The New Republic

It's the for profit insurance industry that has won - they can live with the mandate and PPACA, with its government supplied customers, or without it, with some able to afford care and no great concern about the rest of us. But with PPACA or without it, it's a bad deal for us as a country, as we pay almost twice as much per person (or as a percent of the GDP) for health care as the rest of the industrialized world, and have fairly poor outcomes. By 2020 the Commonwealth Fund estimates the cost of insurance for a family of four will be just over $20,000 with PPACA and $23- to $24,000 without it. How can we thrive as individuals or a community with out of control costs like that and not getting good value for our health care dollars. The real win will be when we get to a single, publicly accountable system to pay for our health care and with the other reforms for which that can be the basis.

- bsemple

March 27, 2012 at 12:23am

Jonathon makes a good case for the hypocritical cowardice of Republican politicians and the base that supports them. If the individual mandate loses in the Supreme Court, I think a new case should begin to make its way up the courts--if someone refuses to buy insurance, he or she doesn't get health care. Libertarians want to be government-free, stand-alone citizens, but when they need health care, they're perfectly willing to let the taxpayers or insurance holders foot the sometimes multi-million-dollar bill. They loudly claim to be brave existentialists, but when they need help on somebody else's dime, they're weaselly cowards, taking advantage of the medical industry's Hippocratic Oath. No health care for those who refuse to buy health insurance! Be brave like you say you are! Have your mother do your heart surgery on you!

- magboy47.

March 27, 2012 at 1:16am

Obamacare, itself, is just a first step towards universal medical care. If the courts overturn it's key funding provision we go back to square one. I saw how flummoxed Santorum was yesterday when asked if medical care is a right.

- paskunac

March 27, 2012 at 6:46am

If the mandate is thrown out will hospitals refuse to treat uninsured patients in ER and then challenge the mandate that they do so.

- stanmvp48

March 27, 2012 at 8:19am

paskunac, Santorum was hilarious, he said health care was a right endowed by God...and I suppose magically performed by God. Someone here wrote we now will have Single Prayer instead of Single Payer. As I wrote way back when this was in the offing I warned about the mandate and Cohn ignored the hell out of people who warned him. We did not need a mandate, a tax and credit system would have worked just as well and would have been Constitutional. Politically it might have been a little tougher but with 60 Senators if we could not do it then, then the Democratic is useless.

- blackton

March 27, 2012 at 8:23am

Gore v. Bush and Citizens United are purely political court decisions where the rights of individuals seemed like a ruse (e.g. the rights so acknowledged in Gore v. Bush were banished from being mentioned ever again). Those decisions have had and will continue to have significant impact on our country that, from my perspective, diminishes the competence of government. Overruling the ACA would be the third of such decisions.

- Nusholtz

March 27, 2012 at 8:32am

I'm a little perplexed about the origin of the concept of the mandate (which I support). We keep hearing it was a GOP/Heritage Foundation idea. But don't other countries have it, or something similar, e.g. Japan, Switzerland, the Netherlands? Did they get it from the Heritage Foundation, or develop it on their own?

- ballston

March 27, 2012 at 10:01am

Always funny when liberal moonbat cheerleaders attempt to characterize Republicans with sweeping generalizations. They are always wrong. Cohn-less-ness implies that mainstream conservatives not opposed to individual mandate... ... yet the 2010 elections (a historic liberal crushing) prove otherwise.

