Mitt Romney and President Obama may be the most sharply divided nominees of their generation on the issues of the day, but they’re also the only two people in the country to sign an individual health care mandate into law. The difference is that Obama has a party that’s willing to defend him.

Romney boldly predicted other governors would follow right behind him when he jumped into the universal health care pool in 2006. None did — until Obama came along. The president’s embrace of the mandate prompted Republicans who previously had supported a mandate to flee. Romney, on the other hand, refused to condemn his signature achievement, making him the last prominent Republican holding the bag. The result is a mess for Team Romney as the former governor’s campaign is forced to defend his signature law on its own, without a single like-minded surrogate to back him up.

For some time, Romney downplayed the resemblance by attacking the Affordable Care Act as an unconstitutional intrusion on states’ rights. But now that it’s the law of the land, Republicans are moving on to parsing its policy details, where the similarities are much harder to gloss over. Their first big post-ruling attack line revolved around Chief Justice John Roberts’ classification of the mandate as a tax. The mandate, therefore, was a tax hike on the middle class, Republicans charged. Romney adviser Eric Ferhnstrom quickly broke with the pack — since embracing the line would mean admitting that his boss’s own mandate was a tax hike as well.

These awkward exchanges aren’t going away, either. The Obama campaign is all too happy to put Republicans on the spot about Romney’s Massachusetts law. Adding insult to injury for Republicans: Romney’s GOP primary opponents predicted precisely this uncomfortable scenario

The GOP’s universal disgust with anything linked to the ACA raises the question whether there’sanyone Romney can trot out to take his side on the Massachusetts law. Perhaps, Newt Gingrich, who hailed the passage of Romney’s law as a landmark moment for health care at the time? Nope, that ship sailed during the primaries.

“You watched [Romneycare] go to work,” Gingrich told CNN in December. “Where Romney and I are different is, I concluded it doesn’t work. He still defends it.”

The only other governor to lend public backing to a Massachusetts-style reform bill was Arnold Schwarzenegger, and he’s persona non grata within the party for a variety of reasons. The Republican senators who joined Romney in supporting the mandate-driven Wyden-Bennett bill in 2009 have either abandoned their position or been ousted in primaries.

The GOP can’t expect to win their argument while they leave Romney out to dry, said Republican strategist Brad Blakeman, even if the Massachusetts law is a “diversion” in his eyes.

h/t: Benjy Sarlin at TPM

Massachusetts, Congress was told, solved the adverse selection problem. By requiring most residents to obtain insurance … the Commonwealth ensured that insurers would not be left with only the sick as customers. As a result, federal lawmakers observed, Massachusetts succeeded where other States had failed.


From The Atlantic:

So the president was ready for the Court to break right or break left. But instead, Chief Justice Roberts juked. He agreed with the challengers that the mandate couldn’t be justified under the Commerce Clause or even the Necessary and Proper Clause — thereby reinforcing the narrative that the Democratic Congress overreached in passing the bill. His opinion — though not the result — may provide much help in the future to judicial conservatives, as it suggests that, with the dissent, five justices are in favor of a more aggressive role for the Court in policing the bounds of the Commerce Clause (and the Spending Clause, which was at issue in the Medicaid legislation). And while Roberts ultimately voted to uphold the Act, he did so on a ground that, for Obama, plays terribly: that it’s a tax.

Now, much as Jefferson was two centuries ago, Obama is boxed in. What is he to do? He can’t criticize the Court for judicial activism, as it upheld the law (putting aside the way the Court limited the Medicaid provisions, which are not particularly salient to voters). The decision undercuts a potential theme of his campaign — that a conservative Court is out of control. And yet Obama can’t trumpet the decision either, since it states that Democrats overreached in trying to justify the law under the Commerce Clause. Worse yet, it calls the mandate something that Democrats didn’t want it to be: a tax.

Conversely, the decision may be the optimal result for Mitt Romney. If the Court had struck down the mandate, it would have taken off the table an issue that Republican base voters care tremendously about. But in upholding the law, the Court didn’t just leave that issue on the table; it gave Romney tremendous ammunition he can use to criticize Obama as a tax raiser.

There was much contrarian wisdom floating around prior to the decision about how a defeat might be helpful to Obama, as he could run against the Court. Jeffrey Toobin criticized this as “nonsense”: “Winners win, and losers lose.” We’ll never know if Obama could have potentially won by losing the health care case. But the coming months will tell whether he might have lost by winning.

In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.
Amy Howe, on the SCOTUS liveblog. (via whorlsaway)

An Historical Comment on Health Care Benefits


As discussion of the Obama health care law heats up again, now that the primary seems decided for the Republicans, I thought I’d throw out a piece of information that not a lot of people appear to know, but that seems relevant to the issue:

Have you ever wondered why you get health care benefits from your employer, rather than buying them on your own (like you do your house and your car) or getting them as part of a national package of benefits (like pretty much every industrial/postindustrial democracy other than the United States)? It turns out the answer is an accident of history.

