President Obama's biggest concession to Democratic congressional leaders going into this process was allowing an individual mandate for health insurance to be included in the bill. During the primary campaign, he staked out a position in opposition to individual mandates, warning that it would force Americans to buy insurance that we may not succeed in making affordable.
Given where we are right now, his warning seems quite prescient. At a time when health care is hanging in the balance and many Progressive Democrats are caught between a rock and hard place in deciding what our leaders should now do with this bill, there are two things that are pretty clear:
- Letting healthcare reform collapse is not an option. That would pretty much make legislating for the next year impossible and quite possibly hand the keys to congress to the Republicans.
- Creating an individual mandate without ensuring that healthcare is affordable is a potential disaster of even greater proportions, both in terms of its negative effect on society and in terms of the political cost it could reap on those who vote for it.
But many of us also know that there are some elements of the healthcare reform proposal such as those barring insurance companies from denying care for preexisting conditions or barring rescissionthat quite simply are absolutely necessary. Killing the bill and letting more people die because their insurance wouldn't cover them just isn't an option.
So I propose we push for the one thing that will allow all of these considerations to be met, if not optimal: Congress should pass a more limited bill that drops the individual mandate. At this point, it's pretty clear that we are not going to get any kind of public option past the Senate. And barring that, the consequences of doing nothing are just as bad as the consequences of doing something that hurts more than it helps.
I don't really think we have any other solid course of action, unless the political considerations revolving around healthcare change drastically in the next month.