The news that the Supreme Court will take up Obamacare is certainly news welcomed by the law’s opponents. Even more intriguing than the court’s interest in the individual mandate is that it will also look at the Medicaid issue, namely whether the conditions placed on that program amount to “coercion” by the federal government. As one law professor put it: “As a purely legal matter, this is a bigger issue than the individual mandate. For much of the modern liberal state is underwritten by Congress’s use of the conditional spending power.” The Supreme Court may have found an issue even scarier to the left than the potential for voiding the individual mandate.
But we shouldn’t confuse the Supreme Court cases with the larger issue concerning Obamacare. Yuval Levin’s must-read piece explains that its central flaw “is the overall concept — which begins from the premise that our system of health-care financing will only keep costs under control if the government becomes an even greater force in the health sector than it is now.” Enumerating many of its flaws, he writes:
It aims to spend a trillion dollars on subsidies to large insurance companies and the expansion of an unreformed Medicaid system, to micromanage the insurance industry in ways likely to make it even less efficient, to cut Medicare benefits without using the money to shore up the program or reduce the deficit, and to raise taxes on employment, investment, and medical research. CBO does not expect it to make a real dent in the inflation of health-care costs or to avert the fiscal implosion of Medicare. Instead, it will double down on price controls and centralized administration and make a real reform of our system much more difficult.
This is a critical point for several reasons. The need to expand the debate beyond the individual mandate is evident.
First, ripping out the remaining parts of Obamacare (if the Supreme Court strikes down the individual mandate but not the entire measure) should remain a point of discussion for conservatives. What would they replace it with? The GOP candidates have discussed this only briefly in a single debate. In some sense, the objection to Obamacare has given the presidential candidates and other Republicans an excuse not to do the hard work of crafting the “replace” part of “repeal and replace.”
Second, this frankly is a more complete argument in defense of Mitt Romney’s health-care record than what Romney himself has offered. Now, if Newt Gingrich becomes his primary challenger, this issue may recede into the background (since Gingrich was an early and forceful advocate for the individual mandate). But if Romney is going to win over the conservative base, he’d be wise to stress these other disagreeable aspects of Obamacare, which in fact do make it worse than his Massachusetts version.
And finally, this is a reminder that the most potent argument politically with independents may not be the individual mandate but something far more objectionable, the Independent Payment Advisory Board. The 15-person board, empowered to step into the patient-doctor relationship and determine what services are too expensive or too expensive for certain age groups is, and always has been, the distinctly non-progressive part of Obamacare. It is rationing, plain and simple, the flat denial of certain courses of treatment. Conservatives should not forget to raise this issue, making the case that what we are ultimately talking about is the right to control one’s own health care. (Liberals apparently only care about the “right to choose” when it involves abortion.)
The Supreme Court’s decision, in other words, shouldn’t signal that conservatives’ work is done. To the contrary, the task of educating the public, devising an alternative scheme and creating a mandate from which to govern after the 2012 election is just beginning.