The vast majority of voters, and a plurality of Dems, have strong objections to paying taxes as well. Nonetheless we recognize that the only way to preserve a social insurance program like Social Security is with a broad based mandate known as the payroll tax. Universal Health Coverage is no different, it is social insurance, not an entitlement, and will not survive unless it is mandated insurance like Medicare. If we abandon that central concept then we have lost the policy debate, regardless of the politics.

Simplistic verbal jousting doesn't make for good policy or good politics.

How do you propose to enforce a mandate?

As I stated above, paying for coverage through a broad bsed tax is far different than an individual mandate.  If you think it is tough to pass a tax increase, try passing a mandate.  It will make things much easier for opponents.

Don't pay taxes and watch what the IRS does.

Now, where are the teeth in these so-called 'mandates' in the Clinton and Edwards plans?

Keren Brown Wilson, who was involved in getting Medicaid reimbursement for assisted living/residential care in Oregon (starting a mini national wave) and then went on to develop a chain of small assisted living facilities?

Thank you for the detailed and substantive response.  Glad you are interested in having a positive discussion.  Why is my view "utter bullshit," as you so delicately put it.

I could go on for ages about the complexity of the politics involved in trying to pass significant health care reform.  There are many reasons that universal care has been talked about for sixty years with very little success.

The big advance was the creation of Medicare and Medicaid in the mid sixties.  If you know any of the history of their passage you will realize that there were two nescessary preconditions:

1) was the existence of a broad consensus that a problem existed and that older Americans and poor and disabled Americans had a right to access care.

2) was the existence of a very large Dem majorities in both houses of Congress.

Part of what I argued in my original post is that the same combination will be needed to make further progress.

Mandates are primarily a sop to the insurance industry, but they come at a significant cost.  Mandates will be used as a wedge to splinter public support for any significant change.

I am sorry if you are disappointed, your post doesn't explain your disagreement or what sort of analysis you were hoping for.  Having clicked on your name I can tell that your comments are nearly all critical of Obama.  Perhaps you are criticizing my post, less because it is "insufficiently wonky", than because you dislike my conclusion about who would have the best chance of passing health care reform.

If you want to have a real discussion, I am all ears.

I have long been an advocate of a single payer system.  I think it is by far the most comprehensive and efficient model from a policy point of view.  However, I think it is not politically viable.

You are right that my objection to mandates is primarily, but not entirely, political.  I think mandates are low hanging fruit for any opponent to exploit.

The US has a very libertarian streak.  People don't like being told what to do with their money. Even those who would not directly be effected will not like the idea of others being told what to do with their money.  

I have some sympathy with this position. I know many people who live modestly from paycheck to paycheck; they struggle mightily to pay their car insurance on top of their basic bills.  Based on current prices, health insurance costs would be many times more expensive than car insurance.  How will these people come up with this money?

I do have a philosophical preference for having health insurance costs paid for through a broad based tax rather than through a patchwork of government, employers, and individuals.  Obviously not all mandates are created equal and the devil is in the details.  A mandate could be structured that would limit the burden that would be placed on individual families.  

Again, the problem is that you will never get to this point if you propose a program that draws opposition to millions of people who would otherwise support health care reform.

I'm curious about your antipathy toward Obama.  Why do you dislike him so intensely,  Who are your first and second choices?

I appreciate your willingness to try to engage people in an open, objective discussion of this issue. The truth of what you're saying can be found in the many unions and policy advocates who have come out against mandates, both federally and with respect to Massachusetts and the recently proposed plan in California.

I believe that reasonable minds can disagree on the policy, but on the politics you are absolutely right. If they want to torpedo Obama's candidacy over this, it's only going to come back and haunt them ten times over in the general election.

That said, I'm afraid you won't get any reasonable debate on this topic here. This internet forum has come to be dominated by people who hate Obama for whatever reason, starting with its founder Jerome Armstrong, who has posted a more or less continuous stream of severely biased tracts against Obama on the front page everyday for the past few weeks. Good luck!

Thanks for an eloquent entry. I enjoyed reading it, as well as the few substantive criticisms that others have raised.