Prior to WWII, basically no one had a health care benefit plan in America. If you got sick, you paid your bill out of your savings and earnings. In rural areas, doctors took barter—the infamous chicken, for example. After all, there wasn’t all that much doctors and hospitals could do for you in the days before penicillin, and you weren’t going to linger for weeks and months in a hospital before you died. Paying for care was “manageable,” to use that loaded term.

That changed during WWII. As men got drafted in their millions, vast labor shortages broke out across the nation—at exactly the time labor needs increased to produce the weapons of war. In part, the labor shortage was met by the infusion of women into the paid workforce, but regardless of women’s contributions to the labor pool, labor shortages were endemic throughout the war.

Elementary economic theory notes that anything scarce tends to go up in price; the same is true for labor. When labor is scarce, employers seeking workers raise their salary offerings to attract labor from other jobs.

However, in WWII wages were frozen. Employers couldn’t compete for labor with salaries. So they competed on benefits—including, notably, health care benefits. They couldn’t pay you more directly, so they gave you more indirectly.

The principle of employer-provided health care benefits stuck after WWII. Unions negotiated generous packages; white collar workers wanted at least as much; and the modern system of employer-provided health care benefits became the established norm—just a few decades after a time when no one would have had any health care benefits at all.

Note that this was never the case in the rest of the industrial/post-industrial democracies.They decided to make national health care benefits part of their national mission after WWII because just as they had borne the suffering of the war together, they believed it was right to provide care in a collective, state-centric way. Hence they built national, non-profit health care systems, not employer-derived, for-profit systems.

In the US, of course, we now live in a world where there is so much health care, and that health care is so expensive, that we are frightened of living as my grandparents basically did, and my great-grandparents certainly did: paying for our own medical care on an as-needed, fee-for-service basis. Instead, as an accident of history, we are all just a job loss or poor job opportunity away from being without good insurance for health care. Which ought to scare pretty much, well, everyone in the United States.


Three things we learned about the Supreme Court and health care


  • one The court was not swayed by arguments suggesting that the decision get delayed — an argument put forth with a 19th-century law, the Anti-Injunction Act, which blocks preemptive injunctions against taxes.
  • two Justices didn’t see the penalty for ignoring the individual mandate in the Affordable Care Act as a “tax”: ”It’s up to Congress, and they did not use the word ‘tax’,” said moderate Justice Stephen G. Breyer.
  • three Eight of the nine justices seemed eager to talk about the case, at times talking over each other to get a word in. The one guy who didn’t? That’s right, Clarence Thomas, who (as always) kept quiet. source

» So what’s next, anyway? With a question over whether the Supreme Court would decide before the law fully took effect largely off the table, the court will next look into the details of the law. The case, brought by 26 states and small business groups, is highly-anticipated, with many protesters outside the court on Monday. The court will likely make its decision by June, just in time to throw a wrench in the election.

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The United States stands out as performing very well in the area of cancer care, achieving higher rates of screening and survival from different types of cancer than most other developed countries. The United States does not do well in preventing costly hospital admissions for chronic conditions, such as asthma or complications from diabetes, which should normally be managed through proper primary care.


On his “conscience” bill - The Blunt Amendment - Senator Roy Blunt (R-MO) said the following in a February press release:

This bill would just simply say that those health care providers don’t have to follow that mandate if it violates their faith principles. This is about the First Amendment. It’s about religious beliefs. It’s not about any one issue.

Except that it is about one issue: a woman’s choice.

It’s about her choice to follow her own principles, be those in faith or godless heathenism. It’s about her choice whether or not to use contraception based on those principles.

The Blunt Amendment tells me women should not be allowed to make that choice. Rather, the employer makes those health care decisions for the entire company based on his or her own moral compass. Keep in mind this amendment is applicable to any kind of health coverage and allows employers to opt out of coverage based on “their religious beliefs and moral conviction.”

From S.182:

[The Affordable Care Act] does not allow purchasers, plan sponsors, and other stakeholders with religious or moral objections to specific items or services to decline providing or obtaining coverage of such items or services, or allow health care providers with such objections to decline to provide them.

By creating new barriers to health insurance and causing the loss of existing insurance arrangements, these inflexible mandates in PPACA jeopardize the ability of individuals to exercise their rights of conscience and their ability to freely participate in the health insurance and health care marketplace.

I’m thoroughly entertained by legislative language like the sentence I bolded above. You’d think the Affordable Care Act forced employers to escort their female employees to the Abortionplex.