Is the insurance mandate constitutional? Of course – health care reform wouldn’t work without it!

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Will

Will writes from Washington, D.C. (well, Arlington, Virginia). You can reach him at willblogcorrespondence at gmail dot com.

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  1. Avatar Mark Thompson
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    I’m trying to think of the last time I saw the phrase “_______ has a great column today in the Washington Post.” I’m drawing a blank. This certainly keeps the streak intact.Report

  2. Avatar Katherine
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    In constitutional terms, how does this differ from requiring people to buy car insurance. (I know, techinically you can get out of that by never owning a car, but the vast majority of people regard them as necessities.)Report

    • Avatar Michael Drew in reply to Katherine
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      @Katherine, Refer to your parenthesis.Report

      • Avatar gregiank in reply to Michael Drew
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        @Michael Drew, I’ve always thought the car insurance analogy was fair at best. Its simple and easy to understand, but not that exact. The only people who definitely will never use health care are those with one in a billion genes who die peacefully in their sleep at age 121 having never been to a doc or those who die from very sudden and very catastrophic injuries so that there is nothing to take the hospital except a bucket of various parts. The car insurance analogy fails because it does not accurately point out this fact. Cars are an option. But we’re all going to use health care and if you don’t have any insurance others will end up picking up your bill.Report

        • Avatar Michael Drew in reply to gregiank
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          @gregiank, Not if you can pay. I do take your point, but it’s just a bad example rhetorically and in appealing to people’s sense of justice, because the situations are extremely different in terms of incidence on people’s freedom – car ownership is 100% voluntary; but it’s a bad example Constitutionally, because the Constitutional point doesn’t rest on the issue being a matter of insurance or shared risk or the like.Report

    • Avatar Mark Thompson in reply to Katherine
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      @Katherine, It doesn’t matter that many people view them as necessities (and there are certainly many people who don’t)- purchasing a car is still a fundamentally economic act, and it is unquestionably an affirmative act. Moreover, to my knowledge, car insurance requirements are almost entirely a function of state law, so there’s no federalism issues either. Mind you – I still think the mandate is constitutional under existing precedent, but the car insurance analogy is not a good one.Report

    • Avatar MadRocketScientist in reply to Katherine
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      @Katherine,
      Also, you are only required to carry liability insurance to protect others from your own recklessness or carelessness. Maybe a requirement to purchase a catastrophic policy would be more analogous.Report

  3. Avatar Boonton
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    OK I just skimmed the editorial but I’m not seeing the silliness. Assuming you want something like universal coverage but do not want something like single payer or ‘Medicare for everyone’ how do you get there without something like a mandate?Report

  4. Avatar Michael Drew
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    I’m not a lawyer or a scholar so correct me if I am wrong, but aren’t measures routinely considered in to context of whether the government has a legitimate, compelling, etc. interest in achieving the aim of certain legislation, whereupon if such is found measures that might be seen to run afoul of certain restrictions in the Constitution are given leeway if not outright endorsement? You can say this is a corruption of ancient canons of Constitutional interpretation (natch Jason K.) , but isn’t it indeed the kind of reasoning that populates a fairly large part of SCOTUS jurisprudence certainly since we fully industrialized for good or ill?Report

    • Avatar Mark Thompson in reply to Michael Drew
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      @Michael Drew, The varying levels of scrutiny to which you refer are typically in the context of analyzing infringements of individual liberties; in the case of intermediate and strict scrutiny, you’re also looking at analyzing whether the legislation at issue is appropriately tailored (ie, whether it’s overbroad).
      I may be wrong, as this is not an area of law with which I’ve got an overwhelmingly large amount of experience, but the varying levels of review would not be relevant here because the debate isn’t over whether this is an impermissible infringement of individual rights (which would probably just face a rational basis review) but instead over whether this is even a power granted to the federal government at all. IOW, the levels of review operate as a way of deciding conflicts between individual liberties and the powers of government, whilst here the argument is that there’s no conflict at all since the government doesn’t have the power in the first place.Report

  5. Avatar Jake
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    ” No one disputes that the federal government has the power to stop insurers from denying coverage based on preexisting conditions. Under the Constitution, the feds thus have the corresponding power to enact reasonable measures to assure that this reform actually works.” That’s an appeal to the necessary and proper phrase… not exactly a non-sensical argument: but I see the glibertarian BS machine is up and humming at the LOOGReport

