NEWS BLOG (WSAU) I’m writing this blog less than 24-hours before the Supreme Court ruling on health care reform.
Today’s topics: what I think will happen, what I’d like to see happen, and what needs to happen.
I think, with very high certainty, that the individual mandate requiring everyone to buy health insurance is unconstitutional. There are no limits on federal power under the commerce clause if the government can force private citizens to enter into a contract (which is what an insurance policy is) with a private company. If we are a government of enumerated powers, there would be nothing left that the government can’t claim as its province if the insurance mandate remains. The Justices seemed to parrot this point during oral arguments, although those are tricky tea leaves to read.
I’m less certain whether the entire law will be struck down or whether heath care reform will be surgically gutted. As a practical matter, Democrats and Republicans should hope for a ruling that goes all the way. Leaving part of the law standing, without the individual mandate to fund it, would be untenable. The White House would propose an immediate repeal of the Bush era tax cuts to make up the difference. That’s a non-starter with the GOP. We’d have an election year political stalemate that would balloon our already too-large deficit – all in the name of a law that can’t provide what it was supposed to: health coverage for almost all Americans. That’s a lose-lose.
(The irony of all this is the one-word argument: tax. If the federal government call the penalty for not having insurance what it is – a tax – their case in front of the Supremes would be immeasurably stronger. Congress’ power to tax flows directly from the Constitution and is unquestioned. But the political climate from two years ago was such that a broad-based tax increase to pay for this was out of the question. The White House already had to resort to unprecedented deal-making to get the bill through Congress by the narrowest margin. It wouldn’t have been accomplished with more taxes hung on it.)
So what do I want to happen? I want the slate cleared, and the process to start again. A narrow-margin, partisan health care law that hinged on a 5-4 Supreme Court ruling would be politically impossible. We’d never know what our health benefits would be from one election cycle to the next. A switch of a few seats in Congress could change funding for health care. A change in the White House could lead to different Supreme Court appointments where future cases would expand or contract health benefits. Future Presidents’ powers to appoint the Health and Human Services Secretary could mean dozens of new federal rules for coverage. Health care coverage should not shift like sand on a beach.
So what needs to happen? The Republicans – the party that’s likely to claim victory – need to have their own health care plan ready. An alternative for what’s likely to be wiped away. They don’t. What’s sorely missing is a member of the GOP caucus who knows this issue the way Paul Ryan knows the budget. Agree or disagree, Ryan has a plan. That compels the other side, eventually, to offer their own plan. Even if large swaths of the law are wiped away, health care is still an expensive mess. We need a plan, be it vouchers or expanded medicare/medicade, or health savings accounts. The issue isn’t going away after Thursday’s ruling.