In Monday’s New York Times, Ross Douthat explains the devious reasoning behind the Democrats’ adoption of the individual mandate: “It protected the Democratic bill on two fronts at once: buying off some of the most influential interest groups even as it hid the true cost of universal coverage.”
Clever! But I can’t help feeling like Ross is forgetting something. There was some other reason Democrats adopted this policy. I’m almost sure of it. If you give me a second, I’m sure it’ll come to me.
Ah, right! Because Chuck Grassley, the ranking Republican on the Senate Finance Committee, was saying things like “I believe that there is a bipartisan consensus to have individual mandates,” and “individual mandates are more apt to be accepted by a majority of the people in Congress than an employer mandate.”
And it wasn’t just Grassley. A New York Times columnist by the name of Ross Douthat praised Utah Sen. Bob Bennett for “his willingness to co-sponsor a centrist (in a good way!) health care reform bill with the Oregon Democrat Ron Wyden.” That health-care reform bill was the Healthy Americans Act which included, yes, an individual mandate. But while Douthat did later say that the Healthy Americans Act wasn’t his “preferred health care reform,” at no point did he accuse Bennett of “buying off some of the most influential interest groups” even as he “hid the true cost of universal coverage.”
The Healthy Americans Act, meanwhile, had been cosponsored by a bevy of heavy-hitting Senate Republicans, including Lamar Alexander, Mike Crapo, Bob Corker, Judd Gregg, Norm Coleman and Trent Lott. And it’s not like they were off the reservation in some significant way: In 2007, both Sen. Jim DeMint and the National Review endorsed Mitt Romney, who had passed an individual mandate into law in Massachusetts. In their endorsements, both icons of conservatism specifically mentioned his health-care plan as a reason for their endorsement. DeMint, for instance, praised Romney’s health-care plan as “something that I think we should do for the whole country.”
Avik Roy points out that many liberals — including candidate Barack Obama — were historically skeptical of the individual mandate. And that’s true! There was a robust debate inside the party as to whether Democrats should move from proposing a government-centric health-care model to one Republicans had developed in order to preserve the centrality of “personal responsibility” and private health insurers. Many liberals opposed such a shift. But they lost to the factions in the party that wanted health-care reform to be a bipartisan endeavor.
Roy tries to use this to draw some equivalence between the two parties. Both Democrats and Republicans changed their mind on the individual mandate, he argues. But there’s a key difference: The Democrats changed their mind in order to secure a bipartisan compromise on health-care reform. Republicans changed their mind in order to prevent one.
And so what did Democrats get for their troubles? Well, the individual mandate is the least popular element of the health-care law. The entire Republican Party decided the individual mandate was an unconstitutional assault on freedom. And today, even relatively moderate Republicans like Douthat present the mandate as some kind of underhanded trick.
That’s politics, I guess. But ask yourself: If Obamacare is overturned, and Obama is defeated, who will win the Democratic Party’s next fight over health care? Probably not the folks counseling compromise. Too many Democrats have seen how that goes. How much easier to propose a bill that expands Medicaid eligibility to 300 percent of the poverty line, covers every child through the Children’s Health Insurance Program, and makes Medicare availability to every American over age 50. Add in some high-risk pools, pay for the bill by slapping a surtax on rich Americans — indisputably constitutional, as even Randy Barnett will tell you — and you’ve covered most of the country’s uninsured. Oh, and you can pass the whole thing through the budget reconciliation process.
I don’t think that’s a particularly good future for the health-care system. And I doubt that bill will pass anytime soon. But, if Obamacare goes down, something like it will eventually be passed. And what will Republicans have to say about it? That no, this time, they really would have worked with the Democrats to reform America’s health-care system? Who will believe them?