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Posted at 4:31 PM ET, 12/16/2010

What do conservatives think will happen if the individual mandate gets struck down?

By Ezra Klein

Real-life libertarian Tim Lee is confused by the arguments against the individual mandate:

There’s nothing particularly outrageous about the health care mandate. The federal government penalizes people for doing, and not doing, any number of things. I’m currently being punished by the tax code for failing to buy a mortgage, for example. I’d love it if the courts embraced a jurisprudence that placed limits on the federal government’s ability to engage in this kind of social engineering via the tax code. But no one seriously expects that to happen. The same Republican members of Congress who are applauding Hudson’s decision have shown no qualms about using the tax code for coercive purposes.

The test case for conservative seriousness about federalism was Raich v. Gonzales, the medical marijuana case. Justices Scalia and Kennedy flubbed that opportunity, ruling that a woman growing a plant in her backyard was engaging in interstate commerce and that this activity could therefore be regulated by the federal government. If Scalia and Kennedy now vote with the majority to strike down portions of ObamaCare, it will be pretty obvious that they regard federalism as little more than a flimsy pretext for invalidating statutes they don’t like. Or, worse, for giving a president they don’t like a black eye.

I take it for granted, of course, that most conservatives aren't serious about federalism, or even about the abstract issues behind the individual mandate, and that if President Romney had proposed this plan, it'd be Democrats mounting the court challenges. But here's what I would like to know: If Republicans manage to sabotage this bout of health reform, what do they think comes next? I occasionally hear people mutter something about Singapore, but Singapore relies on a compulsory national savings scheme -- that is to say, the government forces you to put away money for health-care expenses even if you don't want to do it. That's just another form of an individual mandate.

So this is a real question: What's the end game here? For liberals, it's opening Medicare up to other age groups. It's really not impossible to imagine that happening at some point in the future, and if it happens, the estimates are that Medicare will be something like 20 percent cheaper than private insurance and will drive most insurers out of business. But what do conservatives think will happen?

By Ezra Klein  | December 16, 2010; 4:31 PM ET
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Why do you think conservatives care about what happens?

What they hope for is a complete repeal of health care and then damn the consequences.

Posted by: lauren2010 | December 16, 2010 5:42 PM | Report abuse

"Conservatives" (a funny word for these people) gave up asking "and then what?" a long time ago.

Posted by: pmcgann | December 16, 2010 5:58 PM | Report abuse

More to the point, do conservatives think at all, or do they just fall in behind Mitch McConnell or Dick Armey or Rupert Murdoch or some other clown who is really just out for himself?

Posted by: Mimikatz | December 16, 2010 6:11 PM | Report abuse

"So this is a real question: What's the end game here?...But what do conservatives think will happen?"

President Obama's signature achievement will be destroyed. Republicans only care about liberty as a useful talking point. A party which is pro-liberty doesn't enact new entitlement programs, push through the PATRIOT Act, intervene in family life/death decisions, etc.

I'd imagine conservatives hope for an insurance death spiral to occur relatively quickly, with obvious government finger prints all over it. Then, you'd have widespread support for the repeal of ACA. Of course, it could easily go the other way and people will demand a Medicare-for-all type solution.

Maybe Singapore is the end game. Despite the mandate and price controls, government spending on health care in Singapore is only 0.8% of GDP, and total spending is 3.8%.

Posted by: justin84 | December 16, 2010 6:13 PM | Report abuse

"What do conservatives think..." They don't. Conservatism as it is so-called in this country today is a letal cocktail of greed and delusion. Thinking doesn't enter into it.

Posted by: jtmiller42 | December 16, 2010 6:21 PM | Report abuse

"But what do conservatives think will happen?"


Freeeeeeeeeedom!(R) is a registered trademark of the Republican National Committee. All rights reserved. Used by permission.

Posted by: davis_x_machina | December 16, 2010 6:21 PM | Report abuse

"But what do conservatives think will happen?"


Freeeeeeeeeedom!(R) is a registered trademark of the Republican National Committee. All rights reserved. Used by permission.

Posted by: davis_x_machina | December 16, 2010 6:22 PM | Report abuse

pretty sure forced savings is constitutional. that's basically what social security is. it could easily be structured as a gov't tax forcing you to put money into a health savings account, then spending it immediately as opposed to saving it like social security.

