Opinion: The One Word Missing from Obama's Health Care Speech

(March 3) -- Out of the more than 2,600 words President Barack Obama delivered in his latest pitch for health care reform, one word was noticeably missing: mandate.

It's an odd omission. The health care reforms in the House and Senate, and the outline the president proposes, rest on a new and historic mandate that everyone in the country have or buy health insurance -- or face a fine. It's a core element of the reform, in fact, without which many of the other insurance industry reforms won't work.

The reason is this: All the reform plans on the table would ban two insurance industry practices: denying or dropping coverage for the sick, or charging them exorbitant rates. As Obama put it Tuesday, under reform, "those practices would end."

But without a mandate to buy insurance, those reforms would also lead to upwardly spiraling health insurance costs, as people gamed the system, waiting until they got sick to buy coverage knowing they couldn't be denied it.

The only way to avoid that is to mandate that everyone have coverage. The mandate ideally would also lower premiums for everyone by requiring younger and healthier (and less costly) people to get insurance.

It's a point Obama made last September, in his health care reform address to Congress. "Improving our health care system only works if everyone does their part," he said then, explaining the mandate.

So why didn't he make this point clear in his speech Tuesday?

After all, backers of the mandate say the public supports it, pointing to polls like the October one by Washington Post/ABC News that found 56 percent in favor of the idea.

But plenty of other surveys have found support for the mandate to be soft, at best.

A January Kaiser Family Foundation tracking poll found that 62 percent say they are less likely to support reforms that "require nearly all Americans to have a minimum level of health insurance or else pay a fine."

A Health Affairs report from April found that "on its own, an individual mandate does not have broad support across partisan and sociodemographic groups."

An October survey by the Galen Institute (no fan of Obama's plan) found that 71 percent opposed requiring people to buy insurance or pay a fine.

Yet another survey found that most oppose a mandate without a public option (there's no public option in Obama's plan).

As Jane Hamsher, writing at the Firedoglake blog, put it: "For months now, polling has shown that a mandate with no public option is an extremely unpopular combination. The annual penalty for failure to comply makes it even more unpopular in swing districts."

Then there's the fact that, as NPR reported earlier this year, "more than 30 states are moving to block the federal government from imposing a central feature of the bill: the individual mandate requiring that everyone buy insurance."

Obama may have figured, why take the risk in bringing up the mandate? Especially given the hurdles he already faces in getting reform across the finish line against strong public opposition generally and with weak-kneed support from key Democrats.

But for an administration that prides itself on transparency, the idea of not mentioning the word mandate at all is a bit, well, foggy.

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