The ACP Advocate Blog

by Bob Doherty

Thursday, December 16, 2010

Irony

If you appreciate irony, it doesn’t get much sweeter than this:

A GOP-appointed judge rules that a GOP idea, recently embraced by a Democratic president who a few years ago campaigned against it, is unconstitutional, possibly paving the way for a government-run program.

Strange, but true. A Republican-appointed judge in Virginia has ruled that the ACA’s individual mandate is unconstitutional (although two other federal judges appointed by Democrats have upheld it, and the Supreme Court will ultimately decide). The irony is that the roots of the individual mandate can be found in conservative proposals from the early 1990s.

In 1990, the conservative Heritage Foundation developed a plan for universal coverage that described the individual mandate as a “social contract” between the government and individuals:

“Under this social contract, the federal government would agree to make it financially possible, through refund able tax benefits or in some cases by providing access to public-sector health programs, for every American family to purchase at least a basic package of, including catastrophic insurance. In return, government would require, by law every head of household to acquire at least a basic health plan for his or her family.”

The individual mandate was then incorporated into bills proposed by GOP stalwarts Orrin Hatch (R-UT) and Chuck Grassley (R-IO) as an alternative to “Hillary Care.” It later became a lynchpin of the Massachusetts health reform plan championed by then governor (and likely 2012 presidential candidate) Mitt Romney (R-MA).

That was then, this is now.

The Heritage Foundation now argues that the individual mandate is “unprecedented” and “unconstitutional”- conveniently ignoring its own past ownership of the idea. A few days ago, Senator Hatch hailed the Virginia judge’s decision to overturn the individual mandate as “a great day for liberty. Congress must obey the Constitution rather than make it up as we go along. Liberty limits on government, and today those limits have been upheld.”

The irony isn’t limited to Republicans. During the Democratic primary, candidate Barack Obama not only opposed an individual mandate, he used it in attack ads against Hillary Clinton:

"What's [Clinton] not telling you about her health care plan?" an announcer asks. "It forces everyone to buy insurance, even if you can't afford it."

That was then, this is now.

Following the Virginia ruling, the White House had this to say:

“Opponents of reform claim that the individual responsibility requirement – the requirement that all Americans carry a minimum level insurance by 2014 – exceeds Congress’ power to regulate interstate commerce because it penalizes economic ‘inactivity.’ Make no mistake -- individuals who choose to go without health insurance are actively engaged in economic decision making – the decision to pay for health care out-of-pocket or to seek uncompensated care. Every year millions of those who have chosen to go without health insurance actively seek medical care, which is evident in the billions of dollars spent on uncompensated care every year.”

(I wonder what Obama’s Secretary of State would have to say about this now, but of course, she can’t.)

The above is fact – you can look it up. More speculative is the part about the Virginia ruling possibly leading to a single payer plan. But the Washington Post’s Ezra Klein plausibly writes:

“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.”

If Ezra Klein is correct, could anything be more ironic?

Today’s question: What do you think about the irony involved in today’s debate on the individual mandate?

5 Comments :

Blogger rcentor said...

I love irony, but politics transcend irony. I wonder how many politicians really act on principles. Rather, as you show, politicians are always changing to fit their "opinions" to the prevailing winds.

Sometimes those winds come from party members, sometimes from polls, sometimes from lobbyist pressure.

I do believe that on this issue both sides are playing pure politics. They are trying to stake out positions that will help help them in future elections.

It is a shame that both sides play politics and neither side really espouses consistent principles.

December 16, 2010 at 2:38 PM  
Blogger DrJHO7 said...

"isn't it ironic...
like a fly in your chardonnay"

I agree with Dr. Centor.
Priorities 1, 2 and 3 for those who are elected: get re-elected.
No matter whose idea it is/was, the individual mandate will fail because there is no affordable insurance, even catastrophic/bare bones benefits insurance has very high premiums, especially for individual family policies. Most who need it will go bare rather than suffer the premiums.

The tax penalty is lame because it is not of sufficient magnitude, and is probably unenforceable.
A properly run public plan with no profit incentive would be helpful but has insufficient support in congress.

winners (for now): blue crosses, aetna, united, coventry, amerihealth, etc, especially their CEO's and their shareholders.
losers: the 1/6 of our population who are and will remain uninsured.

And, of the unpopular single payer system proposal: something like this will be the salvage plan when the system crashes - but only when we're forced into it.

Medicaid expansion, even to the limited extent that has been proposed, is not likely to succeed because there is no plan to pay for it via federal or state governments that all have huge budget deficits at the outset.
Not ironic, but sad.

December 17, 2010 at 1:18 PM  
Blogger Harrison said...

I think it is sad to think that our Supreme Court will get this case and they too will struggle. The decision will likely be 5 to 4 and the guide will be politics and not the constitution.

If the guide is politics, then the decision of Congress should stand.
If the next Congress wants to undo it, then that is their prerogative.

A 5-4 vote of the Court would be the worst thing that can happen in this case.

And the worst thing that happened to the Court still stands as the Bush v Gore decision.
They undermined their own authority.

December 19, 2010 at 3:22 PM  
Blogger w said...

Oh, I don't know. There have been plenty of bad Supreme Court decisions.

The worst "thing to happen to the Court" is still probably Dred Scott, followed by Plessy v. Ferguson.

-wbond

December 20, 2010 at 5:19 PM  
Blogger Harrison said...

I agree.
I too succumb to hyperbole and short term views.
There is always time to recover from bad decisions and to make things right.

But a 5-4 decision in this case would be unfortunate.

And if the court is split along ideological lines it would seem that the decision of the Congress maybe should be allowed to prevail.
At least that carried electoral authority.

Harrison

December 21, 2010 at 11:44 AM  

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Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog

Email Bob Doherty: TheACPAdvocateblog@acponline.org.

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