Saturday, June 30, 2012

Obamcare's Mandate as a Tax

I've written on this blog about my generally sympathetic view to the concept of requiring people to buy health insurance. For example, see this, and this. The mandate--as many of you know--was a policy creation of the conservative intelligentsia at Heritage during the healthcare debate of the 1990's, though it was then (as it is now) couched as an exercise in Congressional tax authority, and not explained as legal under the Commerce Clause. 

My sympathy for the idea is two-fold; ideological on the one hand, pragmatic on the other. 

Ideologically, the notion that the rest of us should pay for the (usually emergency room administered) health care of those Americans who do not buy health insurance who can afford it, or those who could participate in Medicaid but do not, is zany.  This is an issue of personal responsibility, and as long as we as a fee people collectively agree that no one should be turned away from emergency care, then its financing should not fall entirely upon those responsible enough to see to their own insurance.  This personal responsibility argument was at the heart of Heritage's individual mandate proposal from the start, and it was the aspect of the policy that then Governor Romney pushed hard for in Massachusetts. 

Pragmatically, we cannot as a society achieve policy goals in healthcare without paying for them.  We seem to have collectively reached a consensus around the notions of 1) ending the denial of care for pre-existing conditions 2) maximal coverage (in terms of people, not a menu of care) and 3) guaranteed access to emergency room care.  These things are expensive, and they will not pay for themselves.  In a free-market (sort of) healthcare system, a sufficient number of young and healthy people are needed in order to subsidize these policy goals.  As long as there are healthy people who could buy health insurance but choose not to--there will be insufficient money in the system to achieve the policy goals.  We either have to 1) deepen the pool through a mandate 2) eliminate the policy goals  3) adopt a single-payer system or 4) enact broad cost-containment initiatives designed to reduce the cost of insurance and make it more affordable.  Or some combination.

For my Libertarian friends, I realize the tax mandate is yet another instance of the growth of the power of the Federal Government.  But it is one that I believe achieves useful and worthy policy goals, and it is one with which I am ideologically happy.  Plus, I am not a Libertarian.

The Supreme Court's latest decision puts both parties in a bit of a bind.  Clearly, the President is confronted with a challenge on the basis of the mandate now being considered a "tax".  It will in fact, represent (along with the various other taxes in the bill) a substantial tax increase on Middle Class Americans--and as such, it is yet another broken campaign promise.

For the Republicans--the Democrats are already seizing upon the "personal responsibility" nature of the tax (mandate), referring to it throughout the blogosphere/Twitter world as "the slacker tax"--as in, it will only impact the slackers who don't buy insurance.  This is a wise move on the part of a Party for whom the notion of personal responsibility is in most other spheres, anathema.  It recaptures the original intent of Heritage's idea in a way that many Americans can find palatable.  After all, I don't have to pay the tax. Only the slackers do. 

So--Republicans now find themselves in the position of undercutting personal responsibility by crowing about the tax, and Democrats find themselves in the pickle of significantly raising taxes on the middle class.  Don't you love modern politics?

So, what to do?  (and now I am writing to my Republican friends)

1.  It's the economy, stupid.  Forget the healthcare debate as a healthcare debate.  It is now simply a part of the larger hammering away we must do on the President's stewardship of the economy.  In the depth of the worst recession in decades, the President saddled the country with a job-killing, economy dragging measure that doesn't lower anyone's costs AND enacts a huge tax increase on the middle class.

2.  Stop talking about Obamacare as a healthcare issue (see #1).  I think MOST of the Americans who need to be persuaded to vote for Mitt Romney are sick and tired of the issue and just want it to go away.  Those who will take to the ramparts are probably already in the R column in November.  Give them enough red meat to keep them happy, but FOCUS on the economy and on how Obama's policies have and will make things worse ECONOMICALLY.

3.  Don't make this into a John Roberts jihad.  We'll need him, for years to come.  His basic conservative tendencies were on display in his decision, including the very basic tendency to defer to the legislative branch on political measures. 


LL said...

Roberts pushed the issue back to the American Taxpayers by (in effect) allowing them to elect representatives who can raise or lower taxes as the public wishes.

Health care reform can be carried out much more painlessly though regulations mandating portability of coverage, finding a way to equitably handle pre-existing conditions and to open markets to competition.

One way to deal with the emergency room problem is to deal with the illegal immigration problem (not in the emergency room per se, but as a matter of national policy). It won't solve the expense, but it will eventually lower it.

If we are to fund something useful, it would be to eliminate student loans across the board for all but hard science or engineering majors and particularly people who want a career in the healthcare field. If you want to major in social studies or liberal arts, you are free to do that, but at your own expense.

Anonymous said...

Chief Justice Roberts May Be A Genius
Before you look to do harm to Chief Justice Roberts or his family, it’s important that you think carefully about the meaning – the true nature — of his ruling on Obama-care. The Left will shout that they won, that Obama-care was upheld and all the rest. Let them.
It will be a short-lived celebration.
Here’s what really occurred — payback. Yes, payback for Obama’s numerous, ill-advised and childish insults directed toward SCOTUS.
Chief Justice Roberts actually ruled the mandate, relative to the commerce clause, was unconstitutional. That’s how the Democrats got Obama-care going in the first place. This is critical. His ruling means Congress can’t compel American citizens to purchase anything. Ever. The notion is now officially and forever, unconstitutional. As it should be.
Next, he stated that, because Congress doesn’t have the ability to mandate, it must, to fund Obama-care, rely on its power to tax. Therefore, the mechanism that funds Obama-care is a tax. This is also critical. Recall back during the initial Obama-care battles, the Democrats called it a penalty, Republicans called it a tax. Democrats consistently soft sold it as a penalty. It went to vote as a penalty. Obama declared endlessly, that it was not a tax, it was a penalty. But when the Democrats argued in front of the Supreme Court, they said ‘hey, a penalty or a tax, either way’. So, Roberts gave them a tax. It is now the official law of the land — beyond word-play and silly shenanigans. Obama-care is funded by tax dollars. Democrats now must defend a tax increase to justify the Obama-care law.
Finally, he struck down as unconstitutional, the Obama-care idea that the federal government can bully states into complying by yanking their existing medicaid funding. Liberals, through Obama-care, basically said to the states — ‘comply with Obama-care or we will stop existing funding.’ Roberts ruled that is a no-no. If a state takes the money, fine, the Feds can tell the state how to run a program, but if the state refuses money, the federal government can’t penalize the state by yanking other funding. Therefore, a state can decline to participate in Obama-care without penalty. This is obviously a serious problem. Are we going to have 10, 12, 25 states not participating in “national” health-care? Suddenly, it’s not national, is it?
Ultimately, Roberts supported states rights by limiting the federal government’s coercive abilities. He ruled that the government can not force the people to purchase products or services under the commerce clause and he forced liberals to have to come clean and admit that Obama-care is funded by tax increases.
Although he didn’t guarantee Romney a win, he certainly did more than his part and should be applauded.
And he did this without creating a civil war or having bricks thrown through his windshield. Oh, and he’ll be home in time for dinner.

Mudge said...

LL - I like the targeted student loans. Of course, prepare yourself now for new curricula such as "women's studies science" and "social justice science" and "transgender activism science.". That is, of course after a year's worth of liberal whining about how the LL Student Loan program is killing the arts. That alone is worth moving ahead with the plan.

Newer Post Older Post Home