- mr_rationale

March 27, 2012 at 11:13am

To their credit, conservatives appreciate the value of tradition, consensus, and order, and object whenever the courts deviate from the mainstream by, for example, recognizing rights that are not clearly set forth in the constitution. The challenge to the minimum coverage provision (or mandate) in ACA doesn't fit with this conservative principle. Today's NYT has a front page article about Randy Barnett, the libertarian law school professor at Georgetown who is credited with driving the constitutional challenge to the mandate from the fringes to the mainstream, mostly by giving opponents of ACA the patina of "scholarly respectability" by providing an "intellectual and legal framework" for the challenge. Professor Barnett acknowledges that he was motivated because his initial objections were not taken seriously by mainstream legal academics. And while his status as a law school Professor provided the "scholarly respectability", it did not discourage him from employing more rudimentary political tactics, in particular his repeated use of the words "unprecedented, uncabined, unnecessary and dangerous" to describe the mandate, pricking the emotions of the Tea Party and other hysterics. It some respects I must admire the Professor, the revolutionary willing to go it alone and challenge both the legal establishment and well-settled legal principles. Yes, revolutionary, for his challenge defies tradition, consensus, and order. A conservative he is not.

- rayward

March 27, 2012 at 11:20am

Always count on Rat with the brain fart. The point of Cohn's article is that mainstream conservatives were not opposed to the mandate until a liberal, Democratic President proposed it and made it a lynchpin of his major legislative accomplishment. Then they decided it was socialism and made hay out of it in order to triumph in a midterm election. So now "mainstream conservatives" are against the individual mandate. But if you canvassed conservatives about this idea in, oh, 2007, they would have probably given it a big thumbs-up as an example of the Federal government forcing lazy freeloaders to carry their own weight in society.

- wildboy

March 27, 2012 at 11:40am

Another mr_rat basic-reading-comprehension fail! In more important news, thanks to Cohn for continuing to point out the opportunism of this relatively recent change of heart among conservative politicians. It takes such great courage to oppose so stridently something they used to support, now that it has become unpopular.

- frippo

March 27, 2012 at 11:48am

Obama's health care plan was originally a Republican idea from the Nineties, as was the individual mandate. Republicans said both proposals would eventually reduce health care costs. They were right. But today's Republicans turn viciously on their own ideas, if Obama, who is basically a liberal Republican, supports them. Their ferocious opposition to their own ideas is simply a way to get Obama out of office. What we have here is a textbook case of mass psychosis--sometimes called politics. blackton, Santorum said health care was a right endowed by God? Hmmm. According to Tricky Ricky, the Constitution is there to protect God-given rights, so if health care is God-given, then it's also a constitutional right. Hmmm.

- magboy47.

March 27, 2012 at 11:53am

With a sweeping generalization mr_rat says "Always funny when liberal moonbat cheerleaders attempt to characterize Republicans with sweeping generalizations. They are always wrong." (Cognitive dissonance alert.) ___________________ The mandate isn't the issue. It's the Right's unnerved acceptance that the middle-left adopted their idea. Suddenly what was seen as the Right's panacea to fixing the system suddenly became anathema to liberty and pursuit of European socialism once the Left embraced the idea as a cumbersome alternative to a single-payer system. What have the Right to lose? Instead of running from an idea of their own creation, that while not perfect is perfectible, they should have embraced it. But I guess the real reason is that if they did let such an idea loose upon the world and let the Government enforce it, and it worked, it would contradict the last 30+ years of Conservative ideology that has been built upon an intellectual house of cards. The GOP is a party of emotion. Despite the largesse of money that goes into 'think tank' apparatchiks like the CATO or Heritage Institutes, the underlying foundation upon which most GOP policies seem to be built upon are emotional beliefs buffered by self-supporting numerology exercises. We've had GOP directional control of this country for 20 of the past 32 years and all of the promises and emotional calls to greatness have resulted in nothing more than a stack of bromides that the middle class and working poor get to placate themselves with while quietly acquiescing to supply-side/market policies that favor corporations and the top quintile of income earners. So now we face the issue of the ACA and 'individual mandate' that would require working Americans to take responsibility for their health care insurance needs with limited assistance from the government and the GOP is lobbying against such 'responsibility' because if the Left embraces such a position how much further right will the GOP have to lurch? Well, we've witnessed the meteoric rise of direct assaults on health insurance coverage of contraceptives for women, regressive and aggressively invasive 'sonogram' bills aimed specifically at marginalizing a woman's right to privacy and choice. The GOP have no place to go on the issue except frontal assaults on women by institutionalizing government 'mandated' invasive procedures and laws which actually strip the right to life,liberty and pursuit of happiness from 51% of the American population. The GOP makes singular claims to being the only party that cares about America and American values but has consistently shown that their 'care' extends only to a limited few. The current GOP party is nothing short of regressive in its values and beliefs. It's travelled so far to the extreme right that Ronald Reagan wouldn't have made it past this primary season had he run. Short of calling today's GOP fascist brownshirts, let's just say that if the American people continue to let themselves be led by 'true believers' instead of thinkers, we get what we deserve.

