First off I would like to say that the last few days of Supreme Court news have been eye opening. This whole ordeal should serve as a reminder of why it is unwise, dare I say down right idiotic to ever enact Republican policy ideas. Universal Health Care was the obvious though politically difficult solution to the issue of Health Care reform. The Public Option was a decent compromise solution to keep costs down while insuring everyone.
The individual mandate was a stupid idea that should have never been included in the bill. President Obama and our Democrats in Congress made a fateful mistake when they adopted this poison pill policy out of the GOP playbook.
Let's not forget the Individual Mandate was a Republican idea from the 1990s, and was included as part of a compromise with Republicans, in an attempt to win their support.
Rachel Maddow had a great segment on this phenomenon the other night:
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I have no doubt that they truly believe the mandate was a great idea. An idea so worthy of including in the bill that they convinced President Obama to change his position on the matter and include it in his legislation. Remember candidate Obama stressed his opposition to such a mandate as far back as 2007 before the Democratic Primaries. He was very proud of the lack of a mandate in his plan. It was a point of contention between him and Hillary Clinton, who was well aware of the fact that a plan without such a mandate would not receive a single Republican vote.
The video below also contains a great anecdote regarding Mitt Romney's Massachusetts Health Care system straight from then Senator Obama.
Speaking of Romney Care it should be noted that the Etch-a-Sketch had nothing but positive things to say about mandates before Obama got on board. In fact he penned an article for NewsWeek in which he laid out the sort of things a Federal Health Care overhaul ought to include and #1 was an individual mandate.
1. Get everyone insured. Help low-income households retain or purchase private insurance with a tax credit, voucher or coinsurance. Use the tens of billions we now give hospitals for free care to instead help people buy and keep their own private insurance. For the uninsured who can afford insurance but expect to be given free care at the hospital, require them to either pay for their own care or buy insurance; if they do neither, they would forgo the tax credit or lose a deduction. No more "free riders."
http://www.thedailybeast.com/...
I cannot think of a better indicator of how dumb an idea it truly is, than to have it endorsed by Mitt Romney.
So that's where we were and this is where it has brought us. On or around June 25th the Supreme Court will make their decision known on the constitutionality of this historic piece of life changing legislation.
I think the mandate is dead in the water and I base this prediction on a few observations. First, the fact that the Justices spent so much time leveling criticisms against the logic of the mandate, proposing hypothetical example after hypothetical example trying to find the perfect analogy to the mandate for which there is none. Second, so little time was spent discussing precedent of law that it gave me the impression that they were not concerned with the legal justification for it's existence or it's constitutionality, and were only concerned with finding the right ideological rational for deeming it unconstitutional.
Instead of a conversation about the law as it is written, we had a quasi-philosophical discussion about the relationship between a Government and it's citizens. Followed by a hypothetical (and ridiculous) discussion about what the scary, far reaching (and far fetched) effects the law may have in the future. In my mind the discussion ought to have centered on the technical details.
Instead we saw the sort of discussion fit for Real Time with Bill Maher.
Lastly, I don't think the Justices would have heard the case if they didn't intend to strike down the law. There was obviously a majority who wanted to decide this issue, otherwise they would have punted it out to 2015 when people actually begin paying the penalty. To me that means a majority of the court already wants to overturn this thing.
So will the whole bill be deemed null and void? Will the Medicaid expansion be upheld? Those are the only remaining questions in my mind. There is a good chance the mandate will be dead but the bill will live on forcing Congress to address the issue of covering every man woman and child legally. That could be a mess but at this point that is our best case scenario.
The medicaid issue on the other hand is probably safe and will be used as a bone thrown to our side. A token victory to appear as if the court was being fair to both parties. But this question of Medicaid Expansion is perhaps the most important in regard to how we move forward under the worst case scenario in which the entire bill is null and void.
How do we move forward after such a ruling? Does Obama go silent on Health Care content with blaming the GOP on it's failure while vowing to work with them at some unspecified time? Worse yet do they come up with some lame plan that tinkers around the edges but doesn't really accomplish anything major?
I hope not. I hope uses this moment to do something bold. I would advise President Obama to move forward on Health Care if the Supreme Court deems it null and void. And here is how I would suggest he do it.