Posted by: jfcarro | December 16, 2010 6:45 PM | Report abuse

"Democrats mounting the court challenges"...that's rich. No, the Dems would gratefully take any weak-tea Romneycare they could get.

Posted by: tdub123 | December 16, 2010 7:11 PM | Report abuse

"But what do conservatives think will happen?"

Conservatives would attempt market based health insurance reform through the repeal of the employer tax exclusion for health insurance as part of a broader tax reform. Medicare/Medicaid would be transformed along the lines Ryan/Rivlin into a unified health insurance market with everyone else.

Posted by: jnc4p | December 16, 2010 7:59 PM | Report abuse

Link was messed up above:

Posted by: jnc4p | December 16, 2010 8:00 PM | Report abuse

--*[W]hat do conservatives think will happen?*--

I can't speak for conservatives, but as long as government continues to destroy the health care marketplace, and that's exactly what it has been doing for the last seventy years (Medicare, by itself, is a prime example, and will presumably survive any GOP rear action), costs will continue to rise at excessive rates, access will suffer across the board, DeathCare panels, already a reality, will become obvious, innovation and expertise will slowly grind down, and then, with all the other fronts collectivism has opened up against the people, the whole utopian, incompetent edifice will eventually collapse, leading to wide scale suffering and death. That's what your collectivism promises, Klein.

Posted by: msoja | December 16, 2010 9:22 PM | Report abuse

While I realize losing the mandate may force us into single payer, as a conservative I would much rather have single payer and not allow the federal government the power to make me buy things at will.

The logic behind the mandate is thus: If you don't buy health insurance, it makes health care more expensive nationally, which affects interstate commerce.

What would prevent a future Congress from using the same logic and applying it to cars: the more American cars bought, the better American car companies will do in R&D, making cars less expensive, which affects interstate commerce. Therefore, everyone must buy an American car.

Is there a difference here that I'm missing?

To me, the single payer issue, while huge, is much less important than this expansion of federal power.

Posted by: BradBlasiar | December 16, 2010 10:14 PM | Report abuse

Two minutes on Wikipedia should convince any Republican that while Singapore may have the second most right-wing health care system of any industrialized nation, it is still WAAAAAAYYYYY to our left.

Nearly half the hospitals are government-run! Poor people can show up and get care for a modest co-pay! People are forced to save money in a private account, everyone is covered by catastrophic insurance, and (heaven forbid) prices are regulated.

Posted by: brickcha | December 16, 2010 10:14 PM | Report abuse

They think they'll be old enough for Medicare in 20 years so they won't care anyway.

Posted by: Hopeful9 | December 16, 2010 10:36 PM | Report abuse

@Brad: You really think it would be unconstitutional for govt to put a tax on foreign goods? That's an expansion of federal government powers? All I can say is wow.

Posted by: Hopeful9 | December 16, 2010 10:40 PM | Report abuse

There simply isn't a good model for insurance after the fact, except for making those folks pay a lot more. If we lose the mandate, we need to loosen the cost differential limitations for insurance plans based on pre-existing conditions.

The good thing about Singapore is that the consumer benefits from choosing a lower cost option. Any plan that doesn't add that is missing the absolute best way to control costs.

Posted by: staticvars | December 16, 2010 11:09 PM | Report abuse

Hopeful9: Where did I say anything about taxing? You're not implying that if you weren't in the market for a car, but the government taxes Japanese cars, that this means you will then have to buy an American car, are you? Because I would have to reply the same: wow

Posted by: BradBlasiar | December 16, 2010 11:19 PM | Report abuse

Are you looking to refinance your mortgage? Best way is to contact at least three to five lenders for input on mortgage programs and rates. Also search online for "123 Mortgage Refinance" since refinanced my loan to 3.29% with my OK credit history.

Posted by: wiliamallen | December 17, 2010 12:20 AM | Report abuse

You guys should stop complaining because, one the health care we have now isnt as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price search online for "Wise Health Insurance" If you have health insurance and do not care about cost just be happy about it and trust me you are not going to loose anything!

Posted by: patewart | December 17, 2010 12:55 AM | Report abuse

We know what Republicans want as a health care "system". Alan Grayson explained it: they want sick poor people to go die and stop trying to annoy them.