    • Avatar Mark Thompson in reply to Jake
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      @Jake,
      That’s a rather gigantic leap of logic in that paragraph. One does not need an individual mandate in order to put an end to denial of preexisting condition coverage. One needs an individual mandate in order to eliminate the adverse selection problem caused by ending the denial of preexisting condition coverage. Elimination of the adverse selection problem is not, in and of itself, a power of Congress.Report

  6. Avatar MFarmer
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    “You can’t force health plans to offer coverage to everyone, regardless of medical condition, if you don’t make sure everyone is in the insurance pool.”

    It frightens me that people can’t see the danger in this line of thinking. You can’t force X to do Z, if you can’t force Y to do B — on and on. The problem goes back to the beginning — Government forcing their will on private citizens in economic transactions and business decisions — there will be no economic freedom if we continue in this direction.Report

    • Avatar Mark Thompson in reply to MFarmer
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      @MFarmer, That’s probably a good rule of thumb that a policy solution should be second guessed: if, in order to achieve goal A, which you blame on Group X, you must exercise the use of force on the entirely innocent and infinitely larger Group Y, then perhaps you should second-guess whether your prefered cure isn’t worse than the disease, and whether perhaps a less harmful cure can be found.

      Unfortunately, of course, the Republicans weren’t offering any actual alternative cure, and there’s about two Congresslizards in the GOP who actually find the use of force to be immoral while also acknowledging the fundamental problems with our existing health insurance system.Report

      • Avatar Trumwill in reply to Mark Thompson
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        @Mark Thompson, Unfortunately, of course, the Republicans weren’t offering any actual alternative cure,

        This is huge and needs to be said over and over again until the GOP is forced to explain how they’re going to get rid of the mandate (as they want) while mandating PEC coverage (which the Pledge to America supports).Report

        • Avatar Simon K in reply to Trumwill
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          @Trumwill, Easy. They do what the GOP always does. Cut the tax without cutting the spending.Report

        • Avatar Koz in reply to Trumwill
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          Why? Why can’t we just repeal the Obama bill first and figure out something wrt preexisting conditions later (if at all)? If anything we can modify the Pledge to America (which you surely don’t believe is binding on you anyway).Report

        • Avatar Boonton in reply to Trumwill
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          @Trumwill, Why repeal the bill? And when exactly is this ‘later’? When Clinton’s attempt to pass something went down we waited ten plus years (unless you count Bush’s unfunded entitlement idea as the model of what you get as the ‘Republican alternative’)Report

        • Avatar Trumwill in reply to Trumwill
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          Koz, if they want me to vote for them on the basis that they will produce a health care plan that will produce cotton candy for all without the risk of tooth decay, I want to know what that plan is. Instead addressing these problems, they’re saying “And you won’t even have to brush your teeth!”

          “We’ll figure out the tough stuff later” doesn’t work for me. Obamacare (which I would have voted against) did not occur in a vaccuum. It occurred because the GOP refused to admit that there was a problem. It occurred because Obama made some wrong choices on some of these tough decisions. On what basis am I to assume that the GOP will make the right ones?Report

        • Avatar Koz in reply to Trumwill
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          When does “the Republican plan” happen. Maybe never. The point being is that the Obama bill, when and if it actually comes into force will inflict horrific and crippling damage upon the already precarious financial situation in America.

          First we can prevent that from happening, especially since there’s good reason to believe that the Obama will won’t help anybody’s health care anyway.Report

        • Avatar Boonton in reply to Trumwill
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          @Trumwill,
          When does “the Republican plan” happen. Maybe never. The point being is that the Obama bill, when and if it actually comes into force will inflict horrific and crippling damage upon the already precarious financial situation in America.

          Yawn, I think it will just be horrific, not crippling. Let’s see what happens, I’ll bet you $1 it won’t be more than one of the two you just said.Report

        • Avatar Koz in reply to Trumwill
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          Right. That’s more or what I expected, the point being is that if you aren’t willing to see Obamacare being repealed, the rest of the world which does care about the financial stability of the United States will have no choice to but to completely wipe out liberals/Democrats in America as we know it and that after this election cycle that will appear to be a quite plausible course of events.Report

        • Avatar Boonton in reply to Trumwill
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          @Trumwill, OK the rest of the world hings on the US not having a modest universal coverage policy? But just about every other country can do single payer or something closely related without the universe blowing up?Report

        • Avatar Koz in reply to Trumwill
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          No, no, I’m exaggerating a little and you misunderstood me. The rest of the world meaning everyone who is opposed to the Obama health care bill.

