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NationofChange / Op-Ed
Published: Sunday 25 March 2012
The most compelling sentences in the Obama administration’s brief defending the constitutionality of the health-care law come early on.
116 Billion Reasons to be for the Individual Mandate
The most compelling sentences in the Obama administration’s brief defending the constitutionality of the health-care law come early on. “As a class,” the brief advises on Page 7, “the uninsured consumed $116 billion of health-care services in 2008.”
On the next page, the brief drives the point home: “In 2008, people without insurance did not pay for 63 percent of their health-care costs.”
Those figures amount to a powerful refutation of the argument that the individual mandate — the requirement that individuals obtain insurance or pay a penalty — exceeds the government’s authority to regulate interstate commerce. To me, $116 billion seems like a whole lot of commerce.
But let’s leave the Supreme Court justices to hack their way through the underbrush of the Commerce Clause. Because those numbers are not only relevant to Commerce Clause jurisprudence, they illuminate the fundamental irrationality of public opposition to the individual mandate.
The mandate is by far the most unpopular feature of a law on which Americans are otherwise evenly divided. A Kaiser Family Foundation poll this month found that two-thirds of those surveyed disliked the mandate. Even among Democrats, a majority (53 percent) opposed the requirement; independents (66 percent) and Republicans (77 percent) were even more hostile.
Yet this is a provision that the overwhelming majority — those with insurance — should support, for the simple reason that these people currently end up footing the bill for much of that $116 billion.
As the government’s brief notes, “Congress found that this cost-shifting increases the average premium for insured families by more than $1,000 per year.”
In other words, those worried about having to pay ever-higher premiums should be clamoring for the individual mandate, not agitating for repeal.
Indeed, for all the bristling over the mandate, it will be irrelevant to the 80 percent of non-elderly Americans who already have insurance, either through their employers, government programs, or purchased on their own.
The biggest real-world risk to these people would be if the court were to overturn the mandate yet allow the rest of the health-care law to remain in place, driving premiums ever upward.
Amazingly, Republicans have managed to transform the mandate from an exemplar of personal responsibility into the biggest public policy bogeyman of all time.
The irony of the fight over the mandate is that President Obama was against it before he was for it. During the 2008 campaign, one of the signature differences between Obama and Hillary Clinton was that Clinton’s health plan included an individual mandate whereas Obama’s mandate covered only children.
Once elected, Obama quickly recognized the inescapable truth: An individual mandate was essential to make the plan work. Without that larger pool of premium-payers, there is no feasible way to require insurance companies to cover all applicants and charge the same amount, regardless of their heath status.
In part, hostility to the mandate reflects a broader uneasiness with the perceived encroachment of big government.
In the Kaiser poll, 30 percent of those who opposed the mandate cited government overreach as the biggest reason. Not surprisingly, twice as many Republicans (40 percent) cited that reason as did Democrats (18 percent).
But opposition to the mandate also stems from the public’s failure to understand — or, alternatively, the administration’s failure to communicate — basic facts.
For example, Kaiser found that when people were told that most Americans “would automatically satisfy the requirement because they already have coverage through their employers,” favorability toward the mandate nearly doubled, to 61 percent.
Favorable attitudes rose to nearly half when people were told that without the mandate, insurance companies would still be allowed to deny coverage to those who are sick; that without the mandate people would wait until they were sick to purchase insurance, driving up premium costs; or that those unable to afford coverage are exempt.
“People don’t understand how the mandate works at all and they don’t understand why it’s there,” Kaiser’s polling director, Mollyann Brodie, told me.
Brodie suspects that it’s too late to change minds. “This law as a whole has really become a symbolic issue to people and they really aren’t open to information,” she said.
Maybe, but the administration must keep trying — not only to sell the law’s goodies but also to explain how the mandate makes them possible. Otherwise, they could end up winning the minds of the justices, yet losing the hearts of the people whose votes they need to keep the law in place.
© , Washington Post Writers Group
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ABOUT Ruth Marcus
Ruth Marcus is a columnist and editorial writer for The Post, specializing in American politics and domestic policy. Marcus has been with The Post since 1984. She joined the national staff in 1986, covering campaign finance, the Justice Department, the Supreme Court and the White House. From 1999 through 2002, she served as deputy national editor, supervising reporters who covered money and politics, Congress, the Supreme Court, and other national issues. She joined the editorial board in 2003 and began writing a regular column in 2006. A graduate of Yale College and Harvard Law School, she was a finalist for the Pulitzer Prize for Commentary in 2007. She lives in Maryland with her husband, Jon Leibowitx, their two daughters, and the world’s cutest dog.
