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Posted at 4:14 PM ET, 02/ 7/2011

Why do conservatives oppose the individual mandate?

By Jennifer Rubin

Greg Sargent tries to sooth nervous conservatives:

Given the uniqueness of the health care market, it seems obvious to this non-lawyer that the individual mandate doesn't set precedent for the sort of future Congressional overreach that so frightens conservatives.

This is wrong legally and wrong politically. For starters, the "everyone sooner or later" has to access the health-care insurance market argument is belied by the millions who self-insure. But more fundamentally, it is fairly easy to justify mandates in many areas. A government mandate that we all buy a new GM Volt would collectively reduce carbon emissions. Under the argument put forth by defenders of the individual mandate there would be no problem. What about a mandate that we all maintain bank accounts to provide banks with cash or that we all take out a second mortgage to stimulate economic activity?

Moreover, the legal argument is only part of the problem. The political reaction against compelled action goes to the heart of many Americans' objections to the Obama agenda. They see this as political incentive to grow the federal government ever bigger, to intrude into more areas of life and to transfer marketplace negotiations into government mandates.

And by the way, Greg may want to reconsider this assertion: "Anyone arguing at some future time that the individual mandate gives Congress precedent to cite the commerce clause in order to force you to buy broccoli, or vouchers for it, would be laughed out of court." Actually, a federal court judge in Virginia found precisely this argument compelling. And the Florida judge who ruled against the constitutionality of the health-care law was compelled by the asparagus argument. So far, judges aren't laughing.

By Jennifer Rubin  | February 7, 2011; 4:14 PM ET
Categories:  Obamacare  
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Comments

More odious than the individual mandate is the thoroughly dehumanizing rationing and control by the government of individuals' healthcare. That is EXACTLY what ObamaCare is ultimately all about. The idea that the government can outperform a free market in providing health care by realizing efficiencies of scale and innovation is more stupid than ridiculous.

Control maniac liberals love to dismiss this charge, but do so by denying the truth. This is exactly what is going on already in Oregon. If you do not think so, read the first nine paragraphs at least of this:

http://www.weeklystandard.com/articles/about-those-death-panels_536874.html

Posted by: nvjma | February 7, 2011 6:00 PM | Report abuse

is belied by the millions who self-insure

Hey,I'm self insured,but my account's a bit low right now because some of my naked short selling needs some adjustment. What,Me Worry? Until my health account gets a transfusion,if me,my wife,ten kids gets a little under the weather,Hello ER,and let some other sucker pay my bills.

Posted by: rcaruth | February 7, 2011 6:20 PM | Report abuse

Sargent's argument is basically that there's no reason to think that two-thirds of the way down the slippery slope could possibly lead to the bottom.

Posted by: mgmax | February 7, 2011 6:42 PM | Report abuse

What Greg actually said was that health care is unique because every single person will get sick at some point, and need health care.

I know Jennifer isn't stupid, so I can only guess she had a point she wanted to make, and rather than just make it, she felt her column would get more page views if she could set up her argument as a rebuttal of someone else's argument, whether they actually said what she claims they said or not.

Posted by: mustangs79 | February 7, 2011 6:43 PM | Report abuse

Millions of people self-insure? So you think that one out of a hundred or so Americans has enough money to pay for the most expensive procedure or long-term custodial care without insurance?

Posted by: barrysweezey | February 7, 2011 6:59 PM | Report abuse

Rubin is a Palin doppelganger . . . long on a political point of view, but completely lacking subject matter expertise . . . on anything.

That's the secret of her blogging success . . . burying readers with neo-conservative spin on everything under the sun a (or at least everything Obama under the sun) while knowing absolutely nothing about which she which she writes. It's a dream job . . . fact is irrelevant. It's the point of view, stupid.

Clickety-clack, don't talk back.


Posted by: russellglee | February 7, 2011 7:24 PM | Report abuse

Conservatives assert that you’re not free if the government can force you to spend the fruit of your labor on some good or service.

On another thread and in the comments here is the notion that everyone needs health insurance; that’s simply not true. Anyone may purchase health care services without benefit of insurance if their wallet has the cash; the wealthy and many young adults can finance their own medical care. Many folks have found that a health savings account for preventive care coupled with a catastrophic medical insurance policy meets their needs quite well and is much more cost-effective than a typical comprehensive health insurance policy or the coverage that ObamaCare purports to offer.