SHOCK AND AWE!
The day the news of the Supreme Courts Ruling comes out, Obama should have a new plan on Harry Reid's desk. The whole plan written. Done. Ready to be voted on. And he should announce this fact at the press conference he holds to give his reaction to the high courts verdict.
This would accomplish 4 things.
First, it would throw the GOP through a loop immediately. Coming off their victory with the Supreme Court they wouldn't have even a moment to collect themselves before being presented with the prospect and details of Plan B.
Second, it would deflate any whispers about Obama being a failure as well as any other attempts to demoralize Democrats. Obama would be seen as prepared, taking action and ready to right a wrong.
Third, it would ensure the conversation about Health Care Reform continues and is not swept under the rug. Once that conversation is seen as finished, it will be hard to get it going again due to the fact that the last round of legislation was so nasty. So it's important to strike while the iron is hot.
Fourth, it creates a dramatic Election issue and rallying cry for the nation to give President Obama a Congress that can pass his new plan so we can move forward with the problems facing America.
Next I would make sure the legislation itself is as easy to understand and contains as few pages as possible. It should also contain on PAGE 1 a summarized version of the law in plain English, which should count as part of the official law itself. This is important because it would not only serve as a clear outline for the intent of the law for both political and legal purposes but it would also serve as a prop President Obama can hold up on camera and refer to as the bill.
One of the GOPs biggest complaints about ACA was that it was 2,700 pages and they couldn't read it. Imagine the power of one piece of paper summarizing the entire bill being referred to as the bill. Obama could hold it up at the debates and say "Here it is." There is some legalese that goes along with it, but here it is. And the whole thing should be available on Obama's site the moment it is on Reid's desk.
It should also be iron clad in regard to it's constitutionality. I don't care if they have to drag Sandra Day O'Conner into the White House to help write the damn thing. Get it done and get it Court proof. So how do you do this? By expanding programs already in place.
Medicare Part E:
"Medicare for Everyone who wants it."
Essentially the bill would only do 3 things.
1) Eliminate some of the requirements for enrollment/Create a few new ones.
2) Set up a buy-in schedule based on personal income.
3) Provide for retroactive enrollment/Automatic payment for emergency services.
Basically if you want Medicare and you don't have any other coverage you can buy into the program. The amount you pay every month is based on your income. Incredibly poor people pay nothing. If you're uninsured and you get in a car accident the Hospital can bill the Government using the Medicare fee schedule even though you have yet to enroll. This eliminates the rising cost of health care problem.
"FREE LOADERS!" Mitt Romney will cry, tears of battery acid streaming down his robotic face. "What about the FREE LOADERS!"
Well after paying for services rendered the Government would give the patient a choice, either they can be billed directly for the services (at cost) or they can enroll with the program and retroactively reap the benefits of doing so. Either way there are no free rides. Everyone who can, pays their way.
This is the easiest and most straight forward way to tackle the vast majority of issues facing the health insurance debacle. You no longer need to require private companies cover preexisting conditions because Medicare will. You no longer need the mandate because if you get hurt you are billed or given the chance to enroll. You no longer have cross-state discrepancies, gender discrepancies, or any of the other problems you get with private insurance company corruption.
People will have a choice.
And best of all we get to argue that "the invisible hand of the market" will decide the fate of insurance companies.
Medicare will be taking the poorest and sickest patients in the nation, often offering lower payments to hospitals and doctors for services rendered and really only covering the basics. If the private companies cannot compete with that, they do not deserve to exist. If they refuse to reinvent themselves by offering quality care at reasonable rates they will lose their customers.
However, if they get their act together and decide to start covering preexisting conditions, maybe going the extra mile for their patients, they won't lose customers.
It really is that simple.
We have a sort of collusion in the insurance industry right now where all of the companies have decided to work together to screw over their customers in a coordinated and uniform manner. Direct competition to the entire industry may be the only way to discourage that practice and ensure quality care for everybody.
Such a piece of legislation should be able to be contained in less than 300 pages as it would mostly consist of amendments to current laws regarding Medicare eligibility and payment. This should be simple, straight forward and court proof. It will force Mitt Romney to debate Health Care and hopefully deliver a friendlier Congress in the process.