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Another Perspective On Health Care Mandates

Last week, as the Supreme Court heard oral arguments in the case challenging the legality of health care reform passed by the 110th Congress and signed into law by Barack Obama, most journalists have framed the associated popular debate in terms of the two dominant political parties. They report that Democratic voters support the health care reform law, saying that it makes adequate medical coverage available to all Americans by bringing healthy, low-risk people into health insurance plans while requiring the maintenance of coverage for unhealthy, high-risk people. They also report that Republican voters oppose the health care reform law, saying that it violates a constitutional right for individual Americans to decide what to buy for themselves, though nowhere in the Constitution is such a right established.

green party candidate for president 2012What the journalists almost never report is that there are other opinions, held by other voters who are neither Democrat nor Republican. One opinion that doesn’t fit into the tidy Liberals Pro vs. Conservatives Con model was recently provided by Jill Stein. Jill Stein is neither Democrat nor Republican. She’s a liberal Green, and will be the likely Green Party presidential nominee in the 2012 election.

Stein said of the health care reform law being scrutinized by the Supreme Court, “The mandate that every American buy expensive, inadequate health insurance is a scheme developed by Republicans and foisted on the nation by Democrats. The winners are the health insurance companies.”

Dr. Stein’s comment takes a route unanticipated by the standard journalistic interpretation in that it’s a rejection of the health insurance mandate from the Left. Beyond that, though, Stein suggests that mainstream journalism is inaccurate in describing a great rift between Republicans and Democrats on the issue. According to Stein, the very idea of mandated purchase of health insurance that Republicans are now railing against is something that the Republicans came up with in the first place.

Do you accept that political analysis?

8 thoughts on “Another Perspective On Health Care Mandates”

  1. Ron Tenin says:

    The insurance companies have never muttered a bad word about the Affordable Health Care Act. They have a pool of 30 to 40 million people they can sell expensive, inadequate insurance to. It’s an insurance executives wet dream.

    1. t ball says:

      Yep. Like almost every major piece of legislation over the last decade, a major industry lobby practically called the shots.

  2. Stephen Kent Gray says:

    Reason TV has been running several great series on Obamacare!

  3. Stephen Kent Gray says:

    Wikipedia summarizes it very well!

    The insurance mandate has faced opposition across the political spectrum, from left-leaning groups such as the Green Party and other advocates of single-payer healthcare to right-leaning groups such as the Heritage Foundation, FreedomWorks, and the Cato Institute as well as some members of the U.S. Senate and House of Representatives.[24][25] In the Senate Finance Committee, Republican Jim Bunning of Kentucky has called a mandate ‘un-American’ and argued that it “may even be unconstitutional”.[26]

    However, the idea has traditionally gathered support from insurance companies[18] and some politicians within the Republican Party (Charles Grassley, Mitt Romney, and the late John Chafee are examples),[24] and became part of the defeated Clinton health care plan of 1993[27][28] and Hillary Clinton’s plan in 2008.[29] Some sources trace the idea to the Heritage Foundation around 1990,[30] but the Heritage Foundation has since concluded that the mandate is unconstitutional.[31] In 2008, mandate supporter Larry Levitt, Vice President of the Kaiser Family Foundation (founded by the founder of the Kaiser Permanente HMO), stated in a Kaiser Network “interactive web show” that the mandate has been at the heart of health care reform proposals in the United States.[32] In the same Kaiser network show, Dr. Len Nichols, Director of the Health Policy Program at the New America Foundation, called an individual mandate an “absolutely necessary” pre-condition to universal health care: he stated that, without a mandate, only a maximum of about half of uninsured Americans would likely obtain coverage under any non-compulsory reform.[32] A 2008 AHIP/Kaiser forum cited Dutch and Swiss mandates (see below); AHIP’s published report does not mention penalties but says Switzerland “enforces the rules in many ways…”[33] In October 2009, Kaiser Health News reported that “the mandate has become a target for both Democrats and Republicans” and stated, “The insurance industry is clearly worried about the mandate being defanged.”[34]

    Opponents such as Michael Cannon, Director of Health Policy Studies at the Cato Institute, make a philosophical argument that people should have the right to live without government social interference as a matter of individual liberty. He has stated that federal, state, and local governments are not willing or able to raise the necessary funds to effectively subsidize people who cannot currently afford insurance. He has also stated that the costs of increasing coverage are far higher than other reforms, such as reducing the amount of errors and accidents in treatment, which would accomplish as much or more benefit to society.[32]

    Writing in the Huffington Post, Michael Moore criticized mandates as part of a “massive government bailout for the insurance industry.”[35] On FireDogLake, Jane Hamsher called it “lemon socialism.”[36] Consumer Watchdog (CWD) writes, “Requiring people to buy unaffordable and unreliable insurance policies is not the solution to the health care crisis;”[37] CWD’s John Simpson added, “Mandating that everyone must buy insurance from private companies simply guarantees huge profits for the industry.”[38] Interviewed on Democracy Now!, Ralph Nader said people are “being forced to buy junk insurance policies” and called the bill’s imminent enactment “a disaster.”[39]

