Note to Barack Obama: Choice is the Problem, Not the Fix in Health Insurance

I hesitate to write about health care issues at this moment as a colleague of mine is embroiled in a controversy regarding his comments about health insurance policy ads being released by the Obama campaign.

I don't want to go into the controversy or to try and speak on behalf of or defend my colleague other than to say that I very much disagree with the tenor and content of his reported comments on a Clinton campaign conference call. (Len Nichols does offer a statement here on this subject)

That said, I do want to raise an issue about the "choice" question that Senator Obama raised last night in the debate.

And like Senator Obama, I have an open mind on this as well as I don't understand why he thinks that people who are not well off financially would be better off "choosing" not to have health care if in fact he, like Clinton, plans to subsidize the provision of that health insurance.

From my reading of the problem in comprehensive health insurance, "choice" is the problem -- not the fix.

Someone on the road with him should ask Senator Obama if he thinks we should give the elderly the "choice" of being in Medicare.

I received a note this morning from an Obama foot soldier (this may be from a self-appointed follower of Obama rather than an official campaign representative -- I'm not sure) that was sent to me and a good number of other publications and editors. This individual wrote:

Barack Obama's Health Care is the Same Universal Health Care offered by Hillary and Edwards, but with one Major Difference: You Have the Option of Choice!

We as a nation have to decide, do we want to be forced to pay for universal medical insurance, like we are mandated to pay for auto insurance now? Or would we rather have the option of CHOICE -- to be able to decide whether or not we want to buy our medical coverage when we think the time is right?

Barack Obama's plan thoughtfully does not want to put another mandated cost, like auto insurance, on the backs of the people, especially the young, who already have college costs to contend with. However, the coverage is always there for you, if and when you need it. That is our decision and our choice!

This emphasis on choice by Obama and his followers seems misplaced to me. I don't think he fuly understands why the American health care system is struggling today.

One of the reasons that the health insurance system is failing is that some healthy, young to middle-aged people with the resources to buy insurance are electing not to -- or in your words, their "choice" is not to participate in any insurance at all.

This creates the problem. Choice means that many who are healthy and don't have insurance don't kick into a system that would help subsidize the less well-off economically and those who may be ill. Thus, insurers want to cherry-pick among those they want in their portfolios and want to avoid covering those at the lower end of the spectrum.

Including the non-participants in a comprehensive program would make everyone's costs decline on average, but you need full participation.

Barack Obama is trying to do an honorable thing by putting a plan forward that would cover more Americans -- but he needs to listen to his own words offered in last night's debate. He said that he's not always right and will listen to others. I think he may be wrong on this front -- and his embrace of "choice' may not only inhibit provision of health insurance for the poor but also for others in our society because his system would propogate adverse selection.

I may be wrong as well and have an open mind -- and don't feel as passionately about this as apparently others do. I'd welcome informed comment and thoughtful commentary below on both sides of this question -- and personally, I feel regret for the unfortunate imagery that a colleague of mine used in this policy conversation -- but I don't want to speak for him. He'll do that himself.

But just intellectually and practically on the subject of choice and health insurance, choice seems to me to be part of the problem, not the fix.

-- Steve Clemons publishes the popular political blog, The Washington Note