Senator Claire McCaskill (D) at a town hall in Concordia, Missouri on August 10, 2010:

Senator Claire McCaskill (D): town hall in Concordia, Missouri – media availability

….Question: You like the individual mandate?

Senator McCaskill: Uh, I mean, the mandate obviously is the most unpopular part, but, um, when you ask people if they want to do away with preexisting conditions they say, well of course, that’s so unfair. Well, who’s gonna buy insurance before they’re sick. You can’t do away with preexisting conditions unless you set up an environment where everyone has insurance. The nice thing about this is it’s not gonna be government run, it’s not gonna be government policies. People are gonna be able to shop, make choices. And if they can’t afford it we’re gonna help ’em by making it more affordable with some help from the government. So I think it’s, is it a perfect solution? No. But it’s the best solution I think that anybody’s come up with to an untenable spiral of healthcare costs in this country….

In today’s Kansas City Star:

McCaskill looks for alternatives to health care mandate

By STEVE KRASKE

The Kansas City Star

Sen. Claire McCaskill’s once rock-solid support for a key component of President Barack Obama’s national health care reform law appears to be wavering.

While saying she still backs the individual mandate portion of the law – the controversial section requiring that virtually every individual carry health insurance or pay a penalty – the Missouri Democrat said Thursday that she is searching for alternatives.

“I think there are different things we could look at to see if they would work, and I’m open to that,” she said….

The Star story quotes a Sarah Steelman (r) Twitter post. Sure enough:

Senator McCaskill voted for Obamacare now looking at alternatives to health care mandate.Try following the Constitution and honoring freedom 1:18 PM Jan 5th  via web

Methinks republicans protest too much. Here’s the punchline:

Summary Of A 1993 Republican Health Reform Plan

Feb 23, 2010

In November, 1993, Sen. John Chafee, R-R.I., introduced what was considered to be one of the main Republican health overhaul proposals: “A bill to provide comprehensive reform of the health care system of the United States.”

Titled the “Health Equity and Access Reform Today Act of 1993,” it had 21 co-sponsors, including two Democrats (Sens. Boren and Kerrey). The bill, which was not debated or voted upon, was an alternative to President Bill Clinton’s plan.  It bears similarity to the Democratic bill passed by the Senate Dec. 24, 2009, the Patient Protection and Affordable Care Act…

….Subtitle F: Universal Coverage – Requires each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005. Provides an exception for any individual who is opposed for religious reasons to health plan coverage, including those who rely on healing using spiritual means through prayer alone….

[emphasis added]

Uh, that’s an individual mandate. The sponsors:

…COSPONSORS(20), ALPHABETICAL…:

Sen Bennett, Robert F. [UT] – 11/22/1993

Sen Bond, Christopher S. [MO] – 11/22/1993

Sen Boren, David L. [OK] – 5/17/1994

Sen Cohen, William S. [ME] – 11/22/1993

Sen Danforth, John C. [MO] – 11/22/1993

Sen Dole, Robert J. [KS] – 11/22/1993

Sen Domenici, Pete V. [NM] – 11/22/1993

Sen Durenberger, Dave [MN] – 11/22/1993

Sen Faircloth, Lauch [NC] – 11/22/1993

Sen Gorton, Slade [WA] – 11/22/1993

Sen Grassley, Chuck [IA] – 11/22/1993

Sen Hatch, Orrin G. [UT] – 11/22/1993

Sen Hatfield, Mark O. [OR] – 11/22/1993

Sen Kassebaum, Nancy Landon [KS] – 11/22/1993

Sen Kerrey, J. Robert [NE] – 5/17/1994

Sen Lugar, Richard G. [IN] – 11/22/1993

Sen Simpson, Alan K. [WY] – 11/22/1993

Sen Specter, Arlen [PA] – 11/22/1993

Sen Stevens, Ted [AK] – 11/22/1993

Sen Warner, John [VA] – 11/22/1993…

[emphasis added]

How ironic, eh? Of course, the stenographer neglects to mention any republican hypocrisy.

MBersin  Michael Bersin

@sarah_steelman Uh, in 1993 Bond, Dole, Grassley, Hatch, etc. sponsored HCR bill with individual mandate. Were they dishonoring freedom?23 seconds ago

Claire McCaskill’s first move as she initiates her 2012 re-election dance? According to The Hill, she’s suggesting that if congress is willing to consider alternatives, it can achieve health care reform cost cutting goals without the individual mandate. She acknowledges that the move is politically motivated:

“I certainly noticed the vote on Prop C, the healthcare law, and: message received,” she told state reporters the day after the vote.

I admit to a certain chagrin that McCaskill apparently received that particular message so eagerly, emanating as it did from fewer than the 23% of all Missourians who bothered to vote in that particular primary election, while she ignores many heartfelt messages from her base – you know, those folks who donate money, make calls and perform other sundry electioneering tasks. Apart from such ignoble spleen, though, I would be willing to hear her discuss what she thinks the alternatives might be that could expand insurance coverage and still bring down costs.

Certainly, a politician I respect, Howard Dean, has also attempted to make the case that the mandate is not necessary to get most people to purchase insurance and keep it affordable. I am am not, however, persuaded by his arguments as long as the basis of our health care delivery consists of private insurers. To say, as Dean does, that something worked in Vermont does not necessarily mean that it will scale up.

On the other hand, The Center for American Progress (CAP)’s Michael Gruber developed a “microsimulation” model similar to the model the Congressioal Budget Office used to score the ACA in order to evaluate what would happen if the individual mandate were removed from the ACA.* He summarized his findings as follows:

Total insurance coverage would rise by fewer than 10 million persons rather than the

32 million persons estimated by CBO. The number of uninsured would be reduced by

less than 20 percent rather than by about two-thirds.

• Employer-sponsored insurance, which is projected to erode by about 5 million persons

under reform, would instead erode by over 20 million persons.

• The fully implemented cost of the legislation in 2019 would fall by only about 20 percent-

we would spend 80 percent as much to cover fewer than one-third as many people.

• Those who do not obtain coverage would be the healthiest individuals, causing enormous

adverse selection in insurance markets. The average individual premium in the

exchange would rise by about 40 percent without the mandate.

I’m fine with bringing the mandate up for debate before it is even put to a trial if political folks just really have to do so, but I would want to be sure that each of the points above were addressed – or that the entire approach be scrapped and we move to a public health care delivery system, an outcome so unlikely that it can safely be relegated to the realm of fantasy literature. Costs are a truly important issue, particularly when we’re hearing so much deficit rhetoric from politicians like McCaskill. While Social Security is demonstrably not part of the deficit problem, exploding health care costs are a huge part, and health care reform was designed to address exactly that issue, which should, in turn, ease the pressure to cut Medicare and Medicaid benefits. If the ACA is rendered unable achieve that goal, we will all pay the price down the road. We can only hope that McCaskill will tread carefully.

UPDATE: So is McCaskill afraid of the individual mandate? Maybe not. She appears to be walking back remarks she made during an MSNBC interview as reported by Politico and in The Hill snippet quoted above.

* Sentence edited slightly for clarity.