Republicans Blithely Enter The Individual Mandate Trap

DrRich | November 17th, 2011 - 7:42 am


Progressive Americans have this much going for them: they can, without any reservations, second thoughts (or perhaps even first thoughts), enthusiastically and wholeheartedly support Obamacare’s individual mandate. For them, the individual mandate is an unalloyed good. Not only does it enable Obamacare to proceed, thus giving the government unprecedented control over every aspect of American healthcare, but it also establishes the authority of the government to control the economic activity of individuals. This new authority will come in very handy as our leaders continue working toward redistributive justice. So if you’re a Progressive, what’s not to like about the individual mandate?

Conservative Americans do not have it so easy. In principle, of course, the very idea of an individual mandate is constitutional heresy to a conservative, since it violates not only the letter but the very spirit of the Constitution. This is why, over the past three years, opposing the individual mandate has become for conservatives a more fundamental litmus test than opposing abortion. Accordingly, it is conservatives who have launched the constitutional challenge to the individual mandate, and who have now succeeded in bringing it before the Supreme Court, and who have based their chief strategy for bringing down Obamacare on the idea that the Supremes will agree with them about it.

DrRich, like most conservatives, is aghast at the idea that the Court might actually find the individual mandate to be compatible with the Constitution. Such an expansion of the power of the Central Authority over the lives of individuals will essentially gut the main idea behind our founding, and send us even more rapidly down the path toward tyranny.

But as he contemplates how he might feel on the day the Supreme Court finally strikes down the individual mandate, DrRich can’t help conjuring up the last scene from The Graduate. In that scene, Dustin Hoffman, who has just burst into the church and fought through a horde of wedding guests to grab his girl from the altar, and, with her in tow, has fought his way past the stunned groom and back through the angry crowd, and having at last jumped with her onto a city bus, is now sitting breathlessly, his hard-won love at his side, as the bus pulls away leaving their pursuers behind. And as that last scene fades, his look of elation at finally winning his heart’s desire gradually slackens, and transforms into a look of utter panic, a look that silently beseeches, “Now what?” Or, perhaps, “What have I done?”

DrRich thinks that’s what will happen to Republicans on the day the individual mandate is declared unconstitutional.

There is a reason, dear reader, that Mitt Romney, Newt Gingrich, and the Heritage Foundation, all of whom claim to be conservatives, at one time or another supported something very much like Obama’s individual mandate. That reason is: it is very difficult to conceive of a workable, market-based solution to our healthcare mess without one.

Any scheme for reforming healthcare that is based on private health insurance will fail if a substantial proportion of the population declines to purchase health insurance. Whether people have chosen to acquire health insurance or not, they will still get sick. And when the uninsured get sick there are only two choices.

The first choice is to refuse them care. Libertarians have no problem with this. They believe that if you want some healthcare, you should pay for it yourself. If you choose not to buy health insurance, or otherwise fail to make arrangements to pay for healthcare should it turn out that you need some (as well you might, if you engage in all the activities and abuse all the substances that libertarians say is your right), well, that’s too bad for you. Let your painful and untimely demise serve as an object lesson to everyone else, so that perhaps they will make better personal choices. Most non-libertarians, however, find this option abhorrent.

The second choice is to take care of the uninsured anyway. If you do that, not only do you drive up the cost of health insurance for people who have chosen to buy it, but you also create a huge incentive for people to not buy it in the first place.

This is why Republicans or conservatives who have thought deeply about healthcare reform (Gingrich, the Heritage Foundation), or who have actually instituted healthcare reform (Romney), will often settle upon a solution that incorporates something very much like President Obama’s individual mandate. Unless everyone is strongly “incented” to buy health insurance, a market-based healthcare system will collapse.