Posted by: janinsanfran | December 17, 2010 2:35 AM | Report abuse

Very Interesting! I just now printed Coupons of my Favorite Brands for free from "Printapons" you can find them online.

Posted by: billiecpolk | December 17, 2010 3:47 AM | Report abuse

Conservative want to live free and die.

They also want to take the rest of us with them.

When conservative use the word "freedom" they are using the word as defined by Kris Kristofferson in his lyrics for "Me and Bobby McGee"—freedom is just another word for nothing left to lose.

Posted by: toconn2 | December 17, 2010 7:30 AM | Report abuse

to those of my conservative friends that think Singapore is an option they need to consider that the same procedures here are a LOT MORE expensive thant the same procedures there. I don't know many ordinary Americans that have a couple hundred thousand dollars lying around for when they have a heart attack or stroke. Singapore is not the answer unless it comes with a severe decrease in cost for healthcare services the likes of which the AMA would never let happen.

If they want to argue against a mandate and for other rules and regulations that get us to not have people game the system (as they do now) then fine but don't go thinking people can afford the actual cost of care out of their own pockets.

The end of the mandate with nothing in its place is the quickest way to single payer and that should (and doesn't) have conservatives concerned and should (and does) have liberals and progressives cheering to themselves.

Posted by: visionbrkr | December 17, 2010 7:50 AM | Report abuse

No one can speak for "conservatives" since they are not an organized group and they think for themselves. I can tell you what my multiple degrees, economics courses etc assure me WILL happen. If you cannot FORCE the healthy productive to support the worthless who have destroyed their health - the system WILL collapse and the worthless will die. Stated another way, the death panels will have to allocate resources.

Posted by: IQ168 | December 17, 2010 10:09 AM | Report abuse

Conservatives not only care about health care, they also care about maintaining liberty. The Progressive crowd is willing to give up their (and your)liberty for "free education", "universal health care" and "social justice." To compare the individual mandate to paying taxes is nonsense. The Constitution permits Congress to raise taxes. The President and the Dems passed the Health Care Law that calls for "penalties" which are not the same as taxes. Conservatives want the Health Care Act overturned.

Posted by: acahorvath | December 17, 2010 10:30 AM | Report abuse

--*The logic behind the mandate is thus: If you don't buy health insurance, it makes health care more expensive nationally, which affects interstate commerce.*--

I'm sorry, but that's not logic. Or economics.

The cost of fixing a broken arm is the same no matter how it is paid for, though there is some evidence that doctors charge more to insurance companies, probably to cover the costs of record keeping, etc.

What you probably are trying to suggest is that people who don't buy insurance also never pay for treatment, ie., all uninsured people are free loaders, but that is obviously false.

Further, it's my understanding that existing federal law prohibits the existence of national or regional health insurance providers (you remember the debates about allowing competition across state lines?), so it is difficult to allege that dealing with relatively small in-state companies, somehow entitles the federal government to claim interstate commerce.

Further, Wickard v. Filburn, the basis for all this nonsense, was wrongly decided, and should be revisited, and put to a long overdue death.

Posted by: msoja | December 17, 2010 11:02 AM | Report abuse

I wonder if conservatives would apply this logic to privatizing Social Security? If Social Security were no longer a tax but a mandate to buy private investments for use after 66, would that not be for them an unconstitutional forced purchase?

Posted by: erik1 | December 17, 2010 11:13 AM | Report abuse

--*I wonder if conservatives would apply this logic to privatizing Social Security?*--

People should be free to save, invest, or fritter their own money as they see fit.

In that light, a privatized (but forced) Social Security scheme would represent a freer condition than the current, entirely mandated Ponzi system, but still unjustified in terms of freedom and liberty. Under a privatized system, one would presumably be free *not* to purchase "private investments", as you put it, but merely have the designated amounts held, somewhere, until one's retirement, when one, according to additional government imposed strictures, be allowed conditional access to one's own money.

It's a great country, isn't it? Freedom and justice for all!

