Responding to a comment on my cross-posting about auto insurance mandates and uninsured rates at Talking Points Memo, I note that it’s important to know how states enforce the mandate. A commenter implied that there is almost no down side to going without auto insurance—especially if one is “judgment proof”.

Driving without insurance can be very costly. States impose penalties including license suspension, hefty fines, vehicle impoundment, and jail time.

It’s an unacknowledged reality of our labor market that most people must drive to work. Public transit just doesn’t work in most places or for many workers; less than 5 percent of workers commute using transit and many of those people live in Manhattan, Chicago, Washington DC, and Philadelphia. Thus, loss of license or car as a penalty for driving uninsured has a very high cost and it's one most would avoid If they can.

There are certainly differences between auto and health insurance, yet there are still important lessons in the comparison.

Senators Clinton and Obama are continuing the debate over how best to ensure that everyone has health insurance and access to care.

Some online analysts have raised questions about the effectiveness of mandates by reviewing car insurance mandates.

We have been spending some time looking at access to car insurance in our transportation research.

Car insurance is regulated by states. Only two states do not require drivers to maintain insurance – New Hampshire and Wisconsin. Yet, a recent report finds that nearly 15 percent of drivers across the nation are uninsured.

What happens in the two states without a mandate?

Wisconsin ranks 20th with about 14 percent uninsured, while New Hampshire has one of the lowest rates of all states at 9 percent. Other state rates range from 26 percent (Mississippi) to 4 percent (Maine).

Some writers have noted that California has a low-cost insurance option for low-wage workers. In that state, these writers point out, the uninsured rate is one of the highest at 25%.

We’ve interviewed some of the key actors implementing the California low-cost insurance option and find that there is a major problem with outreach and access. Most low-wage workers probably don’t even know about the option and the incentives don't seem to be structured in a way that encourages brokers to sell it.

A number of people are working on improving knowledge and use of the low-cost option in California, but we should not assume that low-wage drivers wouldn’t buy it—-if they knew about it.

So, what do we know? A mandate does not guarantee universal coverage in this case. And creating and implementing a lower-cost insurance option for low-wage workers will require creativity, careful implementation, and outreach.

Paul Krugman idealizes the democratic process in Clinton, Obama, Insurance (Feb 4, 2008). If Congress adopted policy on merit alone, we would already have guaranteed, quality, affordable health care in this country. And gun control too.

There’s every reason to conclude that proposals sounding like they limit choice —by including something called a “mandate”, for example — will trigger public concerns about government interference and administrative competence. Indeed, even focusing on the “universal” aspect of health care proposals makes people who already have it think about what they would have to give up for others to get it.

We’ve recently had a brief debate about whether words matter in campaigns. Careful consideration about the public conversation that can create the space and public support for guaranteed health care in the future is exactly what’s called for now.

It’s about time.

Finally, a few Senators appear willing to engage in the fight over health care in a substantive way – not just in some (misguided) effort to establish a campaign issue.

Eight Democratic senators say they cannot support any compromise that limits their states’ ability to cover parents along with children.

Democratic leaders had been considering such a compromise. But in their effort to mollify Republicans, the Democrats have begun to alienate some members of their own party on this and other issues.

The eight senators told Democratic leaders this week that they could not support any bill if their states lost money for the coverage of parents.

A compromise bill must “protect state flexibility to cover parents,” the senators said in a letter to Speaker Nancy Pelosi of California and the House majority leader, Steny H. Hoyer of Maryland. “Our states have taken the lead to provide health care to this specific population, and we do not want to inhibit their ability to continue providing this important coverage.”

The letter is signed by senators from five states that together cover more than 250,000 parents. The senators are Amy Klobuchar of Minnesota, Frank R. Lautenberg and Robert Menendez of New Jersey, Jeff Bingaman of New Mexico, Jack Reed and Sheldon Whitehouse of Rhode Island, and Russ Feingold and Herb Kohl of Wisconsin….

…. in their letter, the Democratic senators warned Congressional leaders against “further compromise,” saying it would erode their support for the bill.

Mere passage of legislation is not winning. Better to communicate what you stand for than just pass a bill that communicates something altogether different. Even if it means the bill doesn’t become law.

After all, will anyone believe you when you say you want health care for all but support a bill that moves in another direction?

If you support a bill that provides health care for the “poor kids”, where do you go next?

You will have a hard time convincing anyone that you REALLY want health care for everyone when you were willing to cut eligibility for families who cannot afford health care and whose employers are not providing it. Not only willing to cut, but actively proclaimed your preference for “poor children first”, while denying coverage to immigrants and adults in the same bill.

These senators haven’t said quite everything that’d be nice to hear on this topic – but this is a step in the right direction, finally.