- singlspeed

March 27, 2012 at 12:13pm

It would really be nice to have a real legal expert covering this case. These articles seem very superficial and derivative.

- mlottman

March 27, 2012 at 12:24pm

Libertarians do not want government-financed and government-mandated health care. The biggest problem with health care financing today has been caused by decisions made decades ago about health care insurance being a tax-free employee benefit. Today's health insurance policies, rather than truly being insurance that would pay for unexpected and financially devastating illnesses and injuries, we have a monthly service plan that pays for routine care, including minor expenses, and expected and fully-predictable expenses (like routine visits to the doctor and contraception). The other major cause of problems with health care insurance system is mandates, mostly at the state level but coming your way with Obamacare. I am forced to pay for dozens of coverages that I do not want or need because, in the state of California, I cannot buy individual health insurance without coverage for substance abuse, pregnancy, family planning, mental health "parity" and so forth because the purveyors of those services have successfully lobbied the morons who get elected to make laws. The result is that I pay twice as much for an identical policy in California as I would in Nevada. The reality is that we have too much health insurance; there is too much overhead and dollar swapping; and the price system is broken by the vast differences between the cost to a cash customer versus an insured customer. Get government out of health care and it will get cheaper and better, like every other product and service offered freely and voluntarily without government interference and micromanaging. Has anything ever improved when taken over by the government? Of course not. But there are many who like the idea of something for nothing and they like using the force of government to make others pay for what they think is important. Freedom works; government doesn't! Individual Freedom & Personal Responsibility Maximum Freedom, Minimum Government

- dalefogden

March 27, 2012 at 12:27pm

"Has anything ever improved when taken over by the government? Of course not." Then explain how it is that Britain, for example, with socialized medicine, with the doctors employed by the government, gets better health results than we do, at a fraction of the cost.

- ballston

March 27, 2012 at 12:39pm

singlspeed wrote: just say that if the American people continue to let themselves be led by 'true believers' instead of thinkers we get what we deserve The problem is that *WE* get what *They* deserve. --bh

- blackhat

March 27, 2012 at 1:02pm

mlottman There is no such thing as a real legal expert when lawyers are capable of arguing two sides of an issue. I used to think we could look to the Surpreme Court as the final arbiter of the law, but that would only happen if there was a unanimous opinion, otherwise it's just 5 people who happened to agree on something and they aren't necesarily right about it except for the fact that we have all agreed that they have the final say.

- Nusholtz

March 27, 2012 at 1:12pm

Sorry, Charlie, ACA is dead! The handwriting is all over the wall. Republicans will cheer, but it will bite them in the ass come November, to their astonishment. ):

- Tgossard

March 27, 2012 at 1:27pm

I worried that all the complex arguments are ultimately meaningless. Right or wrong don't matter, economics and morality don't matter. What matters is that the Supreme Court has been stacked with a majority of Right Wing judges. The end. I hope not, but, that's what I fear. PS: Really I don't think I care anymore what libertarians want. They drive on our highways, fly in our very safe, government regulated skies, which we all pay for, despite the fact that some folks whose ideology is odious to me use them too.

