The health care reform straw man


If you watch conservative media and blogs, you’ll see a lot of hay being made about how the health care law’s individual mandate is unconstitutional, and that’s why thirteen Attorneys General plus Tim Pawlenty (because Minnesota’s top law enforcement official actually read the law and supports it) are suing to get it overturned.

The logic goes something like this: the federal government can’t force individuals to buy a product from a private corporation, and that’s what the individual mandate does: forces you to buy insurance from private insurance companies.

Never mind that this is essentially what President Bush’s Social Security privatization push was all about in early 2005 (forcing some social security payments to be invested with privately held funds). The argument is a straw man on its face, because the health care reform law does nothing of the sort.

The law does not force anyone to buy insurance; rather, it dictates that everyone who can afford it must be insured or pay a penalty. The distinction is subtle, but important. If you’re working for a mid-size company today and your employer provides health coverage, nothing will change. You’re already insured.

If you don’t have insurance today — if you work for a small company that can’t afford to cover its workers, or you’re self-employed, or you work for Wal-Mart and are subject to its fulltime/parttime rules that prevent thousands of workers from achieving fulltime wages and thus qualifying for coverage — you need to get insured by 2014 or pay this penalty. This mandate comes with a bunch of subsidies and new programs (including state-based market exchanges so you can shop around for the insurance that works for you) to ensure that you can afford it. If you’re close to or below the poverty line, you’re exempt. If you still don’t get insurance, you pay a penalty to defray the aggregate costs of you getting sick.

Why aggregate costs? Insurance is a funny business. You, individually, may not get sick, but speaking to the collective you (those without insurance) a certain number will get sick, require care, and not be able to afford it on their own.

Who pays for that care? The answer is, we all do, whether through direct subsidization or through damaged property values and economic vitality when a family’s home is foreclosed and they declare bankruptcy.

That’s the core of the straw man being argued by conservative “repeal and replace” advocates right now – the choice under the new law is no longer “have insurance or don’t have insurance” but rather “have insurance, or pay the costs of your illness or injury another way.” Either way, you’re paying your own way rather than depending on others to pick up the slack (a concept I would hope the repealandreplacers could get on board with). The new law doesn’t force you to purchase anything — rather, it dictates that you’re paying for your own health one way or another, and lowering the marginal cost of doing so by being insured.

Is the new law ideal? Of course not; a public insurance option would have helped bring down the deficit much faster than this version, and there are plenty of other provisions that lean much closer to President Nixon’s plan than to that put forth by contemporary progressive thinkers. But it’s a big step in the right direction, and puts America on the path toward getting back into the First World on health care.

Those trying to argue that it’s unconstitutional either don’t know what they’re talking about or have other things on their minds.