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By Richard (RJ) Eskow
10 comments on "116 Billion Reasons to be for the Individual Mandate"
March 25, 2012 11:37pm
Okay mr. cudspan the article isnt wrong headed when you consider that health care is one of the most expensive necessities in life. Every year the increase is 200% The u.s. has the worst outcome out of all the countries who have single payer sytem.
Mr. cudspan you are already paying through the nose for those uninsured every time your insurance raises. It doesnt matter if you get sick or develop a chronic illness.
It is like car insurance. If you go on vacation to another state you have to have car insurance. That is interstate commerce. How do you figure that driving is a privilege that the state can take away? How do you explain drunk drivers then that end up with 12 revocations on their licenses and still get another one? Now with texting and cell phone usage there are people driving into buildings because they are texting and using their cellphones.
I worked as a nurse in the operating room for 17 years until a driver hit me while I was crossing the street in 1995. He was high on PCP and drunk. I already had an associates' degree. I had multiple injuries and HE HAD NO INSUANCE NO DRIVER'S LICENSE. I GET NOTHING UNTIL I AM 59 1/2 YEARS OLD. I worked another ten years after breaking two plates in tibial plateau left leg. I sustained a TBI, PTSD and two total knees which I had at 42. I have had 26 surgeries to date. I finally had to apply for SSD. I tried to get a job less physical (at the time of applying for SSD I was making 25 bucks and hr. top of the chart and would get no more raises)and I finished my bachelor degree.
I also got no extra money for getting my BSN. I attempted to go to get a masters' but had trouble with memory for the exams. When I was on COBRA is when I had to have my surgeries. The plates they put in was defective steel. I was not obese or overweight. I had scrubbed on pts that were five hundred pounds. Plates are supposed to be able to bend. Synthes plates have a plate bender in the set when we do the surgery. When my dad heard(he worked in the steel mill in buffalo, NY all his life and he poured liquid steel)he said they didnt cool the steel correctly. If it is cooled too quickly it becomes brittle.
I tried to sue for the plates but was told I would have had to hire a metallurgist and no atty. would take the case. It comes down to health care organizations being corporations now. The CEO'S are the ones making the bucks. Nurses certainly dont make the money. I have been a nurse for over 20 years now.
I still keep my license active due to the fact that I worked too hard for that six years for me to give that license away. I just cant get myself to do that.
So every two years I renew my license. I have seen some of the doctors work until 70 years of age. I worked with an ortopedic surgeon at 70 who used to put in austin moore prosthesis in backwards into the femur. When that happened the femur would split and we would have to call one of his partners in to fix it.
Finally, one sat morning on call(after our hospital became a level one trauma center)the surgeon did it again. Split the femur. then the nurse who worked on weekends in house stole the xrays from the room. She went to the surgeon who was head of surgery that year(they rotated that position)to give him the xrays and asked him to do something. The man who kept putting them in that way didnt LEAVE FOR ANOTHER YEAR.
There are many things that are wrong with the health care system. It starts with the insurance companies not wanting to cover sick people. I know have developed thyroid disease since I have moved back to NY state. Medicare which I am now(being that I paid into it since I was 16 years old with my first job)being covered with wont recommend to have the nodules since they are "hot" not "cold" or cancerous. At least now they are not.
Along with the nodules I now have HAs, high cholesterol and need disc replacement in my back. Along with insurance companies not covering people who have disorders is the hospitals having to use agency nurses who are given 40 bucks an hour. That is because no one is going into nursing. Nursing instructors are retiring and dying. When I left in 2005 the average of a nurse on the floor was 45 now it is 50 to 55.
Many nurses left the year I left going into health care informatics since there is more money and less physical work. Most of the hospitals across the country are corporations, very, very large corporations. The one I was at had 20 hospitals in its network.
Then there is the problem with implants in this country not having to be approved by the FDA as with drugs. J&J who developed a new total hip around two years ago have had to take it off the market. They have had to put in a different hip and pay for it themselves. It was made out of cobalt and that would rub off the patient and it poisoned them. Yes, you say dont sue but then what happens to those people who are younger(as I was when I had my total joints)and cant work after the surgery and then have to have it done again.