The following is not a nationwide issue, but rather applies in many states / regions where state mandates, union agreements, and employer policies have run amuck.)
The problem with comprehensive coverage is that too many folks use it, and use it, and use it because it’s free. Well, we’ve become accustomed to that and to choice to the extent that we want chiropractic and acupuncture and aroma therapy and who knows what else as part of our health coverage. Allowing the purchase of health insurance across state lines is an attempt to solve one of the real problems: state coverage mandates. Health insurance in New Joisey is more expensive than in Pennsylvania because the former requires that health insurers offer lower deductibles and a huge smorgasbord of treatments. In the Garden State consumers do not have the opportunity to purchase limited coverage that meets their needs in their stage of life. (Health insurance is quite screwed up in NJ also because most state and many municipal employees pay only a nominal amount, if anything, for full family health and dental coverage. Some of the larger private employers have, until recently, done the same.)

What about deadbeats and those suffering from chronic diseases like diabetes? What about folks with severe mental issues? These are areas where experiments at the state level can find remedies like asset seizure, insurance pools, charitable organizations, and so forth that can be employed to find the right mix. There is no universal solution: for example, ObamaCare won’t solve the deadbeat problem because the deadbeat won’t buy the insurance or pay the penalty.

Posted by: SCMike1 | February 7, 2011 8:52 PM | Report abuse

many young adults can finance their own medical care.

Until they get in a serious auto accident.

Posted by: rcaruth | February 7, 2011 8:55 PM | Report abuse

Adding to Jennifer's comment: health care is not synonymous with health insurance. Even stipulating to one of the mandate supporter's big arguments, even if everybody is in the health care market at one time or another, it is not true that everybody will be in the health insurance market. And if the government gets the power to mandate behavior (buying health insurance) that merely influences health care, why wouldn't government power extend to everything that influences or has a bearing on the cost of health care... such as eating broccoli?

Posted by: stevesturm1 | February 7, 2011 9:15 PM | Report abuse

rcaruth -
Auto insurance covers that up to the statutory / policy limits.

I agree it’s not wise for most to forego some sort of healthcare coverage, but it’s less wise to mandate coverage. The logical outcome of ObamaCare mandates is lifestyle regulation and / or exclusions for the overweight, the over-cholesteroled, those with high blood pressure, etc. Such measures would certainly be accompanied by food manufacturing / processing restrictions on “unhealthy” food. What’s unhealthy? More than just Slim Jims, chips, fried foods, and (shudder) bacon.

Entire ethnic menus will disappear, creating a black market in piroshky, sauerkraut, dumplings, spaetzle, country ham, bratwurst, and pork hocks. You want gravy? Expect to pay the equivalent of ten gallons of premium for a quart of the brown kind. Hunter sauce, hollandaise, and béarnaise will be found only in the stories of the few old folk left rocking on their front porches.

BATFE will be known as BATFEDF as “dangerous food” is added to their purview. Chris Christie will be exiled as an enemy of the state, in part for what he did to New Joisey, but mostly because of what he looks like.

Obama’s and Bloomberg’s work will be complete…

Posted by: SCMike1 | February 7, 2011 10:44 PM | Report abuse

It's highly likely that the US Supreme Court will find ObamaCare unconstitutional. That's why Obama doesn't want to expedite the appeal. But since it's already been struck down, there's no reason Congress or the states should waste any more money on implementing it.

I hope the Supreme Court will not just refuse to extend the Commerce Clause further, but will also take the opportunity to limit some of its earlier decisions. The Commerce Clause was not intended to make the Enumerated Powers Clause moot. The Congress cannot take away what remains of our liberty under the guise of regulating interstate commerce.

Posted by: eoniii | February 7, 2011 11:12 PM | Report abuse

But for many hardworking families, affordable insurance can be hard to find. The new "Wise Health Insurance" is giving you more control over your family’s health care by expanding your options for health insurance and making them more affordable.

Posted by: timoryan1 | February 8, 2011 2:11 AM | Report abuse

nvjam stated:

"More odious than the individual mandate is the thoroughly dehumanizing rationing and control by the government of individuals' healthcare"

Currently heathcare is controlled by insurance companies who deny treatments or coverage based on "pre-existing conditions". So based on the above argument nvjma must be against insurance companies rationing healthcare as well. With that said what is your answer to rationing either by "government" as you claim will happen or by the insurance companies who since there inception have been in the practice of healthcare rationing.

Posted by: JDYoung | February 8, 2011 4:24 AM | Report abuse

While I find the idea of the individual mandate odious, I completely understand the necessity of broadening the risk pool. I believe Greg’s larger point is that like it or not, unless you live in the woods outside of society, you’ll utilize the health care system and without insurance, you’ll more than likely place the financial burden on others. It is easily compared to any other of the myriad of taxes, just in a different form. Taxes have repeatedly been found constitutional and this is nothing but a tax in a different form. If it weren’t for a poisoned political process, one could change out the mandate for a tax and it would work much the same.

