Tuesday, December 14, 2010

Mandates, ObamaCare and Social Justice

A U.S. District Judge in Virginia, Henry E. Hudson, has recently ruled that the individual mandate in Obama's health care bill is unconstitutional. When I first read this, I was ambivalent. On the one hand, I've got no love for the Republican boneheads for whom this is a way of trying to assault the entire idea of health care reform. But on the other, I've long felt that the individual mandate is an oppressive, basically conservative idea.

No wonder, then, that the individual mandate was an idea hatched by the Right. As I've noted elsewhere, it emerged as an idea in the early 1970s from Richard Nixon as a response to Ted Kennedy's push for single-payer. As Ezra Klein notes:
The individual mandate began life as a Republican idea. Its earliest appearances in legislation were in the Republican alternatives to the Clinton health-care bill, where it was co-sponsored by such GOP stalwarts as Bob Dole, Orrin G. Hatch and Charles E. Grassley. Later on, it was the centerpiece of then-Gov. Mitt Romney’s health-reform plan in Massachusetts, and then it was included in the Wyden-Bennett bill, which many Republicans signed on to.

It was only when the individual mandate appeared in President Obama’s legislation that it became so polarizing on the right. The political logic was clear enough: The individual mandate was the most unpopular piece of the bill (you might remember that Obama’s 2008 campaign plan omitted it, and he frequently attacked Hillary Clinton for endorsing it in her proposal). But as a policy choice, it might prove disastrous.

The individual mandate was created by conservatives who realized that it was the only way to get universal coverage into the private market. Otherwise, insurers turn away the sick, public anger rises, and, eventually, you get some kind of government-run, single-payer system, much as they did in Europe, and much as we have with Medicare.

So, before sympathizing with apologists for Obama and the Dems who will, no doubt, jump to the defense of ObamaCare against the recent ruling (by a conservative, Bush-appointed judge), it's important to understand what's at stake.

The range of choices before us is not either (a) Republican non-sense, or (b) whatever Obama puts forward. No, on the contrary, justice itself recommends certain health care ideas and impugns others, regardless of what Obama does or says. Contrary to the beliefs of some of his apologists, he's not God and we're not theistic voluntarists.

Everyone who has spent any time considering the issue of health care can see that single-payer is the most rational and just arrangement. Why, then, should we shed a tear at the demise of a mandate that forces everyone to buy the for-profit health insurance industry's product? I agree with Ezra Klein that we shouldn't shed a tear, because this anti-mandate ruling could even turn out to be a blessing for those who actually believe in real health care reform:
If Republicans succeed in taking [the individual mandate] off the table, they may sign the death warrant for private insurers in America: Eventually, rising cost pressures will force more aggressive reforms than even Obama has proposed, and if conservative judges have made the private market unfixable by removing the most effective way to deal with adverse selection problems, the only alternative will be the very constitutional, but decidedly non-conservative, single-payer path.
I'm tempted to say that conditions with or without the mandate will, in the long run, create pressures for more aggressive reforms. But the point is well-taken, the removal of the mandate erodes even the dubious idea that somehow the market could be made to provide "universal coverage".

This may be a setback for Obama, but it is not a setback for progressives who believe in real health care reform.


fwoan said...

Excellent post. I can't agree with Ezra though, with his statement that this will make it necessary for more aggressive reform. It would have happened (like you said) one way or the other because private corporations are simply uninterested in actually providing "insurance." It may speed up the time table, but more aggressive remedies will be already necessary - whether we take them up or not.

t said...

I basically agree- I'm not sure whether this will speed up the demand for more aggressive reforms or not- but one things for certain, the legal challenge to the individual mandate is no blow to the idea of just health care.

Also, Klein suggests that an unjust state of affairs will mechanistically produce the resistance necessary to win single-payer. That seems dubious to me- resistance may be provoked, but the question of whether it will be sufficient to win single-payer is unclear. For that, organization and a determined movement, conscious of what it's after, would be needed. We cannot expect ruling politicians to gather in good faith our collective preferences and implement them in good faith- that's just not what they are there to do.