To understand the irony of our current situation, and what is about to happen once the U.S. Supreme Court either strikes down the Individual Mandate or the entire Affordable Care Act itself because it cannot be severed from the Individual Mandate, we must first go back to 1993.
President Clinton campaigned on reforming the U.S. Healthcare system to bring universal coverage to all Americans. The core element of his “Health Security Act” was a plan to place the burden of insurance coverage on employers across the country, large and small. In other words, it was an employer mandate.
Republicans gathered from far and wide and labeled this as an attack on small businesses, and offered a counter proposal.
Guess what it was?
Since Republicans are all for “individual responsibility,” their embrace of the policy made sense. Individual Americans would be responsible for purchasing their own insurance, and if they did not, they would be fined, with those fines passed on to the insurance companies to cover the cost of treating uninsured people.
Hillary Clinton made the Individual Mandate the center piece of her health care plan during her presidential campaign in 2008. And once elected, President Obama solved the universal problem of tacking universal coverage in a private insurance market by turning to the individual mandate himself. For you see, if you pass a law that forces insurance companies to cover those with preexisting conditions, while at the same time banning the imposition of lifetime and/or yearly limits on pay outs; if you do not at the same time enlarge the premium-paying insurance pool to include healthy people who may not otherwise purchase insurance, the only way to pay for the coverage of those with preexisting conditions without yearly or lifetme caps is to skyrocket the premiums 1,000,000%. And if that was not feasiable, then the insurance market would collapse, and insurance companies would stop offering health insurance policies.
That has happened before:
But what if the government came along, as it did in Washington state in 1993, and said that your insurance company must provide health insurance to everyone who applies for it even if they have diabetes or cancer or Lou Gehrig’s disease? Wouldn’t that just put your company out of business? The answer is, yes, that would put your company out of business unless it refused to sell any more health insurance policies in that state. And that’s what happened in Washington state, where by 1999 it was no longer possible to buy an individual policy. Was the Washington state legislature really that stupid and short-sighted? Well, not exactly.
The original plan was to have an individual mandate, just like the one in the president’s Affordable Care Act. But when the Republicans took control of the state legislature after the 1994 elections, they got rid of the mandate without getting rid of the provision that the insurance companies must accept all applicants. Why did spiking the mandate wind up destroying the individual market for insurance in the whole state? Because the mandate assured that the insurance companies would have hundreds of thousands of new healthy customers who would cost so little to insure that it would make it possible to cover cancer and diabetes patients and still be profitable. In fact, this is the only way anyone has been able to come with that we can cover everyone with private insurance without bankrupting the insurance industry or having everyone pay impossibly high rates.
Thus, what started out as a free market, capitalist, individual responsibility Republican idea has turned into an evil, communist, socialist, fascist, unconstitutional, unAmerican Democrat idea, just because President Obama embraced it as part of his Obamacare plan. And when the mandate is found to be unconstitutional on Thursday or next week, it will be because Republicans hated the President so much that they challenged the constitutionality of their own previously constitutional idea.
Do you all see the irony here? Republicans developed the Individual Mandate back in the 1990’s because they were fearful of a single payer plan emerging from the negotiations over the Clinton plans. And now their own opposition to it will lead directly to single payer.
How so? The Court has two options available to it if it views the Individual Mandate as unconstitutional.
First, if the Court strikes down just the Individual Mandate itself, then we are left with a situation like Washington State in 1993, meaning the private Health Insurance market will collapse and no company will ever offer a health insurance policy within six years. That will lead to an explosion of costs, an explosion of premiums, and an explosion of bankruptcies, all of which will lead to an explosion of our deficit and debt (remember, Obamacare reduces the federal debt and deficit by trillions over the next decade) and a Great Depression. This is obviously the worst case scenario, and I actually think it is the scenario the Supreme Court will take. Oh joy.
Second, the Court could just strike the whole law. That will take us back to how things were in 2009, with just more slowly exploding costs, premiums, debt, deficits, and bankruptcies. We will still be left with a horrible insurance problem that needs to be addressed.
And the only way to address that problem now is through single payer.
Because we have tried now the only two free market private methods of achieving insurance reform: the individual mandate and the employer mandate, and both have been rejected. The only remaining option is a system like Medicare for All, or a Public Option for All.
The irony.