Since the subject is pretty much the only thing people in the political world are talking about today, I thought it would be a good time to re-run the following column, which originally appeared here September 21, 2010. You might also find interesting another article I wrote, on Mitt Romney and the politics of health care in April of 2011, since it was fairly prescient as to the arc of Romney's campaigning on the issue. I offer up both in case anyone needs a break from Supreme Court transcripts today.
Howard Dean is (as he is often wont to do) making all kinds of sense on healthcare reform today. His idea is to jettison the "individual mandate" part of the healthcare reform law passed this year. And he's right, on both political and practical grounds.
The individual mandate is the least-liked part of healthcare reform. It really has no natural constituency other than insurance companies. There was no call from the public to include this in the final law (as there was with the "public option," in comparison). The Left wasn't in favor of it, and it causes apoplexy over on the Right. President Obama did not campaign on the individual mandate (although Hillary Clinton did, I should point out), so he obviously didn't think it was all that important (or all that good an idea, take your choice) before he got elected. Since the mandate appeared, very few people have bothered defending it in public. Its appearance in the debate was obviously a direct result of demands from the health insurance industry, who will be the obvious beneficiary of the plan.
But, as Howard Dean points out, healthcare reform can succeed without it. Which means there shouldn't be anything standing in the way of throwing the whole idea of the mandate under the political bus, so to speak. Or, since the Tea Partiers hate it too, perhaps "throw it overboard" would be a better metaphor.
Personally, I've never been a big fan of the mandate, although it likely wouldn't affect me in the near future. The idea of paying a fine, or extra taxes, because you can't afford health insurance doesn't exactly have a whole lot of support from anyone these days (again, other than insurance companies). In fact, several states are currently suing the federal government over the constitutionality of the law. The mandate was even put to a popular vote during the primary season, and it lost in a big way (around 70/30). Which means repealing it would be wildly popular, for either political party. Right now, Republicans are drooling at the chance of doing so, but that shouldn't stop Democrats from joining the effort. It's a little late for them to be "leading" the effort, but such a repeal would likely have wide and bipartisan support, so politicians of either stripe could benefit in the end.
Now, the mandate isn't slated to go into effect for another few years. Repealing it would have no immediate impact on the status of health insurance. It would impact the future projections of healthcare, but the only ones who would be screaming about this would be, once again, the insurance companies. But, this time around, they're not going to find a whole lot of politicians willing to champion their position. Especially since the push to repeal it is coming from the Right in the first place. Republicans would be faced with the choice of parroting the insurers' talking points and carrying the legislative water for the industry (as they did in the whole healthcare reform battle over the past year and a half) -- or jumping on the "Repeal!" bandwagon wholeheartedly. This seems to be a no-brainer for them, since a large segment of the folks advocating repealing the mandate are from the Republican rank and file. And Republicans have already burned their fingers on a few hot teakettles this election season, meaning they would likely be very wary of siding with the insurers against their own political base's voters.
Democrats should also realize that defending the mandate is a losing battle for them as well. The mandate, as I said, is the least popular part of the healthcare law they managed to pass. It is the biggest target for those who are against the new law. But while Republicans seem to be dedicated to repealing the entire healthcare reform law (either as a whole, or bit by bit), Democrats could yank the rug out from under the GOP by getting rid of what is seen as the worst part of it, pre-emptively.
The other parts of the new law are a lot less contentious, and benefit families directly. By removing the mandate as the focal point of the opposition, it would force them to attack the other parts of the law instead. And while the Republicans have been making lots of political hay over the mandate issue, it's going to be a lot harder for them to do so on the issues of, for example, getting rid of the concept of pre-existing conditions or letting children stay on their parents' policy until they're 26. Neither of these has been put to a popular vote anywhere yet, but I would be willing to bet that they're a lot more popular with the public than the mandate.
Getting rid of the mandate would remove it as an issue from the debate. It would end the ongoing court cases. It would end the talk of constitutionality by healthcare reform critics. It would focus the debate on the parts of the new law that are much more popular. And even Howard Dean is now arguing that doing away with the mandate doesn't mean the rest of the law won't be successful. The insurance companies would howl, but this time their legislative lapdogs on the Right will be much more concerned with saving their own political skins than with placating the insurers.
Of course, repealing the mandate is not going to happen before the midterm elections. The legislative calendar is just too short. It might be brought up as an issue in the political arena before the elections, but it isn't going to make any legislative progress until afterwards. Democrats might not be inclined to vote for repeal in the next Congress, because the effort will be seen as a Republican one, and Democrats would likely not be happy about "giving the Republicans a political victory." Also, there is the bunker mentality which says the issue is the start of a slippery slope of repealing the entire healthcare law. Democrats may adopt a "circle the wagons" defense of the whole bill, and fight the repeal of the mandate tooth and nail. This would be a mistake, as I see it.
President Obama would also face a choice, if Congress passed a mandate repeal and put it on his desk. No matter what happens in the midterms (no matter which party holds which houses, in other words), he's still going to have enough Democrats in both houses to sustain his vetoes. Meaning he could fight hard for the mandate, and veto any repeal which crosses his desk. This would also be a mistake, as I see it.
Of course, Obama and the rest of the Democrats would have to eat a little political crow during the repeal effort. They'd have to essentially admit "we were wrong about this part," which is never easy for a politician to do. But, in the end, they would benefit politically by going along with the Republicans on a limited basis -- repealing the mandate, not repealing the entire law. Man the barricades and fight for the rest of it, in other words, but dump the mandate part with grace.
No one issue in the healthcare law which actually exists in reality (unlike, say, "death panels") has galvanized the opposition to such a degree. And this opposition is winning the argument in the public arena. The individual mandate has no natural constituency behind it other than the insurance companies themselves. Outside the Beltway, Republicans hate it, independents don't like it, and (at best) Democrats are lukewarm on it. Getting rid of the mandate won't kill the entire healthcare reform law. I hate to say it, but the Right is right on this issue. Jettisoning the mandate is a good idea politically, and the Democrats should realize it and get behind it themselves. It removes a potent issue from the political debate (and from the courts), leaving behind much better issues for Democrats to draw lines in the sand on (again, like eliminating "pre-existing conditions"). Democrats have a choice -- they can either throw their support behind the issue, or wait until after the elections and watch the Republicans talk about it for approximately the next six or seven months, before they repeal it without Democratic help. Getting on board sooner is the smart thing to do in this case.
-- Chris Weigant
Follow Chris on Twitter: @ChrisWeigant