Health Care Jujitsu
Robert B. Reich
The dilemma at the heart of the new law is that it continues to depend on private health insurers, who have to make a profit or at least pay all their costs, including marketing and advertising. Yet the only way private insurers can afford to cover everyone with pre-existing health problems, as the new law requires, is to have every American buy health insurance -- including young and healthier people who are unlikely to rack up large health care costs.
This dilemma is the product of political compromise. The administration couldn't get the votes for a single-payer system such as
But don't expect the
Those who are defending the law in court say the federal government has authority to compel Americans to buy health insurance under the Commerce Clause of the Constitution, which gives
Those who are opposing the law say a requirement that individuals contract with private insurance companies isn't regulation of interstate commerce. It's coercion of individuals.
Unhappily for Obama and the Democrats, most Americans don't seem to like the individual mandate very much anyway. Many on the political right believe it a threat to individual liberty. Many on the left object to being required to buy something from a private company.
The president and the Democrats could have avoided this dilemma in the first place if they'd insisted on
Americans don't mind mandates in the form of payroll taxes for
There's no question payroll taxes are constitutional, because there's no doubt that the federal government can tax people in order to finance particular public benefits. But requiring citizens to buy something from a private company is different because private companies aren't directly accountable to the public. They're accountable to their owners, and their purpose is to maximize profits. What if they monopolize the market and charge humongous premiums? Some already seem to be doing this.
Even if they're organized as not-for-profits, there's still a problem of public accountability. What's to prevent top executives from being paid small fortunes? Apparently that's already happening.
Moreover, compared to private insurance,
So why not
Because Republicans have mastered the art of political jujitsu. Their strategy has been to demonize government and try to privatize everything that might otherwise be a public program financed by tax dollars (see
Obama and the Democrats should do the reverse. If the
When this happens, Obama and the Democrats should say they're willing to remove that requirement -- but only if
Do this and the public will be behind them, as will the
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