had to grant waivers to many.

In addressing this issue, carrots may prove more effective than heavy-handed sticks.

John Walkmeyer
San Ramon, Calif., Nov. 30, 2007