Wednesday, February 9, 2011

In Defense of McCaskill on Health Care Reform

There's been a lot of criticism of Senator McCaskill's recent statements about health care reform suggesting that she's "moving to the center" or "selling out" by saying that she's looking for alternatives to the invindual mandate. In fact, Rachel Maddow has now promised to mail a cardboard cutout of Blanche Lincoln to McCaskill to remind her of the futility of Democrats trying to pretend they are Republicans.

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This is clever and fun, but I actually disagree with Maddow's reading of McCaskill's statements. What Claire has said is that she would look to see if there are other alternatives to the mandate that would accomplish the things she wants accomplished in the health care bill. Here's a specific quote from Politico:
In an interview, McCaskill said she’d “love to” modify the mandate and is “looking at different ways to try to” extend coverage without a mandate.

“We’re running numbers to see how many new people we can get into the pool with something less than a mandate, something that would be more limited enrollment periods with severe financial penalties for not signing up.”

McCaskill added that an alternative “may not be workable; it may be that the mandate is the only way we can do it. But I think we should explore it.
She also was quoted as follows:
“I’m not worried about the politics of this; I’m worried about the substance of it,” McCaskill said. “My goal has always been pretty simple: affordable, accessible, private-market insurance for people in America who want insurance. The politics of this are hard; it’s just easier to stay focused on the substance because that’s what matters.”
So the real question is, what are the good things about the health care bill that she's trying to protect while "looking into" other options? I think, as she's stated many many times, those good things include expanding insurance coverage to the people who need it and making sure that people with preexisting conditions can get coverage. And remember, the point of the mandate is to have enough people buying insurance that the insurance companies can afford to cover others, including people with preexisting conditions:
Senator McCaskill: Uh, I mean, the mandate obviously is the most unpopular part, but, um, when you ask people if they want to do away with preexisting conditions they say, well of course, that's so unfair. Well, who's gonna buy insurance before they're sick. You can't do away with preexisting conditions unless you set up an environment where everyone has insurance.
So McCaskill has always expressed reservations about the mandate, but has stated that it appears to be necessary for protecting the good parts of the bill that outweigh the negatives of the mandate.

And let's be honest: the mandate does suck when considered by itself. The idea that we have to pay the same greedy insurance companies who screwed us in the first place is pretty disturbing. In fact, it was so disturbing that progressives like Markos Moulitsas and Howard Dean were originally against the health care reform bill that featured a mandate without a public option. But they eventually relented for the same reasons Claire and pretty much everyone else who supports the current bill signed on: the bill, which ultimately is an extremely positive step, would not be able to accomplish the good things without the minor annoyance of the mandate.

So now what is McCaskill saying? She's saying she's looking into ways of accomplishing the good things without the negative of the individual mandate. And if we're being honest, I think many people would agree that if we could have the good things without the mandate, the health care bill would be better overall. However, most of us just question whether it's actually possible to take care of preexisting conditions without the mandate (at least, in this system where there are not public options available). So McCaskill says she's looking into other options, and that there might not actually be any other options to accomplish the good things, and I think she's right. But most of the other criticism on this issue, in my opinion, is simply reading too much into her words.

However, if Maddow would like to mail Claire the Blanche Lincoln cutout because of her spending cap suggestions, I'm all for it!


  1. I believe it was premature of Senator McCaskill to discuss ways of replacing the personal responsibility aspect of the Affordable Care Act in question before the SCOTUS has had an opportunity to rule on the constitutionality of that aspect. That being said, one solution being discussed is the establishment of an enrollment period for the state exchanges. (The exchanges are made up of private insurance companies who will have a variety of plans available for those who are not covered by insurance through work or any other way.) That enrollment period would help to prevent people from purchasing insurance only when they get sick or injured. My opinion is that Rachel Maddow would give Senator McCaskill ample opportunity to again defend the Affordable Care Act, and then I too would hope she would put the Senator on the spot regarding the spending cap suggestions you mentioned.

  2. Extending insurance to cover young Americans until age 26 is critical, especially as they make the transition into the tough job market.