More to the point, Republicans ought to recognize that, while it seems to have wound up that way, the individual mandate in Obamacare did not start out as a sneaky way to undermine the Constitution. It was, in fact, a necessary concession to the more conservative of the Democratic members of Congress. President Obama and his minions (or handlers, depending on which talk show hosts you listen to) are on record as saying that their real goal is a single-payer, government-controlled healthcare system. And there is no reason in a single-payer, government-controlled healthcare system to invoke anything like an individual mandate to purchase insurance. The President would have been quite happy without any individual mandate, if he could have gotten his way in the first place.

The individual mandate was inserted into Obamacare purely as a necessary component of healthcare reforms that are ostensibly based on private health insurance, which is the only kind of reform the President could possibly get through even a Democratic Congress in 2010.

If the Supreme Court declares the individual mandate to be constitutional (which will violate everything DrRich holds dear about America), then it’s a huge win for Obamacare.

But if they declare it unconstitutional, that will trigger the Republican’s real problems.

Republicans, Democrats and federal judges all seem to agree that without the individual mandate, Obamacare is infeasible. The moment the mandate is declared unconstitutional, Obamacare disappears.

And this will create a “Graduate” moment. There the Republicans will be, sitting on the bus with the healthcare system they have just saved from the handsome-but-arrogant groom who had Big Plans for it, and heading to – where?  They can’t just go back to the old healthcare system; we’re past that. The health insurance industry has made it plain that their business model is broken, which is why they acceded to and even campaigned for Obamacare (a system under which they are to become federally-regulated public utilities) in the first place. Should Republicans institute their own market-based healthcare reforms? Good idea! But what do they do about the people who choose not to buy private insurance, now that they have had mandates to purchase declared unconstitutional? And even if they have an answer to that question (which they do not), do they have a plan ready to go, one that can be implemented quickly, before the healthcare system implodes? (Remember, Republicans, you will be dealing with a health insurance industry that has run out its string, and that will be at least angry if not panicked at the demise of its public-utility end-game.)

As it happens, DrRich himself has proposed a fix for the healthcare system that addresses all these problems – a system that is based on individual choice and incorporates private insurance, and at the same time covers everyone without any individual mandate, and controls healthcare costs to boot. The details are entirely irrelevant at the moment, and DrRich will not bore his readers with them now. (If you’re interested you can buy a copy of his book in Kindle format for five bucks, or if that’s too steep you can read an outline of his plan here for free.) The point is that workable solutions to our healthcare problems are indeed imaginable. The likes of DrRich has imagined such a thing, and so have others. But Republican candidates for President, and Republican congressional leaders, are not creating these solutions. Instead, they are steering us into a blind alley.

Here is what DrRich fears. When the individual mandate is declared unconstitutional next June, the Republican celebration will last all of 7.5 minutes. The insurance industry will make it very clear very quickly that they simply will no longer be able to function, and to have any hope of survival they will have to resume cherrypicking healthy patients, massively increasing premiums, denying recommended care, and dropping subscribers when they get sick. Even with these drastic steps, they will say, there’s no guarantee that health insurance will still be available for most Americans in a year or two. And at the time these astounding revelations are made, the Republicans won’t even be finished choosing a nominee, let alone be able to articulate a coherent plan for replacing Obamacare. By Independence Day panic will reign across the land.

The President will then make a speech. He will say, “We tried, America. In the spirit of bipartisanship we tried to give Republicans a system of market-based healthcare reforms, just like they say they wanted. But that kind of system requires an individual mandate, and our misguided friends on the right have now shot the individual mandate through the head. And when the American people ask those same Republicans who brought this disaster upon us, “Now what?” the American people get no answer. The Republicans are quite good at destroying healthcare solutions, but are hopeless when it comes to creating them. And you can hear for yourselves what the health insurers are now threatening to do to all of us when we get sick. It will be just like it was before, but much, much worse.

“We tried, America. We tried to create a market-based healthcare system that would be fair to all. But the Republicans, caring for nothing but their own selfish political fortunes, have blocked our efforts, and have left us all for dead.