Of course, Johnson and johnson had to recall lots of over the counter meds also. Tylenol, childrens tylenol among others. You know who owns j&j-the man who owns the NY Jets. He cut off his daugher who had type 1 diabetes and she died in her swimming pool. She died at 25.
The U.S. has no database like australia does for medical implants. That is wrong and should be changed. I cannot believe that something they put inside a persons' body does not have to be approved before coming into the public. I learned that in nursing school. This issue is not so cut and dried. Do some research before you say with this mandate you will be paying for parasites. You are already paying for every person who comes into the ER without insurance.
Dont say they are undocumented workers either. I never encountered any in my nursing career in the ER or the operating room.
Jellog did yoi even read the article?
March 26, 2012 3:58am
Jellogg, I wish they would have consulted someone like you when they "crafted" the Affordable Care Act.
Instead they relied on the insurance industry and the for-profit health care industry to direct and create the bill.
We must remove the profit incentive from the health care equation before we can correct the problems.
March 25, 2012 5:24pm
Cudspan is forgetting how we got here. The original plan proposed by the Obama administration included the "public option". The GOP in Congress refused to go along with that. The only way that a health reform bill would get passed was if the public option was omitted. So that's why we wound up with the mandate. Of course, some of us argue that had Obama started with a proposal for a single payer/Medicare for all plan he might then have been able to settle for one with the public option. We'll never know, but it's a thought. It is also true that whatever Obama had proposed the GOP would have rejected out of hand. At least the plan settled upon has a very reasonable chance of success. Look to Mass. for results. Ooops! sorry Mitt.
March 25, 2012 2:24pm
No matter what kind of system is instituted, single payer, Medicare for all, or a public option, some form of mandate (either in the form of premiums or taxes) is absolutely necessary to make the health care system work. Otherwise, as they do now, the young, the self-employed and others will continue to refuse to buy insurance and the $116 billion dollar bill will be paid by the rest of us. That's neither fair nor responsible, and in fact it constitutes one of those "moral hazards" the Right always rails against.
March 26, 2012 4:15am
"What we have here is a failure to communicate."
Considering how articulate this president is, especially compared to his predecessor, it is downright weird that he has not done a better job explaining the attributes of the Affordable Care Act.
And it isn't only in the area of health care reform. The president has allowed the Republicans to frame every argument. Hell, he even appeared on Fox "News" lending credence to a pure right wing propaganda source as if they were valid.
I remain VERY suspicious of Obama.
March 26, 2012 4:04am
I wouldn't object to the mandate if much of the premium was not going to provide profit for the big care corporations and the insurance industry. These corporate profits are nothing more than parasitic, they do nothing to serve the patient interest.
I do not care if the insurance industry is 16% of the economy. Wall Street had no qualms in dismantling manufacturing that actually served a vital purpose in the nation.
March 25, 2012 1:27pm
I like Cudspan's argument. I agree that the automobile insurance case is different from the individual mandate case. My only reservation is with the line "Living in the US is not a privilege, it's a right for every US citizen." My understanding of the "Obama" health plan is not that one would lose one's citizenship upon refusing to participate, but that one would incur a fine. The "good" afforded by the auto insurance law is the privilege of driving on publicly constructed and maintained roads. Wouldn't the good afforded by the individual mandate be health care (not citizenship)?
March 25, 2012 11:34am
The mandate is fair if the product you are being required to reasonably priced. My wife with her pre-existing condition can now buy insurance in Oregon. The premiums will we 27% of our monthly income.
March 25, 2012 11:26am
This article is dangerously wrong-headed. The individual mandate only makes sense if you insist that insurance companies maintain their strangle-hold on health care. But that's not the only alternative -- it's just the only alternative Obama settled on. Remember when he said he would not sign a bill that didn't include a public option? What happened to that?The Obama health care plan is an unprecedented giveaway to the health insurance industry. And the individual mandate is how it works. The individual mandate forces me to give money to a business that I consider wrong, parasitic, and inefficient. Arguments that compare this to auto insurance mandates are comparing apples to oranges. Driving a car is a privilege the state can grant or take away. To earn that privilege, you must have insurance. Living in the US is not a privilege, it's a right for every US citizen. Yet now I must pay money to a parasitic industry in order to maintain that right.This health care law IS unconstitutional. But it could be made constitutional in a simple stroke. Institute a public option -- then I can choose to fund insurance companies, or to fund a public health plan. But at least I can CHOOSE. Without the public option, I cannot support this law.