Obama campaigned smart.
February 2008<...>
OBAMA: Let's break down what she really means by a mandate. What's meant by a mandate is that the government is forcing people to buy health insurance and so she's suggesting a parent is not going to buy health insurance for themselves if they can afford it. Now, my belief is that most parents will choose to get health care for themselves and we make it affordable.
Here's the concern. If you haven't made it affordable, how are you going to enforce a mandate. I mean, if a mandate was the solution, we can try that to solve homelessness by mandating everybody to buy a house. The reason they don't buy a house is they don't have the money. And so, our focus has been on reducing costs, making it available. I am confident if people have a chance to buy high-quality health care that is affordable, they will do so. That's what our plan does and nobody disputes that.
ROBERTS: Now, there are a couple of issues out there in regard to that. There are studies that are showing that 70% -- 20% of people who are uninsured make $70,000 a year still don't buy health insurance. And Jonathan Gruber from M.I.T., who's a well-known and respected economist did a breakdown. He suggests that for $102 billion, which is greater than the costs you've estimated, you cover 23 million people. But if you add another $22 billion on to that to make it a total of $124 billion, you could cover everybody. So, he suggests that your plan costs 80% as much a mandated plan to cover everyone but only covers 50%. How does that make economic sense?
OBAMA: John, I've got to say, everybody's got experts. I've got President Clinton's former secretary of labor, Robert Reich who says my plan is superior, cuts costs, and more likely to achieve universal coverage. I mean, the truth is that we both have a plan to provide universal coverage. There's a technical difference in terms of how we approach it. I believe that the most important thing is to drive down costs first. Here in Massachusetts, the state where I'm broadcasting from, they have a mandate, but they've had to exempt 20% of the uninsured because those folks still can't afford it. And you've got some people who are not paying fines but also still don't have health insurance. And that's what I don't want to do. I don't want to put people in a position where they can't afford it but they're not getting fined by the government, or as Senator Clinton put it, they're having it taken out of their paychecks.
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Make it affordable before a mandate:
I feel pretty good that I've been pretty consistent on this. The individual mandate is probably the one area where I basically changed my mind. The more deeply I got into the issue, the more I felt that the dangers of adverse selection justified us creating a system that shares responsibility,
as long as we were actually making health insurance affordable and there was a hardship waiver for those who, even with generous subsidies, couldn't afford it. And that remains my position. I think other than that we've been pretty consistent about how I think we need to approach the problem. And by the way, I in no way want to suggest that cost is more important than coverage. My point has been that those two things go hand in hand. If we can't control costs, then we simply can't afford to expand coverage the way we need to. In turn, if we can expand coverage, that actually gives us some leverage with insurers or pharmaceutical industry or others to do more to help make the health care system more cost-effective.
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