The Court and the Mandate: Let the 'Left' Be Left Again

It would be seen as a sign of strength if the President announced that, no matter what the Supreme Court decides, he intends to make sure that health insurance companies don't get a free ride in this country.
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The world's been turned upside down by the Supreme Court hearings on the individual insurance mandate. Left is right, right is wrong, and the future is uncertain. There are only two approaches to health care that we know are constitutional: a European-style 'socialized medicine' system, or the old system of uninsured people dying in the streets.


Conservatives are viciously attacking an idea developed in right-wing think tanks like the Heritage Foundation as an alternative to the Clintons' health reform. That means that, by their own framing, the right is now fighting for the "freeloaders" who don't "take responsibility" for their health costs. That's what you get when a Democratic President tries to compromise with the Right -- Republicans attacking one of their own ideas as "socialism."

It's just as off-kilter on the other side of the aisle. Democrats and some of their liberal supporters are vehemently defending a law that forces Americans to buy insurance from private insurance companies -- companies whose hikes of as much as 24 percent were just ruled "excessive" in nine states -- for coverage so weak that enrollees can still be driven into bankruptcy by medical expenses.

The "left" solution involves forcing people to pay inflated premiums to private corporations, while the "right" is rejecting its own proposal. Who's on first?

Letting 'Left' Be Left

There's a simple solution, however -- one that lets Democrats return to their party's traditional values. Remember, none of the Democratic Party's great accomplishments relied on for-profit corporations. Social Security didn't force people to buy retirement packages from Wall Street banks, and Medicare wasn't created by mandating that old people pay large premiums to for-profit carriers.

Great Democrats of the past understood that government does some things better than the private sector. The Democratic Party can get out in front of this Supreme Court fight the old-fashioned way: by being Democrats.

Robert Reich has pointed out that Democrats could perform a kind of "health-care jujitsu" by saying that the only legal option that's left is Medicare-For-All. That's one approach. Another would be to keep everything in the Patient Protection and Affordability Care Act that limits health premium and restricts health insurance companies' ability to reject people for pre-existing conditions -- but without the mandate.

Whose Problem?

But wait, some health economists will say. That will make insurance unaffordable, because healthy people won't sign up for health insurance and insurance companies will be left with a costlier pool of enrollees. It will be almost impossible for insurers to make a profit. To which the proper response is: Whose problem is that?

If insurance companies can't make a buck that way, let them lobby for an individual mandate, instead of giving them what they want for free as the current bill does. Or let them step aside and admit they can't do the job.

That would put Democrats on the popular side of this issue once again -- fighting for the people against the insurance companies, instead of the other way around. It would re-open the debate and open the door to much better approaches -- from a public option all the way to Medicare For All.

Where Left Went Wrong (or "Right")

The world would make sense again. Right would be Right and Left would be Left -- something we haven't on this issue since Hillary Clinton and John Edwards introduced mandates into the Democratic primaries of 2008 by employing the right-wing frame of "individual responsibility." Back then, too many self-described liberals cheered them for it and attacked Obama for initially resisting it. Without that primary debate we might not be in this mess today.

Back then we tried pointing out that the Clinton/Edwards/Heritage Foundation approach would not provide "universal coverage" and was un-progressive (see also, "How Progressive Groupthink Hindered Health Reform"), that RomneyCare in Massachusetts was not working as well as advertised, and that the individual mandate would be onerous for middle-class families without some sort of public alternative.

Those who said that Romneycare's alleged popularity in Massachusetts proved that mandates were a political winner weren't diving deeply enough into the polling data. The loss of Ted Kennedy's Senate seat was due partly to those who opposed the health care law and partly to those who felt it didn't go far enough -- especially by encouraging a more Medicare-like approach for everyone.

Those were the political warning signs of things to come.

A Second Chance

But this bill's Republican opponents have given Democrats another chance. The White House shouldn't wait for the Supreme Court's decision. It should take a public position immediately, saying that individual mandates were only offered to appease the right and that it's willing to remove them immediately.

It would be seen as a sign of strength if the President announced that, no matter what the Supreme Court decides, he intends to make sure that health insurance companies don't get a free ride in this country. Mandate or no mandate, he expects them to hold their premiums down or be investigated by all appropriate government agencies. And he should add that, mandate or no mandate, the days when people could be refused coverage for pre-existing conditions are gone and will never come back.

If he does that, he won't have to fight for his bill. The corporate political lobby will pull whatever strings are necessary to protect his law. And if they don't he'll have the opportunity to fight on the populist side of this issue, rather than defending for-profit corporations in an election year.

In the end the health insurers will fail anyway. They've proven they can't offer real health coverage at an affordable price. This would put the Left on the right side -- of history. There would be a side benefit, too: When it comes to health care, liberals will be able to act like liberals again and Democrats could return to their party's traditions -- and its strengths.

Richard (RJ) Eskow, a consultant and writer (and former insurance/finance executive), is a Senior Fellow with the Campaign for America's Future and the host of The Breakdown, which is broadast on WeAct Radio, AM 1480 in Washington DC

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