I caught part of the report on NPR this morning about the Presidential candidates’ positions on healthcare. The gist of the story was that Clinton favors more extensive individual mandates than Obama (who only favors mandates to cover children), while McCain favors tax credits to make health insurance more affordable.

Whoever becomes the next President, something will clearly be different starting in 2009. Regardless of the candidates’ campaign/political statements, the next President’s actions on healthcare (unlike in foreign affairs), will largely depend on what they can negotiate with the next Congress – which seems like it will be more Democratic than it is currently, but probably not with 60 Senators to force votes on matters that the minority finds objectionable.

Since individual and business mandates here in Massachusetts have succeeded in significantly increasing coverage, they are now part of the national debate. One of the challenges to the Massachusetts plan will be the Federal government’s renewal of the state’s Medicaid waiver – which is funding a large part of the’ new program. If the waiver is not renewed/extended, then the new healthcare program will face a significant financial crunch.

I think mandates make sense when people (or companies) are able to get something that makes sense. In Massachusetts, the health plan options were crafted in a reasonable and measured way to provide relative affordability, with the phase-in of some factor such as prescription drug coverage. However, other states face additional hurdles to implementing something like Massachusetts mandates because they have many more insurers and populations centers – as well as much higher rates of uninsured….. So just replicating any part of Massachusetts’ plan in other states will clearly not be an easy task – even with Federal financial support. And even Massachusetts hasn’t really tackled the issue of cost containment – although moving towars near universal coverage is a significant step towards being better able to control the growth in healthcare spending.

So what do you think 2009 will bring? How will individual mandates be incorporated into health reform proposals by the next Administration and Congress? Will something significant actual happen? Will budget pressures limit what the Federal Government can do, and will this cause them to punt the actual decisions to the States and entice the States into action with a limited amount of money? And will this play out something like the welfare reform initiative of the Clinton Administration – which has had some successes, but when passed severely upset some more liberal Democrats?