          That, if they want to see the bill go away they will have to eliminate almost all of the institutional political strength of the Democratic party that to do it and that will actually look quite plausible.

          Ie, there’s no fallback position wherein the D’s agree to repeal the Obama bill themselves for the sake of their relevant survival as a party. Frankly, I don’t believe this (yet). When push comes to shove the D’s won’t impale themselves for Obamacare. But it’s a choice they might very well have to make, sooner than they want.Report

        • Avatar Boonton in reply to Trumwill
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          @Trumwill, Your mistake is thinking the right is opposed to the bill it isn’t. After all, it was almost the Republican’s own bill when it was called Romneycare and in terms of left-right it’s far to the right of Bush’s Medicare D which was only a few years ago and mostly voted in by the very same Republicans who today would have you believe bleed only tea.

          No, repealing the health bill will not save any Democrats, it would only doom them. If Democrats think voting with Tea Partish Republicans to repeal the bill will cause the GOP to ‘play nice’ and not go after them then they are being very foolish.Report

        • Avatar Koz in reply to Trumwill
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          “Your mistake is thinking the right is opposed to the bill it isn’t.”

          Whatever support there was for a general health care entitlement was prior to Sep 2008 when the scope of our economic problems started to become clear.

          There was no Republican support for it at Demo political high tide, why do you suppose there be any in the future?

          As far the Senate Democrats are concerned the idea isn’t to “play nice” with the R’s or the Tea Partiers. It’s to preserve their seats from immediate liquidation. Right now, Barbara Boxer, Russ Feingold and Patty Murray are Senators in good standing. Let’s see how many of them are still there in two weeks. Do you really think Jeff Bingaman or Kent Conrad or whoever wants to join them? I don’t, I think they’ll be desperate to get some political distance between themselves and the Obama bill.Report

        • Avatar Simon K in reply to Trumwill
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          @Koz, The thing is most of the Republican pols who opposed the bill were playing politics, and they read the polls a lot better than you do and know that opposition among the public is mostly ill-informed and tepid (44-42 last time I looked). You’re going to be bitterly disappointed come February when at the very most you’ll get a repeal of the mandate or some kind of lukewarm compromise, either of which will make the fiscal aspect (which isn’t nearly as bad as you believe) worse. I’m fascinated to see how you’re going to excuse this show of cowardly hypocrisy when it actually happens.Report

        • Avatar Simon K in reply to Trumwill
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          @Koz, Read the polls – healthcare reform as such drifts around 40-40, usually slightly against. The dramatic turnaround blah blah is better explained by the worlds of one William J Clinton – its the economy, stupid. Even the TPers appear to be a bit confused about healthcare as such – when asked they don’t show great enthusiasm for policy recision and pricing based on pre-existing conditions either.

          The worst possible outcome for the country is that the mandate goes down and the rest of the bills stands. The best possible outcome is the Republican house passes a bill thats not a total disaster and that the Democratic (probably) senate and (definitely) president can sign off on. Unfortunately the former is much more likely than the latter.Report

        • Avatar Koz in reply to Trumwill
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          “The worst possible outcome for the country is that the mandate goes down and the rest of the bills stands.”

          If I understand the way the judicial system works, that’s exactly what will happen if the individual mandate goes. Ie, the courts don’t have to strike down an entire bill if part of it is unconstitutional but they also can’t do “workaround amendments” themselves. That has to go through the legislature.

          If that does happen there will create pressure to do something. The Republicans can push for repeal, the D’s might push for something else. Whatever the D’s want the Republicans can force the D’s to reconfront every sleazy move they pulled to get the law passed in the first place.

