Obama’s Health Plan

Short version: I like it. Long version: The plan preserves the private insurance model, something I’ve opposed in the past for reasons both wonkish and political. But the plan, unlike most I’ve seen, takes cost-containment seriously. This is crucial. Any universal health care plan – from Wyden’s to Hacker’s – has to grapple with the fact that Medicare’s budget is growing at an alarming rate and that increasing government-provided coverage is only going to make that worse. Through mechanisms ranging from prevention programs to better medical technology to (my personal favorite) the reduction of private-insurance company overhead through increased competition, Obama’s plan is calculated to reduce the cost of coverage by about $2,500 a year for a typical family, thus making it a more fiscally responsible option that its competitors.
The plan reflects some of Obama’s Burkean leanings, illustrated very well in Larissa MacFaquhar’s excellent profile in the New Yorker. Obama’s upbringing seems to have left him with a sense of caution about vast social changes. One can see the influences of this thought in the health care plan. Take, for instance, its lack of an individual mandate, which has caused both Ezra Klein and Jonathan Cohn to deny that it’s a truly “universal” plan (this is a quibble, and both Ezra and Jonathan know it). But the plan is designed such that everyone who wants to can afford to be insured, creating conditions wherein an individual mandate would, in the future, be sensible. As Ezra says, the plan “will take us much further along the road, ensure full coverage for all children, and create a system in which mandates could be more easily added later on.” This philosophy is also evident in the plan’s creation of a separate public insurance system for the unemployed, the self-employed, small businesses, and those whose employers deny them insurance. This is a system that, as Ezra points out, would be “trivial to expand it in the future, letting all businesses, or all individuals, buy in.” The overarching philosophy of the plan seems to be that the government must make America safe for universal health insurance before actually creating it.
Overall, the plan is a fiscally prudent method to insure the vast majority of the currently uninsured, while setting the stage for a more universal system in the future.

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