Healthcare: What Democrats Should Have Learned By Now

obama health careWhy the New Healthcare Law Should Have Been Based on Medicare (And What Democrats Should Have Learned By Now)

Two appellate judges in Atlanta — one appointed by President Bill Clinton and one by George H.W. Bush – have just decided the Constitution doesn’t allow the federal government to require individuals to buy health insurance.

The decision is a major defeat for the White House. The so-called “individual mandate” is a cornerstone of the Affordable Care Act, President Obama’s 2010 health care reform law, scheduled to go into effect in 2014.

The whole idea of the law is to pool health risks. Only if everyone buys insurance can insurers afford to cover people with preexisting conditions, or pay the costs of catastrophic diseases.

The issue is now headed for the Supreme Court (another appellate court has upheld the law’s constitutionality) where the prognosis isn’t good. The Court’s Republican-appointed majority has not exactly distinguished itself by its progressive views.

Chalk up another one for the GOP, outwitting and outflanking the President and the Democrats.

Remember the health-care debate? Congressional Republicans refused to consider a single-payer system that would automatically pool risks. They wouldn’t even consider giving people the option of buying into it.

The President and the Democrats caved, as they have on almost everything. They came up with a compromise that kept health care in the hands of private insurance companies.

The only way to spread the risk in such a system is to require everyone buy insurance.

Which is exactly what the two appellate judges in Atlanta object to. The Constitution, in their view, doesn’t allow the federal government to compel citizens to buy something. “Congress may regulate commercial actors,” they write. “But what Congress cannot do under the Commerce Clause is mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die.”

Most Americans seem to agree. According to polls, 60 percent of the public opposes the individual mandate. Many on the right believe it a threat to individual liberty. Many on the left object to being required to buy something from a private company.

Had the President and the Democrats stuck to their guns during the health-care debate and insisted on Medicare for all, or at least a public option, they wouldn’t now be facing the possible unraveling of the new health care law.

After all, Social Security and Medicare – the nation’s two most popular safety nets – require every working American to “buy” them. The purchase happens automatically in the form of a deduction from everyone’s paychecks.

But because Social Security and Medicare are government programs they don’t feel like mandatory purchases. They’re more like tax payments, which is what they are – payroll taxes.

There’s no question payroll taxes are constitutional, because there’s no doubt that the federal government can tax people in order to finance particular public benefits.

Americans don’t mind mandates in the form of payroll taxes for Social Security or Medicare. In fact, both programs are so popular even conservative Republicans were heard to shout “don’t take away my Medicare!” at rallies opposed to the new health care law.

Requiring citizens to buy something from a private company is entirely different. If Congress can require citizens to buy health insurance from the private sector, reasoned the two appellate judges in Atlanta, what’s to stop it from requiring citizens to buy anything else? If the law were to stand, “a future Congress similarly would be able to articulate a unique problem … compelling Americans to purchase a certain product from a private company.”

Other federal judges in district courts — one in Virginia and another in Florida — have struck down the law on similar grounds. They said the federal government has no more constitutional authority requiring citizens to buy insurance than requiring them to buy broccoli or asparagus. (The Florida judge referred to broccoli; the Virginia judge to asparagus.)

Social Security and Medicare aren’t broccoli or asparagus. They’re as American as hot dogs and apple pie.

The Republican strategy should now be clear: Privatize anything that might otherwise be a public program financed by tax dollars. Then argue in the courts that any mandatory purchase of it is unconstitutional because it exceeds the government’s authority. And rally the public against the requirement.

Robert ReichRemember this next time you hear Republican candidates touting Paul Ryan’s plan for turning Medicare into vouchers for seniors to buy private health insurance.

So what do Obama and the Democrats do if the individual mandate in the new health care law gets struck down by the Supreme Court?

Immediately propose what they should have proposed right from the start — universal health care based on Medicare for all, financed by payroll taxes. The public will be behind them, as will the courts.