“Fortunately, in a few short months you will be able to exercise your God-given right as Americans to choose. If you want to, you can vote into office the Republicans, the people who have traded your healthcare security and that of your family in favor of the chaos we are all witnessing today. Or you can re-elect me, and you can give me a Congress I can work with, and let us try to salvage something good from the ruins of the glorious reforms we fought so hard for the last time. Let us try to give you the best healthcare system that is still possible, given the new constraints the Republicans have now made for us. While you and I might not have started out wanting a healthcare system run entirely by the government, today our choice is either that, or the chaos, pain, suffering, disability and death that, thanks to the good offices of the Republicans and their friends in the health insurance industry, are now staring us in the face. But this is not the first time Americans have stared evil in the face. We have done it before, and we have always prevailed.

“We tried, America. We tried – but the Republicans denied, and babies died.

“My fellow Americans, in November you will have the opportunity to say no to the forces of evil, and to set this travesty right. I know the heart of Americans, and I know that you will do the right thing, not only for your own sake, but for the sake of your children, and your grandchildren, and generations of Americans yet unborn.*”

And when President Obama is finished laying out his argument, the Republican nominee, whoever he or she turns out to be, won’t know whether to cry, “Oops!” or “Nein, nein, nein!”


*DrRich is a conservative but also a capitalist, and so his speechwriting services are available to the highest bidder. Mr. Obama, mutual “friends” in the DOJ have proven adept at tracking DrRich down when necessary, and will know how to contact him.

16 Responses to “Republicans Blithely Enter The Individual Mandate Trap”

  1. AlanGrayson4Prez says:

    Dr. Rich clearly has not been listening to the legal geniuses on the Charlie Rose Show sneering at any intimation that the individual mandate might be struck down as unconstitutional.

  2. DrSteve says:

    One way to get people to participate insurance is to offer high deductible insurance, means test it, and declare medical expenses NOT dischargeable in bankruptcy if you fail to avail yourself of the insurance. Bankruptcy code is within the plenary power Congress, totally legal.

  3. pj says:

    As you have instructed consistently, the only real winner here is the health insurance industry. Can there be any doubt that the “uninsured will be taken care of anyway”?–(your second of two choices re: mandated insurance aquistion or lack thereof)–in which case, as usual, those who conscientiously purchase insurance or those Americans who pay taxes will be forced to fund care for the uninsured.
    Contrary to your assertion otherwise, I do not see that the Republicans have considered that a Supreme Court declaration of individual mandate “unconstitutionality” is problematic, since they like the Heritage Foundation are on the side of (wait for it) the Health Insurance Industry. They have not made any good faith efforts to repeal Obamacare to date. Gingrich is interesting, however, and in addtion to the mandate has also proposed an “individual bond”. He is a thinker and very much the Klemens Von Metternich of the GOP. (lots of baggage, three wives etc–) Metternich’s dislike of liberalism (enforced by censorship etc) led to the Central European middle class golden age (Biedermeier period) between liberal revolutions. He might be wiley enough to contend with this issue.

  4. Jupe says:

    Again, you’re assuming Obama is actually a leftist and not a neoconservative/neoliberal whose main task is fooling liberals.

    The whole “I’m actually a fan of single payer” gimmick was a ploy. To fool lefties like me. Very clever, and very effective.

    Obama gets what Obama wants. This was demonstrated in how he took the anti-mandate, pro-public option congressmen on Airforce One and somehow bullied them into voting for this final pro-corporate Obamacare.

    I desperately wish you were right – that Obama was pro-single payer, but his record has disabused me of that notion. (ideas on both the left and the right that he’s just playing “eleven dimensional chess” aside.)

    Even Ron Paul says Obama is a neoconservative (google it.) I’d wonder if that was just a rightwing plot to undermine Obama from the left if I hadn’t thought the same thing first. Me and many, many, many other “progressives”.

    Our language regarding concepts like progressive, conservative, etc has become meaningless. Maybe grassroots lefties like me should start referring to ourselves as “left-libertarians” to highlight the sharp ideological divide between ourselves and Obama et al?

