The New Health Dialogue

Stephen Crowley/New York Times

The bipartisan health care summit may be so last week, but before we move on (to reconciliation and House vote counting?) we wanted to just pull out three pieces of the transcript which made an impression on us. Here's President Obama explaining why he came around to believe in the individual mandate. It's important partly because it gets to the essential point of why we have to do comprehensive reform -- piecemeal just doesn't have the answers.

Here's Obama (and no, we haven't seen any comment from Secretary of State Clinton...):

Now, on the mandate, though -- because the mandate issue is connected, and so I'm just going to mention this real quickly, and then I will move on. When I ran in the Democratic primary I was opposed to the mandate.

Well -- and I'll -- because my theory was, you know what, the reason they don't have health insurance isn't because somebody is not telling them to get it, but because they just can't afford it, and that if we lowered costs enough then everybody would be able to get it. So I was dragged, kicking and screaming to the conclusion that I arrived at, which is, is that it makes sense for us to have everybody purchase insurance. And I have to say this is not a Democratic idea. I mean, there are a number of Republicans sitting around this table who have previously supported the idea of an individual mandate, responsibility.

The reason I came to this conclusion is twofold. One is cost-shifting, which is a fancy term for saying everybody here who has health insurance is one way or another paying for those who don't. Every time somebody goes into the emergency room -- if Jay's son got hit by a bus and his dad wasn't Jay Rockefeller, and he ends up in the emergency room, we'd give him emergency treatment, and we'd all pick up the tab. And the calculation -- not our calculation, but independent economists -- is that each family with health insurance right now is picking up $1,000 to $1,100 worth of costs for people who don't have health insurance.

So when Tom Coburn earlier said, you know, if a kid comes to the emergency room, they're going to get treated -- yes, they will get treated. Who's paying for it? Well, we're paying for it. Every American family who's got health insurance is paying for it. Every employer who is covering their employees is paying for it.

So we're already putting the money in. It's just in a very inefficient way. And so the notion that somehow if we don't ask people to carry their responsibilities, that we're saving money -- no, we're not saving money; it's just we don't see it. It's called uncompensated care, and we all get charged an extra thousand bucks. So that's part of the reason.

(Obama at other points in the summit spoke about how it's difficult to require insurers to cover people with pre-existing conditions without a mandate -- too many people would not buy insurance until they got sick -- it's just too expensive right now.)