Robert Reich
Robert Reich’s Blog


  1. Cacatua says

    It burned my fur as well when I heard that health care workers, who had plenty to say about designing a health care system, were denied a place at the table.

    I never believed in Obama. I couldn’t figure out the mania that took over, as I didn’t see anyhing that special about him, except in comparison to George Bush, and a lamp would have compared favorably to Bush. I’d rather Joe Biden were president. At least he says what he thinks about stuff. Funny how they consider that to be a “gaffe.” No wonder all you get are liars in politics.

  2. Alan8 says

    What Dick and Sharon should have learned by now: The Democrats receive the majority of their funding from corporate sources, so have a strong incentive NOT to cut into corporate profits.

    A public option (let alone single-payer) would have cut insurance-corporation profits significantly, which is why the administration made sure it wouldn’t happen.

    The public, on the other hand, would like a public option, which is why the Democrats went through the motions of appearing to be in favor of it.

    The solution is not to depend on this other corporate-funded party for our medical care, or anything else that would threaten corporate profits.

    The Green Party doesn’t accept corporate money and represents CITIZENS’ interests, like single payer health care, pulling out of the wars, slashing the military budget, and other good things.

    Voting Green Party has the added benefit of sending the Democrats a message that their business-first agenda will cost them votes. This is much better than letting the Democrats take your vote for granted.


  3. says

    Reich is generally insightful but this article misses an obviously constitutional third alternative that the med-insurance plan could all along have (and still could) follow: neither a mandate nor Medicare.

    Namely, give every income-tax-filer a refundable tax credit for expenditures – up to a reasonable standard – for certifiably insuring herself and dependents. If revenue neutrality is desired, slightly increase income tax rates to cover this.

    I don’t understand why – even if determined to avoid expanding Medicare – the Dems opted for the obviously unconstitutional must-buy mandate when this alternative would accomplish the same result and be quite constitutional.

  4. Annette says

    So what do Obama and the Democrats do if the individual mandate in the new health care law gets struck down by the Supreme Court? Immediately propose what they should have proposed right from the start — universal health care based on Medicare for all, financed by payroll taxes.

    The problem is, President Obama didn’t “cave in,” to the Republicans; he actually met with the hospital and insurance industry almost a year before he killed the public option, cutting a deal with them to kill it, but then continuing to lie to the public for months about his support for it.

    He’s actively promoting a right wing agenda that’s destroying the middle class. Our president is likely a stealth Republican, at least as far as the economy is concerned. He’s redistributing wealth from the common American to the billionaires who will fund his 2012 campaign, and most left wing voters will cluelessly vote for him again, in spite of clear evidence that he’s lying by telling us he’s on our side while marching to the tune of the billionaires who own our government.

    Obama apologists explain away every right wing policy Obama has snuck through, from the Bankster bailouts instead of homeowner support, to his “Insurance Industry Profit Protection and Enhancement Act” that forces Americans to support his industry cronies. The Bush tax breaks for the rich are now the Obama tax breaks for the super rich, especially because he snuck them through in a secret deal made just before the holidays in December 2010. Obama’s college age followers were all busy wrapping up their semesters and heading off for vacation, and now say silly things like, “He had no choice, the Republicans MADE him do it.” Wise up, youngsters. If a Republican had done what Obama did to us, we’d be in the streets fighting him. So the masters of the universe have found a more clever way to destroy the middle class – by getting us to elect a President who is actually on their side, but who the left is reticent to criticize.

    We’re running three wars, the Democrats are keeping the pot boiling against gay rights so the wingers can use that again as a fundraiser and GOTV in 2012, and now our own President are willing to destroy Social Security so the government can redirect whatever retirement savings the middle class can come up with to Wall Street instead. When will the left get wise to this guy?

    No doubt Obama will campaign again on his fake “we’re going to rescue our country” mantra, but now we know exactly who he’s beholden to – and it ain’t us little guys.

    We need to primary Obama.

Leave a Reply

Your email address will not be published. Required fields are marked *