    • GlennGreenwald4Prez says:

      Obama is controlled by Paul Wolfowitz! This explains why Guantanamo Bay is still open, the illegal Libyan kinetic military action, and why Bradley Manning has not been given a Medal of Honor!

  5. Scott Sweeney DO says:

    What would help healthcare enourmously? When people without health insurance incur medical bills they pay them. Then they would smarten up and get health insurance.

    I am tired of this notion that if someone is uninsured then someone else has to pay their tab. I was in medical school with no insurance and my wife and I had two children during that time. We paid the doctor’s bill over time. We paid all our other debts as well by working hard.

    The death of the Obamacare bill will be a blow for liberty. We are capable of finding solutions to health care without giving government the right to force us to give up our freedom.

  6. Jupe says:

    Scott, what the American working class pays for Medicare and Medicade alone funds full heathcare coverage for the entire population with the NHS in the UK compared to the US, per capita.
    Why do American people deserve less?

    I paid for one of my pregnancies out of pocket, too, btw. I worked overtime (without any overtime pay, being an independent contractor) while pregnant to make it happen. I’ve never owned a credit card, have saved money to buy used cars up front with no debt without exception, and live in a house worth $10K, that we own.

    I was a huge advocate of avoiding debt and living within ones means, and walking the talk, before it was cool. I just couldn’t pay more than I even earned for health insurance, and ended up in the hospital with more than pregnancy. Don’t extrapolate your luck with going uninsured as evidence for the soundness of the system.

    If you went uninsured and didn’t end up in monumental amounts of debt, you were somewhat lucky. Just because you were/are lucky does not mean that the unlucky are lazy fools living beyond their means.

  7. Mike says:

    The original problem that PPACA purported to solve was that of the uninsured. I think it is fair to compare the plight of those without access to health care as being similar to those without access to food. When faced with solving the hunger problem for a group of our fellow citizens, we have several choices. 1) We can give them food; 2) we can give them the money to buy food for themselves or: 3) we can pay someone else to provide food to them. Option 1 is cheapest but provides very little choice to the receipient, Option 2 provides the most choice for the hungry and is intermediate in cost, and option 3 is the most expensive and provides an intermidiate amount of choice. We have as a society, of course, chosen option 2 – it’s called food stamps. It works fairly well providing the option for the hungry to get the same food as everyone else whilst avoiding the expensive middle man that would be the result of option 3.
    Why is it, when discussing health care for the uninsured, that all we can think of is option 3?
    (I’ll have to spell it out for some – purchasing insurance for someone is option 3, not option 2. The insurer becomes the expensive middle man who then arranges for health care on behalf of the insured – arranging the network of providers, deciding which medications and treatments are covered, etc.)

  8. TMLutas says:

    This analysis assumes that medical standards and procedures will remain relatively constant. But they should not and they likely would not in an increased cash usage world. The bottom end of medical care would fill up rapidly with much cheaper treatments.

    We’re scared that we won’t be able to “bend the cost curve down” sufficient to avoid wrecking our medical system but we’re also terrified to provide cheaper treatments that are being used elsewhere because the poor might have hurt feelings if their treatment is effective but perceived to be too 3rd world.

    • Jupe says:

      Who is this “we’re”?

      “The poor” are happy to have treatment, period, as long as it’s not really crazily bad in quality (like, 1930′s level care.) The poor are currently becoming pseudo-skilled in various forms of self-surgery, like extracting teeth themselves, nuking MRSA infections with bleach, etc. You might be right that there is some Inner Party “we” worried about hurting the feelings of the poor, but that “we” would be really off base. The reality is that much of the medical care of the poor is already third world, because it doesn’t really exist.