    On CNN, Lou Dobbs Tonight analyzed the financial costs of an individual mandate and quoted The Politico’s Nia-Malika Henderson: “the individual mandate is really going to rub a lot of people the wrong way.”[40] Summarizing published sources of the debate from 2007 through 2009, James Joyner concluded: “Forcing Americans to buy health insurance regardless of whether they want it or can afford it is extremely controversial, with not only Republicans but most of the Democratic contenders for the presidency in 2008 opposing it.”[41]

    There is also disagreement as to whether federal mandates can be constitutional.[42] In 2010, a majority of the 50 states filed litigation contending the individual mandate is unconstitutional,[43] and newly elected Republican governors campaigned promising to add their states to the list in 2011; federal district courts have split on the constitutionality issue, which is expected ultimately to reach the Supreme Court;[44][45] also, state legislative actions may at least cause delay.[46][47] The Militia Acts of 1792, based on the Constitution’s militia clause (in addition to its affirmative authorization to raise an army and a navy), would have required every “free able-bodied white male citizen” between the ages of 18 and 45, with a few occupational exceptions, to “provide himself” a weapon and ammunition;[48] however, it was never enforced so its constitutionality was never litigated.[49] In 1994, the Congressional Budget Office issued a report describing an individual mandate as “an unprecedented form of federal action.” The agency also wrote, “The government has never required people to buy any good or service as a condition of lawful residence in the United States.”[50]

    In a September 2010 working paper,[51] a forthcoming article in the NYU Journal of Law and Liberty, and a lecture given at NYU, Randy Barnett of Georgetown University Law Center argues that the mandate is unconstitutional under the doctrine of the Commerce and Necessary and Proper Clauses, and that enforcing it is equivalent to “commandeering the people.” Penalizing inaction, he argues, is only defensible when a fundamental duty of a person has been established. He also notes that Congress fails to enforce the mandate under its taxing power because the penalty is not revenue-generating according to the Act itself.

    Public opinion polls from 2009 through 2012 continue to find that most Americans reject penalizing people for not buying health insurance.[52][53][54] In 2010, voters in at least three states enacted ballot measures to block the individual mandate, “laying the foundation for future legal challenges… Oklahoma approved an opt-out ballot initiative by a 2-to-1 margin. Proposition 106 in Arizona gained 55 percent of the vote. … Missouri voters approved a similar measure, Proposition C, with 71 percent support on a primary ballot in August.”[55] In November 2011, the issue appeared on the ballot in Ohio, where a Quinnipiac Poll of registered voters found that “when asked if they agree with a mandate that they obtain coverage or face fines, opposition jumped to 67 percent, with just 29 percent backing the mandate;”[56] subsequent reports showed 66% of voters rejected the mandate.[57]

  4. Dove says:

    Looks like we may have the joy of a Stein-Romney debate.

    1. Stephen Kent Gray says:

      Which will sadly only happen if she gets 15% or more in the polls. The 15% criterion was created to exclude popular candidates.

      Candidates that met the being on enough state ballot criteria:

      Libertarian Party: Ron Paul / Andre Marrou
      New Alliance Party: Lenora Fulani / (varying running mates)

      Libertarian Party: Andre Marrou / Nancy Lord
      Populist Party: Bo Gritz / Cy Minett
      New Alliance Party: Lenora Fuloni / Maria Munoz
      Constitution Party: Howard Philips / Albion Knight, Jr.

      Reform Party: Ross Perot / Patrick Choate
      Libertarian Party: Harry Browne / Jo Jorgensen
      Constitution Party: Howard Philips / Herbert Titus
      Natural Law Party: John Hagelin / Michael Tompkins

      Green Party: Ralph Nader / Winona LaDuke
      Reform Party: Pat Buchanan / Ezola Foster
      Libertarian Party: Harry Bowne / Art Olivier
      Constitution Party: Howard Philips / Curtis Frazier
      Natural Law Party: John Hagelin / Nat Goldhaber

      Independent: Ralph Nader / Peter Camejo
      Libertarian Party: Michael Badnarik / Richard Campagna
      Constitution Party: Michael Peroutka / Chuck Baldwin
      Green Party: David Cobb / Pat LaMarche

      Independent: Ralph Nader / Matt Gonzalez
      Libertarian Party: Bob Barr / Wayne Root
      Constitution Party: Chuck Baldwin / Darrel Castle
      Green Party: Cynthia McKinney / Rosa Clemente

    2. Stephen Kent Gray says:

      Dove, now that I’ve watched the debates, I think Carla Howell was the best debater.

      1. Stephen Kent Gray says:

        Barbara Johnson did a good job as well debating.

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