Healthcare Reform

This is just the latest chapter of a long saga. Over the last twenty years, as progressives have gushed new ideas, the right has became ever more organized and mobilized in resistance — capable of executing increasingly consistent and focused attacks, moving in ever more perfect lockstep, imposing an exact discipline often extending even to the phrases and words used repeatedly by Hate Radio, Fox News, and the oped pages of The Wall Street Journal (“death tax,” “weapons of mass destruction,” “government takeover of health care.”) I saw it in 1993 and 1994 as the Clinton healthcare plan — as creatively and wildly convuluted as any policy proposal before or since — was defeated both by a Democratic majority in congress incapable of coming together around any single bill and a Republican right dedicated to Clinton’s destruction. Newt Gingrich’s subsequent “contract with America” recaptured Congress for the Republicans not because it contained a single new idea but because Republicans unflinchingly rallied around it while Democrats flailed.

You want to know why the left has ideas and the right has discipline? Because people who like ideas and dislike authority tend to identify with the Democratic left, while people who feel threatened by new ideas and more comfortable in a disciplined and ordered world tend to identify with the Republican right. Democrats and progressives let a thousand flowers bloom. Republicans and the right issue directives. This has been the yin and yang of American politics and culture. But it means that the Democratic left’s new ideas often fall victim to its own notorious lack of organization and to the right’s highly-organized fear mongering.

I suppose I’m as guilty as anyone. A few weeks ago I casually mentioned in a web conversation on Politico’s web page that if supporters of universal health care and a “public option” felt their voices were not being heard in our nation’s capital they should march on Washington. A few moments later, when someone wrote in asking when, I glanced at a calendar and in a burst of unreflective enthusiasm offered September 13. I didn’t check with anyone, didn’t strategize with progressive groups that have been working on health care for years, barely checked in with myself.

I was deluged with emails. Many people said they were planning to march. Someone put up a web page, another a Facebook page, a member of Congress announced his support. But most people said they couldn’t manage September 13. It was too soon. It conflicted with other events. It followed too closely behind a right-wing march against health care reform already scheduled for September 12. It was a day AFL leaders were out of town, so couldn’t lend their support. Many who emailed me wanted another day — September 20, or the 27th, or early October. Others said they’d rather march on their state capital, in order that local media cover it. When I finally checked in with the heads of several progressive groups and unions in Washington — all with big mailing lists and the resources to organize a big march — they said they were already planning a march, for October. But they still haven’t given me a date. (I will pass it on as soon as I hear.)

August is coming to a close, and congressional recess is about over. History is not destiny, and Democrats and progressives can yet enact meaningful health care reform — with a public option. But to do so, we’ll need to be far more disciplined about it. All of us, from Obama on down.

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 healthcare 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 healthcare in the hands of private insurance companies.

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

Remember 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 healthcare law gets struck down by the Supreme Court?

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