I understand the practical necessity of the mandate in the ACA even while I am appalled Democratic leaders utterly failed to include a public option that would have and could have made the mandate palatable (i.e., if you don’t have insurance or have a waiver for purchasing insurance, you have to get it, but you can get it through this great Medicare For All Option that is affordable and easy to use because it’s got millions of members nation wide). Failing to include a publc option was foolish and short sighted. The Democratic base could be rallied to defend a public option, not so much a mandate.
That said, however, without the mandate, health care reform will bankrupt the insurance companies. Universal health care only works if everyone is in the system. Any insurance plan relies on healthy people to pay for the sick people. That’s how it works. The mandate is nothing more than a means of getting everyone into the system (I read somewhere that it will ultimately apply to about 9 million people nationwide, i.e. 3% of the population so it makes me wonder if the brouhaha over it is overblown). Anyway, one of the main arguments deployed against it is that the government shouldn’t be able to force you to buy health insurance. Since it’s already well established that the government can tax you for insurance and other benefits, the issue is that it’s forcing you to buy from private industry. Essentially the case is “If the government can force me to buy insurance, why not broccoli or running shoes or health club membership?”
Ed at Dispatches From the Culture Wars has an interesting answer. The key quotes:
The broccoli argument is like something they said when we were debating the income tax: If they can tax me, they can tax me at 100 percent! And yes, they can. But they won’t. Because you could vote them out of office. They have the power to do all sorts of ridiculous things that they won’t do because you’d vote them out of office. If they can prevent me from growing pot, can they prevent me from buying broccoli? Perhaps, but why would they if they want to be reelected? So if you ask me what the limits are, I’d say read McCulloch vs. Maryland. And reread it. And keep reading it till you understand it. The Constitution is a practical document,. it’s designed to work. And the powers are designed to be flexible in order to achieve the aims of the document.
The analogy of the power to tax is an excellent one. The fact that an exercise of government power could theoretically include some draconian policies does not mean that the government shouldn’t have that power at all. The Constitution gives Congress the power to regulate interstate commerce; one could come up with all kinds of crazy things they might do within the scope of that power, but that doesn’t mean they shouldn’t have the power in the first place.
IOW, just because they could do something doesn’t mean they will and if they go over the edge, we can vote them out of office. Ed concludes that the mandate is constitutional because health care falls clearly into interstate commerce and since its enforced through the tax code, it’s also within Congress’ power.
The ACA, for all its faults, represents an improvement over what we had before. It doesn’t go far enough, and it uses Rube Goldberg devices to accomplish its goals, but it represents a start on something we should have done years ago.