Posted by: msoja | December 17, 2010 12:26 PM | Report abuse

It is probably difficult to argue that the G. can force people to by a product. The issue, it seems, that this is not an independent product, but rather a ticket to other products. The point is not, as many stated, that people without insurance will never pay from their own pocket; the point is they will have the right not to: to buy insurance after they get sick or to come to a hospital for an emergency procedure and get treated regardless of the ability to pay.

To be consistent, canceling this provision would make sense if the decision not to buy insurance would mean forfeiting the right to emergency hospital care and the right to buy a policy once a pre-existing condition is discovered.

It is analogous to allowing some team members not to buy lottery tickets while continuing the practice of splitting the prize evenly.

In other words, it will lead to dismantling the whole proposed reform - perhaps, that's the plan?

Posted by: MR-CRMS | December 17, 2010 12:50 PM | Report abuse

"...The cost of fixing a broken arm is the same no matter how it is paid for, though there is some evidence that doctors charge more to insurance companies, probably to cover the costs of record keeping, etc...."

missing the point. The cost of a given procedure is the same, the doctor's fee (and set of tests and procedures administered to fix the arm) vary greatly - indeed charges submitted to ins. company in average far exceed, e.g. MC payments.

Also, uninsured people don't treat certain conditions. If this is not a necessity, it saves money. But many conditions become chronic - this costs many times more. Overall the societal cost of having millions uninsured is huge and includes (estimates vary) tens of thousand of preventable deaths

Posted by: MR-CRMS | December 17, 2010 1:04 PM | Report abuse


In your world view it might be "freer" but logic dictates it still would be unconstitutional under the anti-mandate ruling.

Posted by: erik1 | December 17, 2010 1:09 PM | Report abuse

@erik1: There are no provisions for "Social Security" in the Constitution, that I am away of, so dickering over the minutiae of the abomination is a little silly.

I thought I couched my comments with sufficient caveats, but...

Posted by: msoja | December 17, 2010 2:00 PM | Report abuse

--*Overall the societal cost of having millions uninsured is huge*--

There is no such thing as "societal cost". It's a euphemism for a wide number of alleged "costs" that looters, manipulators, and useful idiots find handy to lump into one pat phrase so that they can gesture at it and say things like "huge" and "crisis".

Medicare and Medicaid, and the thousand other dislocations piled on what was once a free market, are incurring far greater damage to the wealth and health of this country than a few people who can't pay or won't make the effort to pay their own health care bills ever will.

Posted by: msoja | December 17, 2010 2:55 PM | Report abuse

So this is a real question: What's the end game here? For liberals, it's opening Medicare up to other age groups. It's really not impossible to imagine that happening at some point in the future, and if it happens, the estimates are that Medicare will be something like 20 percent cheaper than private insurance and will drive most insurers out of business.

AGAIN EZRA you fail to FINISH the statment. Once we had a single payer and it priced itself where medicare is priced and saved that 20% how many doctors would we see no longer practicing and retire rather than give up their incomes to the government's whims? We'll already have a horrible shortage of doctors but this would cause it to be much greater.

Why not finish the thought Ezra???

Posted by: visionbrkr | December 17, 2010 3:58 PM | Report abuse

So many of the comments here fail to distinguish between health care and the health care market. The problem is the market; why on earth do we allow speculators (which is what insurance company stockholders are) to take 20% of our health care dollars in the first place? That money should be going to health care, not the market.
That's the problem: the profit that free-marketeers are trying to squeeze out of the misery of human beings; the solution is to get rid of the profit, which is the insurance companies. End of problem.
The insurance industry is what Obama was trying to protect (which is why he copied Romney's Massachusetts plan), and the teapartiers and their ilk are too stupid to realize it. The insurance companies do realize it, that's why they support the program: lots of new profit from new customers! I just wonder what they will have had to say to Mr. Cuccinelli about his great political victory, and I'll bet the insurance industry files amicus briefs in the appellate court defending the government's plan.

Posted by: rewriter | December 17, 2010 9:50 PM | Report abuse

--*why on earth do we allow speculators (which is what insurance company stockholders are) to take 20% of our health care dollars in the first place?

Because it's a free country? Or, at least, it used to be?

