The Truth About the Individual Mandate

| Mon Apr. 2, 2012 7:16 PM EDT

Over the weekend Ross Douthat wrote a column saying that the individual mandate was a "political marvel":

In the negotiations over health care reform, it protected the Democratic bill on two fronts at once: buying off some of the most influential interest groups even as it hid the true cost of universal coverage.

I sort of shrugged when I read this. It wasn't really right, but on the other hand, it's certainly true that Obamacare succeeded politically by buying off a whole bunch of interest groups. And if you stretch things a bit, it's also true that forcing people to buy health insurance is a way of getting everyone insured without having to directly raise a lot of taxes and then have the government buy insurance for them.

But I shouldn't have shrugged. Ezra Klein, who I suspect may be holding back on a growing sense of outrage over the conservative assault on the mandate, fires off a spread of tactical nukes in Ross's general direction:

I can’t help feeling like Ross is forgetting something. There was some other reason Democrats adopted this policy. I’m almost sure of it. If you give me a second, I’m sure it’ll come to me. Ah, right! Because Chuck Grassley, the ranking Republican on the Senate Finance Committee, was saying things like “I believe that there is a bipartisan consensus to have individual mandates,” and “individual mandates are more apt to be accepted by a majority of the people in Congress than an employer mandate.”

And it wasn’t just Grassley.....The Healthy Americans Act, meanwhile, had been cosponsored by a bevy of heavy-hitting Senate Republicans, including Lamar Alexander, Mike Crapo, Bob Corker, Judd Gregg, Norm Coleman and Trent Lott.

....Avik Roy points out that many liberals — including candidate Barack Obama — were historically skeptical of the individual mandate. And that’s true....Roy tries to use this to draw some equivalence between the two parties. Both Democrats and Republicans changed their mind on the individual mandate, he argues. But there’s a key difference: The Democrats changed their mind in order to secure a bipartisan compromise on health-care reform. Republicans changed their mind in order to prevent one.

....That’s politics, I guess. But ask yourself: If Obamacare is overturned, and Obama is defeated, who will win the Democratic Party’s next fight over health care? Probably not the folks counseling compromise. Too many Democrats have seen how that goes. How much easier to propose a bill that expands Medicaid eligibility to 300 percent of the poverty line, covers every child through the Children’s Health Insurance Program, and makes Medicare availability to every American over age 50. Add in some high-risk pools, pay for the bill by slapping a surtax on rich Americans — indisputably constitutional, as even Randy Barnett will tell you — and you’ve covered most of the country’s uninsured. Oh, and you can pass the whole thing through the budget reconciliation process.

I don’t think that’s a particularly good future for the health-care system. And I doubt that bill will pass anytime soon. But, if Obamacare goes down, something like it will eventually be passed. And what will Republicans have to say about it? That no, this time, they really would have worked with the Democrats to reform America’s health-care system? Who will believe them?

Ezra has them dead to rights on this. It's one thing to always push for the most conservative feasible policy — that's what I'd do if I were a conservative — but it's quite another to actively lobby for that policy and then, when you get it, immediately turn around and insist that the whole thing is just a slimy piece of political graft that deserves to be blown up by a politicized Supreme Court using a brand new constitutional distinction that no one had ever heard of before last year. Maybe all's fair in love and politics, but the eventual result of this kind of duplicity isn't likely to be either the most conservative possible healthcare plan or the most liberal possible plan. It's likely to be the crappiest possible plan.