          “No, you fucked up, you did the Cornhusker Kickback, the “executive order” on abortion, all the rest of it, for what? The whole is an abomination. Back this truck up, start all over again, and try something new about preexisting conditions if you want.”Report

        • Avatar Simon K in reply to Trumwill
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          @Koz, The trouble is if the mandate goes – either legislatively (more likely) or judicially (less likely) – the main pressure it creates is from the insurance companies who want to have a viable business come 2014. That creates a very uncomfortable position for Republican congresscritters of having to repeal the provisions of the bill that people like, which happen to be the ones that cost their insurers money – the end of recision, guaranteed issue, and community rating, all without the mandate there to prevent freeloading. The other stuff’s a meaningless sideshow – no way are they going to get away with repealing guaranteed issue by rambling about 1099s like the doofus who was on the radio this evening. My money is, unfortunately, on them taking the easy way out and creating an unfunded liability in the form of subsidies to insurers to replace the mandate. That really will be an abomination.Report

        • Avatar Trumwill in reply to Trumwill
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          @Simon, the polls very, but some still show a significant gap against. What’s noteworthy though is not the for/against gap (or lack thereof) but that the “against” doesn’t seem to climb to 50%.

          I wouldn’t understate the importance of PPACA in this midterm election, though. While the numbers on overall for/against range are often close, there is a pretty substantial enthusiasm gap (more strongly against than strongly for) and is serving as a lightning rod for why elections matter. It’s playing a pretty substantial role here. However, I would also add that because it’s playing a substantial role now does not mean that Democrats will be running scared over it in 2012. They’ll have longer to try to change the subject.Report

        • Avatar Trumwill in reply to Trumwill
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          @Koz, the problem that the Republicans are going to face is that whether the Mandate goes down or not, they’re not going to be able to repeal the whole shebang. The 10-15 Democratic votes they’re going to need aren’t going to be there. Instead, it’s going to be debating this part of it and that part of it and individual parts of it, as Simon points out, are not unpopular.

          I’ve criticized the GOP for wanting to kill the mandate without making any of the tough choices, but after a shellacking the Democrats aren’t going to want to make the tough choices again, either. I don’t think they went far enough last time in realistically addressing the non-candy parts of the bill, but PPACA as it exists now will be downright sober and adult in comparison with what comes out next time.

          The GOP, through its opposition to the mandate and with talk of “death panels” has taken any semblance of sobriety and adulthood off the table.Report

        • Avatar Simon K in reply to Trumwill
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          @Trumwill, I agree there’s an enthusiasm gap, and I’m part of it – although I support the sentiment of the bill and the overall approach is tolerable (albeit not the best – you can take the Wyden-Bennett rant as read), the details are so poor its hard to be very enthusiastic.Report

        • Avatar Koz in reply to Trumwill
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          “That creates a very uncomfortable position for Republican congresscritters of having to repeal the provisions of the bill that people like, which happen to be the ones that cost their insurers money – the end of recision, guaranteed issue, and community rating, all without the mandate there to prevent freeloading.”

          It could end up being that way but I don’t think so. There may be a constituency for dealing recissions or community rating but not a strong one in advance of the main provisions of the law coming into force.Report

        • Avatar Koz in reply to Trumwill
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          “The 10-15 Democratic votes they’re going to need aren’t going to be there.”

          I think they might be. If not, they can be replaced.Report

        • Avatar Boonton in reply to Trumwill
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          @Trumwill, The problem is that repealing the bill will not secure anything for Democrats. If Democrats go along with repealing the bill Republicans will hit them even harder, as they should. Democrats must fight to preserve the bill otherwise the Republicans will say “we told you it was the worse thing in the world” and how would Democrats argue otherwise if they themselves are helping get it repealed?

          No the bill is not going to produce horrible things and is not going to motivate a sane Democratic party to repeal it…..Report

        • Avatar Koz in reply to Trumwill
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          “The problem is that repealing the bill will not secure anything for Democrats. If Democrats go along with repealing the bill Republicans will hit them even harder, as they should.”

