The error of the pro-mandate faction of the Democratic Party (no Republican candidates are in favor of universal anything in the health sector, except universally disappointing experiences, even for the rich) is this: they see the future and know exactly what regulations must be passed, how they will affect behavior, and what outcomes will result.

Speaking as a former regulator, this is an easy error to make. I certainly made this mistake back in my FCC days. It is the inevitable pitfall and trap for the unwary in any system of centralized government. It was the self-inflicted error of the Clinton Administration’s failed health care reform effort of 1993-4.

The starting point for effecting change in markets through government action is a statement of goals, and a clear recognition that tactics are not goals. As I understand it, Obama has four goals in terms of health care: (1) everyone, from birth to death, should have health care insurance; (2) everyone should have affordable health care, as well as affordable insurance; (3) everyone should enjoy the benefits of rising quality in health care; (4) Moore’s Law – ever increasing cost-benefit results – should be enshrined in the health care industry, through investment in r & d, new entry by new competitors, and wise government purchasing actions, inter alia.

If Edwards insists that the primary goal is a federal statute ordering all citizens, or residents, or inhabitants legal or illegal, to buy insurance, then that is not a wise strategic goal, nor a statement of a goal. It is a selection of a tactic, and elevating it to the status of a strategic goal. When Edwards proposes garnishment or IRS enforcement, he delves even more deeply into the tactics of implementation, and moves even farther away from the critical focus on goals.

If Edwards insists that tactical choices define who is the better Presidential candidate, he is not always wrong, but on the topic of health care he is most definitely wrong. In a reform of a system so complex, and so inevitably different in its impact on different individuals at different times, flexibility in tactical choices is the only wise way to govern. Committing in advance to tactics that are never to be altered as facts are learned is a sign that the candidate lacks the experience of government or life or, certainly, regulation that should provide the humility necessary before trying to reform such an important part of the economy and society as the health care system.

As to Clinton, she has supported mandates, but as far as I can determine her definition resembles Obama’s automatic enrollment, with the possibility of opting out. This method of achieving the goal of universal insurance is more sensitive to individual variation and the need to reflect the importance of personal choice. But on occasion, Clinton has seemed to endorse Edwards’ more legalistic and more command-and-control approach. I’m not sure where she is precisely on this question, or even whether mandates is, under her approach, clearly merely a means to an end, as it ought to be.

The most respected economist in America, for me, is Paul Krugman. But having spent a lifetime learning from, hiring, following the instructions of, cross-examining, preparing the testimony of, reading, and very rarely disagreeing with economists, I can only say this: they are better in diagnosis and far better in design of models than in predicting precisely how individuals, person by person, will react to changes in law, or even price. In particular, where value is acutely a function of not only price but also quality, as in the case of cable television or health care, economists reach limits on the efficacy of their art. This is not to criticize Paul Krugman. I think he should get the Nobel Prize for economics and literature too, and I’m not kidding. But I don’t agree with his vehement insistence that mandates vel non define the difference between a good and bad candidacy for the Presidency. Instead, I think the insistence on a legal mandate as the sine qua non of any approach to a problem as multifaceted and changeable as health care is a counter-indicator of fitness for that office, where it is certain that as things change one’s tactics should change, while one’s goals probably should be as close to immutable as possible.

If one of Obama's rivals, or even Krugman, questions Obama's commitment to changing our health care system because he won't commit in advance to one single tactical choice, they have no facts to support their claim. Moreover, anyone who is rigidly fixed to a single tactic thereby suggests that he or she is not adroit, adaptable, and persistent in achieving the stated goals. In a similar vein, it is a goal to catch Osama, and not to be committed in advance to a tactical decision about whether to put troops into Pakistan. It is a goal to achieve peaceful and productive relations with Iran, and it is important not to choose in advance such tactics as promising never to talk to its leaders or voting for military action against Iran without knowing all relevant facts. Candidates that make much of tactics, while not necessarily focussing with unrelenting commitment on specific (as opposed to overly general) goals, are not necessarily wise enough, reliable enough, or even experienced enough to be President. Obama, it seems to me, shows passion and clarity of thought about goals and the flexibility and humility necessary to choose tactics that work efficiently and effectively not only in the area of health care reform, but in all the other major discussions of the time. In other words, Dr. Krugman, please go back to focussing on the Republicans!