And while I don’t wish to pick apart your specific points, I find your assertion that millions self insure to be a little lacking. Why do they self ensure? Is it by pure examination of the risks without regard to their actual ability to pay for insurance? You might have a point, but if you can’t support it with a study that shows that millions self ensure for other reasons than the inability to pay, then your assertion is nothing more than a hopeful guess. You could claim a significant portion of the estimated 40 million Americans living below the poverty lines using this argument and while your fact would be true your narrative would be misleading. I give you more credit than that and assume you mean 20-30 year olds who can afford to pay for insurance but make the conscious choice not to. Still, how many millions are we talking about? Additionally, does the choice of a few percent of American’s (many of which will come from a very specific internal group) really reflect on the overall system?

Posted by: one_timer | February 8, 2011 7:47 AM | Report abuse

So, based on the great anti-mandate argument auto insurance...which is absolutely mandated, is infringing on my freedom, right?

It is mandated to protect yourself, but also to protect you from the...wait for it.."the un-insured".

We are all paying dearly for the uninsured now because they are not in the system. My "feedom" does not feel threatened by auto insurance.

Why don't we really "get free", let's all become hunters and gatherers...no need for taxes to pay for those pesky roads, bridges, police, fireman, airports, health and food inspectors (list of services to create an actual civilization could on on forever).

Slogans...that's all the conservatives have to offer. A healthy, educated, modern and competitive country...not so much.

Posted by: bobgormandesign | February 8, 2011 7:53 AM | Report abuse

JDYoung –

You’re getting to the flaws of the way we think about insuring health, what our system has gotten into.

Insurance is a means of pooling individual risk. If my house burns down, I can’t afford to replace it, nor can my neighbor replace his. But if he and I and all the folks in the neighborhood pool our resources through minimal monthly or annual payments, we can create a fund large enough to cover the expected rate of house fires, reducing the risk of financial ruin and homelessness to those who participate.

On a larger scale, that works for life insurance and vehicle insurance (originally designed as protection from liability for the driver’s actions; it is state-mandated for those who own or operate vehicles), but not so well for flood insurance because some areas will flood over a long enough period of time -- within a river’s flood plain or along an ocean’s coast -- making it a matter of “when” not “if.”

That does not work well for healthcare other than catastrophic events. Actuarily speaking, we can predict what care individuals will need at various points in their lives, but we can’t predict what they will want and expect and when they will want it. Health insurance companies attempt to control their costs by negotiating rates with providers, and control our expectations through deductibles and premiums. Nobody ends up being happy, with consumers feeling that they are being ripped off: they are not getting what they believe they are paying for. ObamaCare will only aggravate that issue because everybody will rightly believe that they have health insurance. Too many will incorrectly believe that it will cover them for anything all the time, and it can’t.

For people who can’t stand the thought of self-insuring for preventive care, insurers might offer different packages of coverage that meets folks’ needs during the various stages of their lives as they have done in some states. Young couples would look toward pediatric and one level of ob/gyn care, while older couples would drop pediatrics and mover toward pulmonary, cardiac, and other such coverage. In all cases they would maintain catastrophic healthcare coverage for the unexpected. That would be the cheapest insurance model, second in my mind to HAS / MSA.

Posted by: SCMike1 | February 8, 2011 8:50 AM | Report abuse

I don't see why it isn't possible to place liens on the properties of and/or attach the wages of those who "game" the system to avoid paying their medical bills. We can also bring back debtors prisons if need be.

Posted by: fbinahoy | February 8, 2011 11:22 AM | Report abuse

Note the complete absence of anything remotely resembling an argument as to why or how the Affordable Health Care Act is unconstitutional. Whether a government requirement that people buy broccoli would pass constitutional muster does not rise even to the level of a moderately interesting academic question, much less an argument that the AHCA is constitutionally infirm. Rubin is good for comic relief. That’s pretty much it.

Posted by: J_B_A | February 8, 2011 4:12 PM | Report abuse

J_B_A -
Rubin doesn't need to make the argument. Her point is that the argument has already been made and that two federal judges have already accepted it.

Posted by: fbinahoy | February 8, 2011 5:08 PM | Report abuse

fbinahoy:

Do you and Rubin trust federal judges -- representatives of the federal government -- more than your own analysis of the US Constitution? Hypocrisy abounds.

But to the point. I challenge you to post a single argument for the unconstitutionality of the Affordable Health Care Act. I guarantee and advance you will not make a serious attempt to do so.

Posted by: J_B_A | February 8, 2011 6:43 PM | Report abuse

In Jen's GM Volt example note that people who fail to puchase become free riders. They benefit from reduction in unhealthy air pollution and greenhouse gasses and the reduced reliance on foreign oil, all of the costs of which are borne by people who do puchase Volts and similar vehicles. Does this strengthen the case for the constitutionality of the puchase mandate? What about a requirement that people who fail to purchase must pay a special fee to GM to help it defray the cost of developing and selling the car? Constitutional?

Posted by: ajbarton | February 8, 2011 6:55 PM | Report abuse

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