It’s June, and the heart of ObamaCare, the individual mandate, has just been struck down by the Supreme Court in a 5-4 vote.
In discussions today, the justices will hear debate about whether they can kill the mandate and leave the rest of the legislation intact, or whether the entire structure comes tumbling down without the mandate.
That legal debate aside, as a practical matter I think it’s clear that without the mandate, insurance companies cannot be required to cover pre-existing conditions, which goes to the heart of what health-insurance reform is supposed to achieve.
If individuals can go without insurance as long as they’re healthy, then force the insurance companies to cover them when they get ill, the whole concept of insurance goes out the window. It is no longer sustainable. That’s precisely why the Heritage Foundation, Newt Gingrich and Mitt Romney, among others, embraced and pushed the mandate approach.
So again, what happens if the mandate disappears?
In the two years since ObamaCare was signed into law, congressional Republicans have campaigned on a policy of “repeal and replace.” In truth, they have made no real attempt to do either.
If the court rules against ObamaCare, of course, “repeal” becomes moot and attention turns to the “replace” part of the problem. Replace it with what?
As I’ve noted before, when I had the chance to discuss the issue with Senate Majority Leader Mitch McConnell and Sen. Saxby Chambliss of Georgia, neither could offer even the slightest idea for how to solve the problem without a mandate. That is also true for the Republican Party as a whole.
What little thinking they’ve done on the issue seems to coalesce around the idea that the problem in health care is third-party insurance, whether acquired through private companies or through the government. The philosophy seems to be that if people are forced to pay out of their own pockets for health care, instead of relying on other parties to pay for it, market forces will once again come into play and the health-care market will begin to behave more like the market for wheat or automobiles.
Theoretically, it makes sense. But people don’t live theoretically. Theory doesn’t explain how a family can pay for one child’s apendectomy and another child’s broken leg out of its own resources. It doesn’t explain how an elderly couple on a fixed income can pay for their medicine and doctor visits. Pristine economic models don’t begin to get us where we need to be.
If ObamaCare is overturned, the fundamental questions that we were all asking three or four years ago will once again come to the forefront:
Is health care a human right, or can it be denied to those who are unable to pay for it? If you want to bring market forces to bear on the problem, you pretty much have to take the second approach. But so far we have been unwilling to embrace it. The Reagan-era law requiring emergency rooms to treat patients regardless of ability to pay still stands as de facto acceptance that health care is a right.
And if health care is a right — if we are not willing to deny health care to those unable to pay for it — how will we as a nation and society cover those costs? ObamaCare attempts to provide an answer to that question. If that answer proves unacceptable to a majority on the U.S. Supreme Court, what’s the next answer?
Come June, that could become a powerful question in a presidential campaign that will be hitting its full stride right about then.
– Jay Bookman