Advocates of individual mandates are right to worry about nonparticipation. "As a practical matter, letting people opt out if they don't feel like buying insurance would make insurance substantially more expensive for everyone else," Krugman points out. But the most logical solution to this problem, as Krugman himself has written elsewhere, is to make health insurance a function of the government, as it is already for the poor and the elderly. People may object to the specter of "socialized medicine," but at least they grasp that there's nothing unusual about the government collecting insurance premiums in the form of taxes for Medicare and Medicaid.
It may be necessary to achieve the goal of expanding government-administered health insurance in stages. All the health care plans of the major Democratic candidates are premised on that assumption, whether they acknowledge it or not. The only Democratic candidate I'm aware of who dispenses with such gradualism is Dennis Kucinich, whose solution—" Medicare For All"—is the only one that will solve the health care mess in the long run. Clinton, Obama, and Edwards all have plans that would steadily enlarge the role of government health insurance. These are accommodations to political reality. I question the wisdom of including, within such an accommodation, a mandate that would render that accomodation unattractive to a large bloc of voters. If we're going to create a ruckus, better to do it in the service of a more comprehensive solution than either Clinton or Edwards has put forth. If we aren't, Obama's resistence to an individual mandate makes perfect sense.
Health-Care Primary Archive:
Oct. 16, 2007: " McCaincare: Provocative But Vague"
Oct. 3, 2007: " Why Bush Was Dumb To Veto SCHIP"
Sept. 28, 2007: " Would Universal Health Care Wreck Cancer Treatment?"
Sept. 20, 2007: " Hillarycare II: New and Improved"
Aug. 2, 2007: " Giuliani's Tepid Health Reform"
July 5, 2007: " Edwardscare: An Elegant, Laudable Trojan Horse"
July 1, 2007: " Health Costs Screw Business, Too"
June 19, 2007: " Obamacare: Better Than It Looks"
March 13, 2007: " A Short History of Health Care"
Nov. 8, 2006: " Time To Socialize Medicine"
March 9, 2005: " Socialized Medicine, Part 2"
March 8, 2005: " The Triumph of Socialized Medicine"