Originally, insurance companies provided a way to spread risk. Insurance companies could insure 100 healthy people knowing that approximately x% would break their arms, and x% would need heart transplants, etc. But then uninsured folks saw their neighbor pay $20 a month and then get the "free" heart transplant, and when they felt the chest pains thought they had a right to get $20 a month health insurance and a free heart transplant, too. And if they got their insurance by hiding their existing condition, they cost the insurer a lot of money, and everyone else's rates went up. And then the government started encouraging and helping other people get insurance on similar terms, too. Until now everyone thinks he's entitled to cheap health insurance and doesn't understand that the risk pool now includes everyone, not just the small x% of yore, whom the insurance companies have to cover.

Health insurance is no longer a matter of calculating risk and managing costs. It's become a matter of having the government decide the income and outgo of the entire health care market. And friend, central planning don't work. It can't. But that's what you're calling for, and I daresay you haven't really thought through any of the why of it.

Posted by: msoja | December 17, 2010 10:43 PM | Report abuse

Not to smart Ezra. Buying a house with a mortgage is rewarded because of the interest deduction. Its not punishment for not buying a house without a mortgage. If you pay cash there's no interest to pay so you're ahead. However, tax policy encoruaging people to engange in socilaly benefical policy takes a new meaning when the policy forces you to purchase a product just because you live. In the case of the house you can purchase a house with a mortgage and note to take advantage of a tax benefit. If not at least you still save because there is no interest to pay. Now tell me what's the option if you ddecide against mandatory health insurance. Die? Goto jail? Wait forever for your government health care, at the government run hospital? Medicare exist on vapors and is in worst shape than social security. I don't see alot of people running for Medicaid. The new health care simply extends Medicaid. Ezra are you presently running to your local county hospital for healthcare? I'm sure you are. Looking forward to Medicaid? Finally your last point makes the case here private insurers will be forced out and then who's your mama?

Posted by: Herbert1 | December 18, 2010 12:31 AM | Report abuse

The Republicans are the ultimate hypocrites! Simply put, Collapse of America!
1. How do we pay for health care reform ?
2. How do you pay for tax cuts for the wealthy ?
(a). First attempt : threatening Social Security and Medicare Cut through the deficit panel.
(b). Second attempt : holding the desperate Hostage, say, by the Ransom.
3. Auto insurance mandate !
Under historical interpretations of the Constitution, Congress can dictate the economic activity of citizens so long as that activity will have profound, large-scale effects on the national economy.
4. Simply put, Collapse of America!
** Inaction cost, $9trillion over the next decade, ((Some of CBO analysis : While the costs of the financial bailouts and economic stimulus bills are staggering, they are only a fraction of the coming costs from Social Security, Medicare, and Medicaid. Over the next decade, the Congressional Budget Office (CBO) projects that each year Medicaid will expand by 7 percent, Medicare by 6 percent, and Social Security by 5 percent. These programs face a 75-year shortfall of $43 trillion--60 times greater than the gross cost of the $700 billion TARP financial bailout)).
Over the duration of healthcare debate, using the preliminary cost analysis of CBO, the reps opposed the public option stubbornly, but after the release of final score, they have been defiant on the referee.
The nonpartisan Congressional Budget Office estimates that :
Inaction cost in relation to health care reform totals $9trillion over the next decade.
Reform will reduce the federal deficit by $143 billion over the next 10 years and as much as $1 trillion during the following decade.

Posted by: hsr06011 | December 19, 2010 9:35 PM | Report abuse

--*threatening Social Security and Medicare*--

Back in the 30s, voices of sanity cautioned against implementing Social Security. Back in the late 50s and early 60s, voices of sanity warned that Medicare would grow to become a monster, and that socialists would use the future crisis to clamor for more money from the populace, and agitate for more power over people's lives. And they were right.

And it is never going to stop (short of collapse) unless someone, somehow, stops it.

Social Security and Medicare were stupid things for the government take up. Warnings were sounded all around. It's very sad that so many people didn't heed the warnings and invested themselves so heavily in schemes that were *bound* to fail. There is nothing you can do about it. Even if you get your mandate, and every other stupid thing you wish for, the tragic end will come. It has to. You can't steal your way to utopia. You can't rip off your fellow citizens more and more and more and expect that they're eventually going to love you for it. You are not entitled to things out of other people's pockets.

Posted by: msoja | December 19, 2010 9:59 PM | Report abuse

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