The Telling Politics of the Individual Mandate

For some time I have been intending to write about how partisanship affects the way we think—how partisanship corrupts fair minded and sound reasoning. There is a great deal to consider on that subject. Numerous factors can be cited as contributing to the partisan divide that has increasingly afflicted our country—the hardening of ideological stances that inhibits those who get caught up in partisan thinking from being able to appreciate any merit at all in opposing points of view. I simply have not yet had the time to construct a comprehensive essay on the subject. Given the great passion that has recently ensued from the Supreme Court’s decision concerning the individual mandate included in the Affordable Care Act (“Obamacare”), however, I thought I would go ahead and write of that one example—a prime example of how partisanship distorts perception.

It is pretty widely understood that those of us who pay property taxes and who pay for our own health insurance are, in doing so, also paying for the medical care of those citizens who have no health insurance. Through our property taxes we pay to support the county hospital district that treats the uninsured for free, and hospitals tell us that much of the cost of treating the uninsured is also passed along to those individuals and insurance companies who pay for medical services. In 1989, as part of an insurance reform proposal, the Heritage Foundation (a conservative think tank) proposed a solution to what they called this “free rider” problem. Their plan, named “Assuring Affordable Health Care for All Americans,” included a suggestion to “mandate all households to obtain adequate insurance.” The proposal was fully consistent with the politically conservative principle of citizens not being imposed upon to support other citizens who can reasonably support themselves. As Mitt Romney would later describe it to reporters in 2005 when he proposed that it be enacted as law in Massachusetts, “It’s the ultimate conservative idea, which is that people have a responsibility for their own care, and that they don’t look to government … if they can afford to take care of themselves.”

After that initial 1989 call for an individual mandate, the idea then became part of a number of conservative and Republican proposals for insurance reform, including one that was developed at the request of the H.W. Bush administration in 1991, but was never acted upon. When Hillary Clinton spearheaded an effort to achieve universal healthcare coverage in 1992 and 1993, Republicans in congress responded with various alternative proposals, all of which included an individual mandate. A bill called the “Health Equity and Access Reform Today Act” was introduced in the Senate by Republican John Chafee of Rhode Island and co-sponsored by Minority Leader Bob Dole and 18 other Republican Senators. The bill called for health insurance vouchers for low-income individuals, along with a mandate that all capable individuals buy their own health insurance. As House Minority Leader at the time, Newt Gingrich strongly endorsed the mandate. Of course Gingrich has been a vocal supporter of an individual mandate until only very recently, when a run for the presidency and a new political dynamic prompted a change of heart.

Republican proposals in response to so-called “Hillarycare” were met with skepticism by Democrats. Democrats were particularly opposed to the individual mandate, which they saw as a “giveaway” to insurance companies. Rather than seriously consider the merits of the mandate and incorporate it into a bi-partisan healthcare reform effort, Democrats were evidently blinded by partisan thinking and assumed, by default, that Republicans were once again simply trying to protect the interests of big business—in this case, the insurance companies—at the expense of ordinary citizens. As a result of that partisan divide, the Clintons’ efforts to enact reform and ensure universal coverage failed.

Here’s where it begins to get interesting.

As a candidate for president in 2008, Barack Obama repeatedly denounced the individual mandate, which, by then, Hillary Clinton had adopted as a part of her campaign’s healthcare proposal. One of his campaign mailers explained, “The way Hillary Clinton’s healthcare plan covers everyone is to have the government force uninsured people to buy insurance, even if they can’t afford it. … Punishing families who can’t afford healthcare to begin with just doesn’t make sense.” As candidates usually do, Obama mischaracterized Clinton’s proposal and offered no alternative of his own that would ensure universal coverage.

By some accounts, Obama’s attitude toward an individual mandate began to change as soon as he had secured his party’s nomination for the 2008 election. In any case, he didn’t have to reverse himself publicly when reform was being crafted because all of the proposals were originating in the House and Senate. It was concluded that the mandate was an important component of any proposal that could realistically ensure universal coverage, other than a government-run single payer system. And since it was a Republican idea to begin with, it was thought that its inclusion would help to ensure Republican support for reform.

It turned out, however, that reforming our nation’s insurance and healthcare delivery systems is very complicated business, and therefore, an easy target for political posturing and propaganda. There are a number of reasons why the “Affordable Care Act” lost the support of all Republicans in Congress and perhaps a few of them are good reasons. The particulars of the legislation are far too voluminous and complicated to get into here (and they are not the point of this writing anyway). But perhaps what is most interesting, and rather telling, is how attitudes completely changed regarding the individual mandate to buy health insurance.

By the time the “Affordable Healthcare Act” or “Obamacare” was enacted, the individual mandate had evolved from a soundly conservative idea espousing personal responsibility to, in the minds of many, a typically liberal, “nanny state” idea espousing an obtrusive government and less freedom for us all. Since the healthcare law had been enacted solely by Democratic members of Congress at the urging of President Obama (which can perhaps be blamed, at least in part, on Obama and the Democrats), it became, especially for those who live exclusively in the partisan world of the FOX News culture, a clear example of a horrible abuse of power by politicians who have no regard for personal liberty and the Constitution. Since virtually every other component of “Obamacare” is rather popular among the public, the individual mandate became the primary focus of attack. When partisanship fully takes hold, simply winning for the sake of the tribe takes precedence over truth or principle.  As a result, ironically, Republicans put themselves in the position of, contrary to everything they believe, defending the right of a few citizens to sponge off of the rest of us.

That’s what partisan thinking can do.

When the Affordable care Act was enacted, President Obama and the Democrats insisted that the sanction for those who didn’t buy health insurance was a penalty, not a tax.  They didn’t want to be accused of raising taxes. They well understood that even though the penalty (or tax) would be imposed only on those who neglected to buy health insurance and would likely lower everyone’s healthcare costs, political opponents could rather easily mischaracterize it for political gain.  (They understood this because that’s the way the game is played in politics, and, make no mistake, Democrats do the very same thing all the time.)  Just as Chief Justice John Roberts aptly pointed out, however, regardless of what politicians might call it, if it looks like a duck, walks like a duck, quacks like a duck, and flies like a duck… well… it’s a tax.  After the Supreme Court’s ruling, we have seen that the Democrat’s concern was well founded.  Since, when the tribalism of partisanship takes hold, winning elections is more important than principle or sound public policy, Republicans have now accused Obama and the Democrats of perpetrating a huge tax increase on the middle class.  Naturally, we are expected to overlook the fact that the tax is imposed only on those whom the Heritage Foundation and Republicans had for many years called “free riders,” and partisans undoubtedly will.

*  *  *  *

As a side note: Since the Supreme Court has now declared that the government can penalize us for not buying health insurance, many have worried that the government can tell us anything about our personal lives—make us buy and eat broccoli, for example. Keep in mind that we still have the 14th Amendment that, according to a long line of precedents made by the Court, ensures that we have a right to privacy. The government cannot tell us to eat broccoli or how we should wear our hair because those are private matters. Whether or not we buy health insurance is not a private matter, on the other hand, because such a decision ultimately affects everybody else.

Of course eating broccoli (or green vegetables in general) is good for our health and some may argue, therefore, in the general public interest. There will always be such judgments to make. That’s why we have a Supreme Court that is, by design, insulated from partisan pressures and, at least theoretically, resistant to partisan thinking.

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