          Actually it might, especially for individual D officeholders who will end up making that call. I’m sure the Republicans will go after the D’s anyway, but they’re not the only variable in the equation. There’s also the D base, and, let’s not forget the voters. It stands to reason the voters will might be much more passive to punish something that could have happened as opposed to something that really did happen. Megan McArdle has written some good stuff on this if you care.Report

      • Avatar Simon K in reply to Mark Thompson
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        @Mark Thompson, Which two? I want to move to their districts so I can vote for them …Report

        • Avatar Boonton in reply to Simon K
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          @Simon K, I think we’ve seen that game more than enough times to see where it goes. It happened during the debate over the bill. Republicans say X is too extreme, too radical, will make it impossible for them to support the bill and would destroy the economy. Democrats get rid of X. Republicans say Y makes the bill too extreme, too radical, will make it impossible for them to support the bill and would destroy the economy. Democrats ditch Y, now Z is too extreme, too radical, will make it impossible for them to support the bill and would destroy the economy. And so on. You just have to ask where did single payer go, public option, public option with a trigger, etc. Now guess what, after ditching all that stuff Republicans said would blow up the world, the bill will still blow up the world!

          Isn’t it amazing that the bill never seemed to get better despite all the ‘most important things’ Republicans said were making the bill bad got dropped one by one?

          This isn’t anything new. For a generation now Republicans have been playing the ‘most liberal’ game in just about every election. Dukakis was ‘the most liberal’ Democrat. Then Bill Clinton, then Hillary, then Gore, then Hillary was ‘Lady MacBeth’ waiting to to take power….then Obama suddenly became the king of liberalism (Hillary was quickly retconned as a moderate). Crying wolf is not a viable long term strategy, whatever poll you may want to point to today.

          Now if only Democrats on an individual level or collectively help Republicans ditch the bill with no replacement things will be ok? Not at all. The Democratic base will not allow the bill to be repealed unless its being done in context of a replacement (or menu of mondifications billed as a ‘overhaul’). Considering the amount of bad faith the GOP used in the debate, the Democratic base will not assume it will be safe to count on a better health bill passing should the current one be repealed.Report

        • Avatar Simon K in reply to Simon K
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          @Boonton, I’ve noticed the same thing. It seems to be a pervasive vice of Democratic politicians. Its even more apparent in California politics – I call it “Compromising with Imaginary Republicans”. They just seem convinced that there’s some hidden cadre of policy oriented Republicans out there who actually want to solve problems and mean criticisms of Democratic policies to indicate a negotiating stance, rather than political posturing and interference.

          I really sympathize – I really wish there were such Republicans. I don’t particularly like the solutions Democrats instinctively reach for when faced with problems, and I don’t much like the interest groups they’re beholden to (give me the Koch brothers over the unions any day …). I’m a lot more comfortable with Hayek than with Keynes and with Nozick than with Rawls. Nonetheless its hard to get past the point that Democrats are actually offering solutions – not great solutions, but solutions – to real problems and Republicans are rambling on about death panels and heavily armed IRS agents and and birth certificates and Kenyan anticolonialists and black helicopters like the crazy old woman in the attic of American politics. Worse, I see nothing coming out of the Republican party that indicates that any of this will change when they take the house back – their healthcare plan was a joke, the pledge thingy is a joke. Ryan’s budget plan was deeply flawed, but even that was too much for the rest of them who promptly disassociated themselves from it.

          None of this can be meant seriously be reasonably intelligent people. They want to obtain power largely for its own sake. I get that. Its true of all political parties to some extent – especially conservative ones that aren’t particularly motivated by the desire to change things. But traditionally there is a sense of responsibility that goes along with that. Again, for conservatives in particular they’re supposed to take care of the country once they’ve obtained power over it. I see no sign of this sense of responsibility, no willingness to make hard choices of any kind.

          This is why I’m interested in the prospects of Republicans willing to look at policy seriously, even if they’re not necessarily going to what I personally would do – I feel it needs to be encouraged.Report

        • Avatar Koz in reply to Simon K
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          “The Democratic base will not allow the bill to be repealed unless….”

          The Democratic base takes a hard one in the nads, from the Democratic establishment. That’s part of the point.Report

        • Avatar Koz in reply to Simon K
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          “Nonetheless its hard to get past the point that Democrats are actually offering solutions – not great solutions, but solutions – to real problems and Republicans are rambling on about death panels and heavily armed IRS agents and…..”

          Oh bullshit. The “solutions” are bills are crap that the D’s don’t believe will solve our pressing problems as Americans understand them. Just the latest brand of big government dope they’ve been slinging.Report

        • Avatar Boonton in reply to Simon K
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          @Simon K, I wonder if you’re even familiar with the bill or could articulate an objection to it other than it being ‘big government’. Actually that’s a good illustration for why Republicans offer no solutions. “Big gov’t”, “it won’t work” etc. are good all purpose memes that can be drawn into just about any policy debate as a substitute for actually knowing anything about the policy that’s under question.Report

        • Avatar Koz in reply to Simon K
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          “I wonder if you’re even familiar with the bill or could articulate an objection to it other than it being ‘big government’.”

