A Bad Conservative Idea, Is A Bad Conservative Idea-- Whether Some Right-Wing Hack Puts It Through Or Obama Does

One more day of oral arguments in the Supreme Court case on, basically, the individual mandate in the health care legislation that the GOP derisively calls Obamacare. The health care mandate, as Rachel emphasizes in the video above, was a conservative Republican idea. The idea was invented and advocated for as a way to avoid the real solution to the American health care crisis-- single payer or Medicare-For-All-- and as a way to keep the multibillion dollar private health insurance industry in business (so that they could continue financing conservative politicians' careers). It was never a good idea. In fact, it was always a crap idea. Rachel and other progressive commentators, make the point that Republicans-- like Chuck Grassley in the clip above-- are hypocrites for liking it when it was a Republican proposal and hating it when Obama put it into effect. Fair enough. But for those of us who thought it was a bad idea when Republicans and insurance lobbyists were behind it... is it any better now that Obama has embraced it?

So far four appellate courts have dealt with it. Two say it's fine, one declared it unconstitutional and one said it can't be ruled on until it goes into effect in 2014 and someone is forced to pay penalties the following year. The only place in America now with an individual health care mandate in effect is Massachusetts (Romneycare) and it seems to be working poorly. More people are covered but medical costs have risen faster than anywhere else in America and the biggest beneficiaries are-- you guessed it-- the insurance industry. This is what Marcia Angell, a senior lecturer in social medicine at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine, had to say about it in 2009:

There would be no need for an individual mandate in a single-payer system, since everyone would be covered automatically and it would be paid for through their income and payroll taxes. So asking me, a supporter of a single-payer health system, about mandates is a little like asking someone whether he’s stopped beating his wife.

But even within our current system, I’m troubled by the notion of an individual mandate. I live in Massachusetts, where we have one. It requires people to buy private insurance at whatever price the companies choose to charge. As might be expected, this is a windfall for the insurance industry. Premiums are rising much faster than income, benefit packages are getting skimpier, and deductibles and co-payments are going up.

Many people can’t afford the premiums for the best plans, and so have to choose bare-bones, low-premium plans with high deductibles and co-payments. They are then left with insurance that they might not be able to afford to use, but have to purchase anyway.

A mandate is also extremely regressive. In Massachusetts, mandated insurance and co-payments can amount to nearly a third of income. Income taxes apportion the costs of public services more fairly, and I see no reason not to adopt that approach in paying for health care. To be sure, President Obama has said he would exempt people from the mandate who couldn’t afford to purchase their own health insurance. But aren’t these precisely the people most in need of it? Massachusetts has exempted 62,000 people from the mandate for that reason.

I would hope the President and Congress would come up with something less regressive and truly universal, and stop holding the rest of us hostage to the private insurance industry.

That's the progressive argument-- not "but Obama and the Democrats want it so it must be good." The Democrats adopted a bad Republican idea to move the ball on universal health care. It was a cowardly (and, it being DC, corrupt) decision when they should have been passing single payer. The Republicans-- always partisan hacks and obstructionists-- bailed on their own idea and left the Democrats holding their bag of shit. And now the media and the political parties have turned it into a partisan circus with team red vs team blue, something to which not even the Supreme Court judges seem immune. Or are they?

Does anyone doubt that if a Republican president had enacted the Affordable Care Act-- with its individual mandate devised by the right-wing Heritage Foundation and with Mitt Romney denouncing "free riders" not paying their share of health care costs - the U.S. Supreme Court's Republican majority would be lining up to declare it constitutional?

Indeed, if the Heritage Foundation, which did dream up the individual mandate, were submitting supportive friend-of-the-court briefs-- instead of denouncing its own idea-- and if Romney were still deriding those "free riders" who palm off the costs for their emergency health care on others, the odds would be that the Court would vote overwhelmingly for the constitutionality of the health reform law.

...[E]ven though the individual mandate was initially a conservative Republican idea-- an alternative to Democratic plans that would have required employer-supplied insurance or a single-payer system run by the government - the GOP and the conservative movement have now turned against their own concept en masse. Not a single Republican voted for "Obamacare."

Therefore, at least some of the five Republicans-- John Roberts, Antonin Scalia, Clarence Thomas, Samuel Alito and Anthony Kennedy-- are expected to find some legal argument that they can use as judicial cover to strike a blow at the Democratic president, Barack Obama.

...[I]t appears that constitutional principles will have less to do with how the Republican partisans on the Supreme Court rule than the perceived need to advance an ideological and political agenda.

These opponents of the health-care law surely will muster some impressive "lawyering" with lots of high-brow references to various articles and clauses - just as they did in the Bush v. Gore ruling. But that will mostly be window-dressing to impress those who still believe in the integrity of this Supreme Court.

Of course, it is still possible that one or more of the Republican partisans will overlook their political loyalty to the GOP and their ideological commitment to the anti-government Right - and agree with Judge Silberman that the Affordable Care Act is constitutional.

Such a justice might even think back on how the individual mandate began as a right-wing idea and thus refuse to behave as a political hack who simply switches constitutional principles based on whose name is associated with a law.

Robert Reich had a good-- if obvious-- idea yesterday: "If the Supreme Court strikes down the individual mandate in the new health law, private insurers will swarm Capitol Hill demanding that the law be amended to remove the requirement that they cover people with pre-existing conditions. When this happens, Obama and the Democrats should say they’re willing to remove that requirement-- but only if Medicare is available to all, financed by payroll taxes."

Dr. Lee Rogers, the progressive Democrat running against anti-health care fanatic Buck McKeon in northeast L.A. county is willing to go even further than Reich. He thinks we should scrap the whole mess and start over again.

As a health professional, I have not been a supporter of the Affordable Care Act. Certainly, there are some good parts of the law, but these provisions don't make enough positive reforms for me to overlook the bad parts. Furthermore, there's something about the individual mandate that just seems un-American. Already, in arguments before the Supreme Court one can see there are issues. In an amicus brief, a libertarian public interest group has questioned the validity of a compulsory contract between a citizen and a private company violating centuries of contract principles which insist that parties enter into a contracts freely and without coercion.

I am the first to stand up and say our system needs major reform. Millions of Americans are uninsured and millions more are underinsured. Doctors and hospitals possess skills and equipment necessary to give a citizen one of their basic rights-- the right to live. American healthcare has to be accessible to everyone. The simplest way to do that is by a single payer plan, like Medicare-for-all. The nuances of how it gets paid for can be saved for another discussion. Personally, I am not wanting to see the President take a black eye for his efforts to reform our for-profit system that benefits only the wealthy and the insurance companies. But, a part of me feels that if the Supreme Court strikes the law, or its most central provision, we can start over and engage in meaningful reform.

It's the dreaded end of the quarter and Lee's got to raise campaign contributions or... or... I don't know... Debbie Wasserman Schultz will flip out or something. If you have the means and if you;d like to see a distinguished surgeon campaigning for single-payer replace a decrepit, corrupt, bigoted old warmonger in Congress, please consider a contribution here at the Blue America ActBlue page.