  9. B. Johnson says:

    What Congress and the media have been ignoring with respect to Obamacare is the following. First, socialist FDR’s activist justices wrongly ignored Thomas Jefferson’s clarification of Congress’s Commerce Clause powers when testing the limits of Congress’s powers in the early 1940s. Using terms like “does not extend” and “exclusively,” Jefferson had made it clear that Congress has no business sticking its big nose into intrastate commerce.

    “For the power given to Congress by the Constitution does not extend to the internal regulation of the commerce of a State, (that is to say of the commerce between citizen and citizen,) which remain exclusively with its own legislature; but to its external commerce only, that is to say, its commerce with another State, or with foreign nations, or with the Indian tribes.” –Thomas Jefferson, Jefferson’s Opinion on the Constitutionality of a National Bank : 1791.

    In fact, while writing about the Founding States’ division of federal and state government powers, Jefferson had noted that the Founders had trusted the states, not Congress and the Oval Office, with the care of the people.

    “Our citizens have wisely formed themselves into one nation as to others and several States as among themselves. To the united nation belong our external and mutual relations; to each State, severally, the care of our persons, our property, our reputation and religious freedom.” –Thomas Jefferson: To Rhode Island Assembly, 1801. ME 10:262

    In fact, reflecting on Jefferson’s clarification of the Commerce Clause, the USSC has already established the case precedent that Congress has no business sticking its big nose into intrastate medical practice.

    “Direct control of medical practice in the states is obviously beyond the power of Congress.” –Linder v. United States, 1925.

    What’s actually going on with respect to Congress and its “mysteriously expanding” Section 8-limited powers is the following. Congress has been wrongly using the “Necessary and Proper” clause, Article I, Section 8, Clause 18, as an excuse to wrongly ignore its Article V requirement to petition the states for specific new powers via constitutional amendments.

    It also works in Congress’s favor when citizens are no longer being taught the Constitution and its history, thus not being made aware of Congress’s constitutionally limited powers.

    • DrRich says:

      B. Johnson,

      Thanks for this. Unfortunately, any Progressive worth his/her salt will tell you that Jefferson (if they’ve ever heard of him) must have been a whack-job, what with owning slaves, and writing the Kentucky and Virginia Resolutions (which practically endorsed nullification), and endorsing revolutions every few generations, and whatnot – and therefore can safely be ignored.


      • Jupe says:

        Oh, this “progressive” has heard of the mighty Thomas.

        “I am conscious that an equal division of property is impracticable. But the consequences of this enormous inequality producing so much misery to the bulk of mankind, legislators cannot invent too many devices for subdividing property, only taking care to let their subdivisions go hand in hand with the natural affections of the human mind.”

        “Another means of silently lessening the inequality of property is to exempt all from taxation below a certain point, and to tax the higher portions of property in geometrical progression as they rise.”

        Madison (do you know who he was?) was likewise a leftwing fanatic by today’s standards:

        “By the silent operation of laws, which, without violating the rights of property, reduce extreme wealth towards a state of mediocrity, and raise extreme indigence towards a state of comfort. ”

        But like I said before, this was before the industrial revolution. The industrial revolution really did change the nature of everything.

  10. Joe the Pimpernel says:

    “That reason is: it is very difficult to conceive of a workable, market-based solution to our healthcare mess without one.”


    Abolish the FDA. Forbid the federal government to have ANYTHING to do with health care.

    Costs will plummet, and services will skyrocket.

    • Jupe says:

      The rise of neo-patent pseudoscientific medicine is our economic hope?

      Or do you contend that the era of patent medicine was superior to the era of the FDA?

      In what nation has abolishing gov-funded science proved superior?

      I’d like to see government control over access to medicine made free, too. I don’t see just abolishing the FDA as the answer, tho.

  11. Rich says:

    An interesting thing about human nature is people operating under a presumptive belief if you burn the village down, you can save it. Get rid of the government and blammo, every problem goes away. Get rid of the market, and money, and everything goes away. Do Project Mayhem and we will have a utopia. No thought is given to what happens when you remove something, just that it will magically sort itself out.

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