- Sophia

March 27, 2012 at 1:28pm

msgr. rationale, as usual you are full up to your eyeballs. The mandate is as constitutional as apple pie and motherhood, but you enthusiastically spit on both.

- Tgossard

March 27, 2012 at 1:32pm

Libertarians are America's Jacobins.

- Tgossard

March 27, 2012 at 1:35pm

It is difficult for me to sit still and hold my tongue while the libertarians preach anarchy. Death to Libertarians! (figuratively speaking).

- Tgossard

March 27, 2012 at 1:38pm

I correct myself: there are no Libertarians, only libertarians. Their chameleon-like deceitfulness is repugnant.

- Tgossard

March 27, 2012 at 1:40pm

"It’s a reminder, Toobin says, of one reason that presidential elections matter: Over time, presidents can and will remake the judiciary. In the best case scenario for liberals, President Obama will win another term and, finally, break the congressional logjam that’s stalled his own efforts to appoint judges." When pigs fly. Since when will BHO do in his second term what he failed to do in his first term when he had the greatest Dem majorities in decades? BHO is in the box he built for himself and Dems on health care, financial reform, adequate stimulus and a host of other issues. You all are all bent outta shape re what may be successful challenges to Obamacare that you have been warned is really complicated insurance reform that affects relatively few Americans. And overall does not have the support of a majority of voters. Until Dems support Progressive politicians who advocate and work for real reform, the right will constantly win. As noted by Artemas Ward a century ago, Supreme Court Justices read the papers.

- drofnats1

March 27, 2012 at 2:50pm

Mr Rat, are you claiming that when The Heritage Foundation came up with the idea of combining forcing the insurers to cover everyone regardless of pre-existing conditions and offsetting it with a mandate, that conservatives were opposed to this? Think carefully before you answer. The gop was just fine with all the tenets of what they now derisively call Obamacare. Right up until some black guy was elected President and adopted this health insurance plan as his own, they were just fine with it. Then they lost their minds, moved sharply to the right of John Birch, and denounced everything Obama did, including their own Heritage-invented national health insurance plan. As usual, Mr Rat, you are incapable of being honest. @Blackton: "Someone here wrote we now will have Single Prayer instead of Single Payer" That was me, buddy. Glad you liked it. ;)

- Tristan

March 27, 2012 at 3:30pm

Magboy writes: "Obama's health care plan was originally a Republican idea from the Nineties, as was the individual mandate. Republicans said both proposals would eventually reduce health care costs." The mandate from the 90's was part of a larger framework (look for the 1989 Heritage doc), which included (among other things): Eliminating tax breaks on health care, direct consumer payment for routine medical events, assistance to those that cannot afford coverage (via tax credits), and the mandate. But not much was specified other than "require everyone to have insurance." This is the same stance that Obama later pounded Hillary on. Later in the 1990's, the idea of a mandate came up again (mostly republicans were advocating it as a counter to Hillarycare), but it was met with massive resistance by the general population then too. Largely because it was demonized by the Clinton's (who ironically would support it later). And so it was dropped. If something is popular, nobody will contest the constitutionality of it and it just moves ahead. Only if things are unpopular will certain things be challenged. Thus, if the dems and republicans worked together and arrived at a mandate in 2009, and both sides were saying "this is a great thing" and 80% of the country believed it was a great thing, then the mandate would readily be accepted. This again highlights the problems with the dems ramming something through: There are enough places legislation this size for your opponents to get a hand hold and destroy it. That is exactly what is happening here. Blame Obama, Pelosi and Reid for this. Instead of crafting something everyone might want, they specifically set out to craft something ONLY THEY could get credit for. They thought, at the time, this would ensure their re-election. Man they misjudged that in 2010.

