As fear among Obamacare supporters (like me) spreads that the tenor of the Supreme Court’s questioning Tuesday means the White House may not have five votes to uphold the individual mandate, a few observations are in order.
First, conservatives need to be careful what they wish for. If the mandate is struck down, mark my words, we’ll end up with Medicare for all before long — once the ranks of the uninsured swell to 60 or 70 million and people are fed up. No one doubts that single payer is constitutional. As I and others have pointed out many times, the only way to push toward universal coverage via private health plans is to have a mandate that gets everyone in the pool (along with subsidies for those who need help buying basic coverage). If healthier people opt out or delay buying coverage until they are sick, premiums skyrocket because only less healthy people are buying insurance. Eventually the system implodes in a spiral of accelerating premiums. This is Insurance 101.
Second: If the mandate does go down, Obama and the Democrats will look extremely careless in retrospect for not designing the law as an INCENTIVE to buy insurance as opposed to a mandate. This is easy to do, as Paul Starr and others have noted. For example, the Bush/GOP prescription drug bill has incentives for seniors to sign up on a timely basis (or lose advantageous pricing) to get everyone in the pool, and virtually all seniors do. It’s an incentive, not a mandate. But now an easy fix to amend Obamacare to the incentive model could never pass because the GOP controls the House and Democrats don’t have a filibuster-proof majority in the Senate.
Third: Having said that, the fact that this easy mandate fix is available proves how the GOP actually has zero interest in expanding coverage to the uninsured. If it was just the supposed constitutional defect the GOP was “concerned” about, it’s a no-brainer to fix the law. But this is ultimately about killing expanded coverage and health security — and the presumed political benefits that would flow to the Democratic party for delivering this achievement.
In other words, today’s legal challenge is an elaborate reincarnation of the famous 1993 Bill Kristol memo that warned the GOP to stop Clintoncare at all costs, lest Democrats gain immeasurably. As the French say, “plus ca change” . . . and to judge from reports on the Court’s questioning today, lots to worry about.