‘Universal’ health care

‘UNIVERSAL’ HEALTH CARE…. Back during the Democratic presidential primaries, one of the few areas of major disagreement between Barack Obama and Hillary Clinton was healthcare mandates. Clinton said individual mandates were key to achieving universal coverage. Obama, in the least attractive part of his campaign platform, disagreed. It was pretty obvious throughout the debate that Clinton was right, and that Obama would have to switch if elected.

And sure enough, that may be poised to happen.

After speaking with administration officials, Ezra Klein reports this afternoon that the administration’s budget will remain deliberately vague, directing Congress to make coverage “universal.”

The budget — and I was cautioned that the wording “is changing hourly” — will direct Congress to “aim for universality.” That is a bolder goal than simple affordability, which can be achieved, at least in theory, through subsidies. Universality means everyone has coverage, not just the ability to access it. And that requires a mechanism to ensure that they have it.

Administration officials have been very clear on what the inclusion of “universality” is meant to communicate to Congress. As one senior member of the health team said to me, “it will cover everybody. And I don’t see how you cover everybody without an individual mandate.” […]

The administration is bringing itself into alignment with senators like Max Baucus. Though they’re not proposing an individual mandate in the budget, they are asking Congress to fulfill an objective that they expect will result in Congress proposing an individual mandate. And despite the controversy over the individual mandate in the campaign, they will support it. That, after all, is how you cover everybody.

Does this count as a flip-flop over the policy details? Probably, but it’s nevertheless an improvement that makes the broader goal more likely. I was always under the impression that Obama got boxed in on opposing mandates for political purposes, and never quite believed his own campaign rhetoric anyway.

The president also probably figures the mechanism lets him off the hook, at least a little — he’s not proposing universal coverage through individual mandates; he’s letting Congress do it and merely going along.

As this moves forward, though, expect congressional Republicans to use every criticism Obama uttered during the Democratic primaries to undermine the initiative.

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