- seattleeng

March 27, 2012 at 4:21pm

seattleeng, Politicians support one thing at one time and demonize it at another. Both Republicans and Democrats do that. Republicans are doing it now. But they're going a step further than the Dems. They're attacking everything that they themselves supported in the past, including the recent past, if Obama supports it. This is my 60th year of studying politics and economics around the world, and the only other instances of this (Republican) phenomenon I've encountered are in Soviet Russia and Red China. Hmmm. BTW, Republicans and the Republican base will never, ever again work with those they disagree with to produce legislation that benefits the American people. They will be screaming SOCIALISM for the next 100 years, and they don't even know what socialism is. Socialism is when the government owns all of the means of production. Last time I looked, the medical industry folks who are gouging the sick, the injured, and the dying in America are capitalists. Quiz question: name one industry that the government has taken over since Obama became president. I really don't care if the whole ACA collapses, as long as it's on its way out by this November. If it is, the Republicans, as Tgossard notes, are going to get a November surprise. The Democratic base can get energized, too. And Independents and even Republicans are already benefiting from parts of ACA. In 2010 very few people had benefited from ACA. Now there's a bunch. They know what they could be losing at the hands of the Radical Right. We'll see what happens.

- magboy47.

March 27, 2012 at 5:14pm

Should read: Quiz question: name one industry that the government has TAKEN OWNERSHIP OF since Obama became president. I know the Radical Right believes that Obama has already taken over the capitalist medical industry in America. Friggin' loons.

- magboy47.

March 27, 2012 at 5:20pm

Magboy: "They will be screaming SOCIALISM for the next 100 years, and they don't even know what socialism is. " And this is your rational for taking a majority win in 2008 and absolutely shutting out the other party? "Hey, John, remember, I won" and "now we begin to drain the swamp" set such a poisonous tone for the debate. Since republican and democrats citizens ALL believe that 1) health care should be available to all (ditch the pre-existing conditions clause), and 2) that it should be affordable (duh), and 3) and that those that plan for health events should have better care than those that don't (even those here are saying let those that dont' buy insurance bleed to death in the street), and 4) nobody should lose their house due to severe illness if they have taken active steps to avoid it (there for the grace of god...)... there is actually a ton of common ground here. The crime here is that dems took all this common ground and tossed it away, and immediately went back to their normal "They want to kill grandma" meme that has been their goto for the last 50 years. And now they are paying the price for flaunting their ignorance. What an enormous waste of time and energy. Here's to hoping the scotus strikes this down, and we can get the dems back to the bargaining table for something more succinct that captures the principles above that everyone wants.

- seattleeng

March 27, 2012 at 5:43pm

And, PS, the greatest hubris of all: The severability clause, which requires the entire thing to sink or swim, all or nothing. Classic. Absolutely classic. That this entire thing falls apart on such a grandiose act of self-assured confidence makes me laugh out loud. It doesn't get any more ironic than that.

- seattleeng

March 27, 2012 at 5:45pm

seattle: And this is your rational for taking a majority win in 2008 and absolutely shutting out the other party? Well yes, this is what elections are about. Who the hell votes for someone who is not going to do what he runs on but will race towards the other party? Elections have consequences. I had no problem with Bush passing his own huge tax cuts for the rich because in doing so he proved once and for all the utter horseshitness of Republican philosophy that if you cut taxes it will create surpluses. And funny how Republicans never considered Bush passing his bill with 50 Senators via reconciliation as ramming a bill down America's throat, but Democrats passing this bill with 60 votes was.

- blackton

March 27, 2012 at 8:50pm

Yes, elections have consequences. But the dems fault was giving a nod to the loony left of the party and ignoring the middle. And it was the middle that put them into office. The right will always feel slighted. Bush's tax cuts were very popular with the electorate, including moderate and including middle class. The wringing-of-the-hands came from the loony left (again) over the lost revenue which they believe was theirs by birthright. But in spite of the naysayers on the fringe left, 2004 to 2007 saw the large federal tax revenue increase over 4 years in the history of the country. Go figure.

- seattleeng

March 27, 2012 at 10:26pm