In response to Peggy Noonan’s claim that Obama should have simply tried to make insurance companies abandon their restrictions on patients with pre-existing conditions, Uwe E. Reinhardt explains why it’s not that simple:

She seems completely unaware that, to be implemented, that step has to be accompanied by (1) a mandate to be insured or, at the least, very powerful financial incentives to be insured. And if government imposes such a mandate on citizens, it must be ready (2) to subsidize low-income families in the acquisition of the mandated insurance. Already we have a bill requiring many pages.

To me, that’s a very helpful way of explaining to lay people like myself, who aren’t thrilled at the prospect of a massive insurance bill but don’t understand the nuances of the issue especially well, why such a bill is necessary even if your goals are relatively modest.

This then moves the debate to a different place, in my mind: if we are forced to go to great trouble and expense to get access to people with pre-existing conditions, is it worth it? If we decide it is, then it’s probably worth having the government involved. But Reinhardt’s point makes me more suspicious of Republican claims that we could just have the parts of the Health Care Reform Bill that everyone agrees on.

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