          Sure. Given the various iterations starting in Congress in April 2009 until the time that it finally passed, the essential political/substantive logic of health care reform became pretty clear:

          The Democrats would give the substantial latitude to the Republicans in Congress wrt program design or most second order details if the Republicans would acquiesce to the creation of a general, universal coverage, health care entitlement. The Republicans didn’t want a new general health care entitlement and didn’t take the deal. Ultimately the Democrats had enough power in Congress to get the deal done by themselves.

          Just to repeat and make clear: the biggest substantive problem with the bill was the entire bill. Ie, the GOP/mainstream conservatives/Tea Partiers don’t want a new general health care entitlement.

          What would you call that if not big government?Report

        • Avatar Simon K in reply to Simon K
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          @Koz, It doesn’t really matter to me whether the Ds see their bills as solutions. I see them as solutions – partial solutions that could use some right wing input, but solutions nonetheless. I see no solutions coming from the Republicans at all. You are to some extent (although with generally better manners) doing the same thing here the Rs are doing on the TV – repeating big government entitlement fiscal apolalypse blah blah without any evidence, without any analysis of the actual legislation, and without any acknowledgement of a real problem to solve. It just doesn’t wash with anyone who looks at these things with any education – there is no general entitlement in the bill, there’s no respectable analysis that says its the fiscal apolcalypse, and if you don’t think there’s a real underlying problem then we have a real, fundamental, ethical difference of opinion.Report

        • Avatar Koz in reply to Simon K
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          “You are to some extent (although with generally better manners) doing the same thing here the Rs are doing on the TV – repeating big government entitlement fiscal apolalypse blah blah without any evidence, without any analysis of the actual legislation, and without any acknowledgement of a real problem to solve.”

          In a certain context I agree with you. For the time that Obama has been in office, health coverage is not a problem that needed to be solved. The lack of employment and growth in the economy was clearly the most pressing concern.

          To some extent you seem to be confusing yourself wrt to the relationship between those two things. That’s the only way I can make sense of your “no analysis” business. It’s not that the health care bill is, by itself, a fiscal apocalypse. It’s the fact that it exacerbates an already intolerable problem. The previously intolerable fiscal situation, combined with the health care bill as a response to it, is a fiscal apocalypse (or more precisely an economic apocalypse). It’s difficult for me to understand how anybody could think otherwise in good faith.

          I guess most of the time it boils down to two things: 1. that the fiscal status quo is okay so we can legitimately evaluate the health care bill relative to the status quo. 2. economic health is a matter of deficits, not spending. Neither one is credible.Report

      • Avatar Koz in reply to Mark Thompson
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        First of all, the idea that opposition to the Obama bill is tepid has to be the single most false assertion regarding our political culture over the last 18 months or so. We haven’t seen the startling turnaround of the GOP and Tea Parties because of tepid opposition to Obamacare.

        As far as the rest of it goes, that’s essentially the “acquiescence” scenario the Democrats are banking on. It’s plausible, though every similar prediction in the health care debate has been wrong. My point is that scenario is less likely if the individual mandate comes down.Report

        • Avatar Boonton in reply to Koz
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          @Koz, The number of people impacted by the mandate is relatively small (and most of them want to have coverage, there’s very few libertarian types walking around wanting to pay for all medical expenses OOP)….and as has been pointed out the ‘teeth’ in the mandate are not very sharp. It’s pretty absurd to say that the mandate is some horrible imposition on the people esp. compared to, say, social security or Medicare taxes. This is a key sign of the weakness in the charge that opposition isn’t tepid. Ask yourself what does the opposition want? Why do they hate the bill. First thing you notice is you do not get consistent answers. Second thing you notice is that the answers are either contradictory (“gov’t needs to spend less so reverse Medicare cuts”) or based on misinformation that cannot survive very long as long as the bill stands as actual law instead of a hypothetical (16000 IRS agents with guns forcing you to show your insurance card, health insurance companies exploding, doctors walking off the job in mass protest etc).

