The No Individual Mandate "Justification" For Lack Of Public Option

Sen Tom Harkin (D-IA) has been a strong advocate for the public option. On a recent call with reporters,
Harkin says a so-called “public option” will be in the senate bill. ”And especially if we’re going to have a mandate that everyone has to buy insurance, then certainly it would be bordering on the unconscionable to mandate that you have to buy insurance from a private company,” Harkin says. “At least, then, by having a public option out there, people at least have the choice of a private or a public option.”

Today, House Speaker Nancy Pelosi made a similar connection between the public option and the individual mandate:
Pelosi came closer than any member of the Democratic leadership has thusfar to suggesting that the individual mandate should be conditional on the inclusion of a public option. Pelosi declined to elaborate when pressed by TPMDC on whether Congress would revisit the individual mandate if the public option can't survive the Senate. But her implication was fairly clear.

The House, she said, "will not force America's middle income families to negotiate with insurance companies."

This is a theme I have heard a lot from the left side of this debate. If there is no public option, an individual mandate is completely unacceptable. If Democrats pass a law forcing people to buy expensive insurance from private companies, it could quickly turn into a political disaster. But for supporters of the public option, there is a dangerous flip side to this argument. That is, without an individual mandate, there does not need to be a public option. It is concerning that this might be the “out” for Democrats if they are killing the public option.

It is important to note that Olympia Snowe is both against a public option and an individual mandate. She already got the individual mandate weakened in committee, and might seek to weaken it further, or eliminate it altogether. The White House has already signaled that they are prepared to do almost anything that Snowe wants.

A health care reform bill without a public option and without an individual mandate is the type of bastard arrangement likely to please almost no one outside the Senate. The fear of losing an individual mandate already has the insurance companies freaking out. The hospitals are very concerned because they made a deal to accept payment cuts in exchange for the promise of near universal coverage. Grassroots progressives demand a public option in order to provide viable competition to the for-profit private plans, and the vast majority of Americans favor the idea. Many health care policy experts agree that an individual mandate is needed to achieve universal coverage (although the Senate Finance bill's insufficient subsidies make anything close to universal coverage impossible regardless of if there is a mandate). But increasingly, I see this set up as a way for Democrats to "justify" their failure to pass a real public option.

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