          And the fact is opposition to the bill is neither focused nor strong. Again and again opposition is manufactured either by insisting on asking people black and white questions (“repeal or keep exactly as is”) or by lumping together people who cannot function together for a political cause (Tea Party types who want no health bill and left wing types who want ‘something more’). The “Repeal and Replace” mantra is a key sign of this weakness. “Replace” gives GOPers cover to not vote for repeal (“I’m voting to repeal as soon as they come up with a replacement folks”). It also provides for a rhetorical out to campaign promises to vote for repeal (a batch of minor fixes and modifications can be tagged as a ‘replacement’)Report

        • Avatar Robert Cheeks in reply to Koz
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          @Koz, I’m thinking the TPers are going to ‘take care’ of the ‘repeal and replace’ Neocon/RINO Republicans and replace them accordingly. Anecdotally, my Republican candidate running here in the very Democratic, Ohio 6th Congressional District, specifically promised my wife and I that he would vote to ‘repeal’ not ‘repeal and replace’ Obamacare. Based on that we gave him our support.
          While he’s been trailing in the polls, this week Real Clear Politics revealed that his race with commie-Dem, Charlie Wilson is a dead heat. And, in this Democratic district that’s pretty much unheard of.Report

        • Avatar Koz in reply to Koz
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          “It’s pretty absurd to say that the mandate is some horrible imposition on the people esp. compared to, say, social security or Medicare taxes. “

          There’s a lot questionable stuff here, let’s just note for starters that the individual doesn’t have to be a horrible imposition to be unconstitutional.

          Also the trajectory for the Republican response to Obamacare with a Congressional majority is not at all set in stone, ie repeal vs. incremental repeal vs. something else. Among other things see Bob Cheeks’ response above.Report

        • Avatar Boonton in reply to Koz
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          @Koz, There’s a lot questionable stuff here, let’s just note for starters that the individual doesn’t have to be a horrible imposition to be unconstitutional.

          No but it would certainly help your case that it’s unconstitutional, and your case does need help.

          Re Bob Cheecks:

          Anecdotally, my Republican candidate running here in the very Democratic, Ohio 6th Congressional District, specifically promised my wife and I that he would vote to ‘repeal’ not ‘repeal and replace’ Obamacare.

          What’s not an ancdeote is that campaign rhetoric is almost always more, umm, dramatic than post-election behavior. Rhetoric about making dramatic changes almost always ends up producing more modest changes, at best. The system is more or less design to stoke up a lot of barn burning rhetoric only to cover it in honey after election day.

          Consider the first problem with a bill to repeal the HCR law is the deficit. Since the bill is scored at cutting the deficit over the next ten years and then cutting it even more beyond that, a bill that simply repeals the law will score as costing a boat load of money which Democrats will hold Republicans to pay for after all the cries about fiscal responsibility. Many of the Medicare spending cuts are quite sensible. For example, requiring hospitals to cut preventable staph infections. Are Republicans really going to bring seniors staph infections in the name of restoring the pre-Obamacare status quo? Of course not. That provision will be kept. Once you keep some provisions you are no longer repealing the law. Once you’re not repealing the law you can rhetorically conflate any mix of modest modifications as some type of radical ‘overhaul’.

          This, of course, is not even thinking about the ads and news stories of children and families about to get kicked off of their insurance policies because their kid has some rare type of cancer or because they have the wrong genetic profile. What will happen is that Republicans will suddenly rediscover that the HCR bill is basically a Republican bill to begin with (let’s all remember, it’s basically Mitt Romney’s bill after all). Some modest fixes will be pushed and that will be retconned as some grand ‘replacement’.

          It’s basically New Coke vs Old Coke.Report

      • Avatar MFarmer in reply to Mark Thompson
        Ignored
        says:

        @Mark Thompson,
        I’ve moved past Republican alternatives. I don’t think this game will end well. My concern is a more objective concern on a deeper level. I believe America is much different than any nation which has implemented national healthcare laws, and I believe the effort will be disastrous. There is no system in place to withstand the demand, and political pressures will cause an overload. The government will have to take full control of healthcare. I had a quintuple bypass 6 years ago, and I expect to be in this system again in the next few years if my family heart history is an indicator — I don’t like my chances.Report

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