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Meredith Bagby

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Death of a Mandate: Why Health Care Reform in America is Over

Posted: 03/29/2012 5:13 pm

"Shock and awe" best describes the reaction of legislators and commentators upon hearing the Supreme Court's closing day of arguments on the constitutionality of Obama's health care legislation. Democrats as well as the beltway media had assumed the bill was safe, thinking that the legislation fit firmly under the Congressional power of the Interstate Commerce Clause and that justices would be wary of repercussions of single-handedly dismantling the most expansive social legislation since the creation of Medicare.

How wrong they were. From the same justices that brought you Citizens United v. Federal Election Commission (the decision that ruled that corporations, like individuals, are protected by the first amendment, which resulted in the unleashing of a wave of super PACS in this year's elections) and Bush v. Gore, now comes the very real possibility of the end of health care reform.

The line of questioning from conservative justices, as well as swing-vote Justice Anthony Kennedy, indicates a majority of justices already think the mandate (which requires all citizens to buy health insurance) is unconstitutional. With this a foregone conclusion, they've moved on to ask the question: If the mandate is ruled unconstitutional, doesn't that mean that the whole law is invalidated? Justice Kennedy said that if they strike the mandate, "by reason of the court, we would have a new regime that Congress did not provide for, did not consider." He went on to say that anything short of striking down the whole bill might be a "more extreme exercise of judicial power." He was echoed by conservative Justice Antonin Scalia, who said it is "totally unrealistic to comb through a 2,700-page law... My approach would be if you take the heart out of the statute, the statute is gone."

Reporters, commentators and Democratic legislators were stunned by the Court's turn. CNN's Jeffrey Toobin called today "a train wreck for the Obama administration." Toobin said, "this morning was unbelievable. It was like a given that they're throwing out the mandate. Anthony Kennedy was like, 'Well, when we throw out the mandate...' -- Do you know what a huge deal that is?" Although shaken, Senate Majority Leader Harry Reid warned that we couldn't draw any conclusions yet, saying that justices ask lots of questions in many different directions, but that doesn't mean they've made up their minds.

The logistical problem is that if the Court strikes down the mandate, the rest of the law may unravel for financial reasons. Obama's new citizen protections, such a requirement that insurance companies cover people with pre-existing conditions, a ban on charging more for those with complicated health problems and the removal of insurance payout caps on medical services, are all supported by the insurance premiums of new people entering the market through the mandate.

Chief Justice Roberts' echoes this argument when he said that Congress was trying to accomplish two objectives, noting the bill's full title: The Patient Protection and Affordable Care Act. "Congress had a balanced intent. You can't look at another provision and say this promotes patient protection without asking if it's affordable." The law's opponents, including 26 states and the National Federation of Independent Businesses, go further saying that without the mandate, the whole law unravels. Paul Clement, a lawyer for the opposition, said that striking the mandate would leave "a hollowed-out shell" not worth saving.

Liberal justices, tried to guide the conversation back to the reality of what it would mean to dismantle the health care law entirely. Justice Ruth Bader Ginsburg argued that the most legally conservative position is to uphold the law even if the mandate were struck down, leaving it to Congress as to the next course of action: She urged her peers not to deliver "a wrecking operation" to the country. Justice Sotomayor continued, "Why shouldn't we let Congress decide what to do? What's wrong with leaving it in the hands of people... who should be making this decision, not us?"

Despite liberal arguments, the reality of this court is that it almost always divides on partisan lines. Conservatives outnumbered by liberals five to four. The tragedy is that the singular achievement of the Obama administration is about to be gutted. The legislation that cost a hugely popular president nearly all his political capital, the battle that cost the Democrats the House in 2010 and used up all the oxygen while America was in the deepest economic crisis since the Great Depression, the law that was the premier social achievement since President Lyndon Johnson signed Medicare into law in 1965, is about to be dismantled with the strike of the court's gavel.

Of course, it is not merely political history at stake. It's real lives. Gone could be the hope that insurance companies treat all of us the same. Gone could be the promise of health care for tens of millions of uninsured Americans. Unchecked and unregulated, our health care costs will continue to soar. The real tragedy is that, given the enormous political capital required for change, no one will touch health care reform for a generation to come and the problems of the past will become our crisis tomorrow. And once again, Americans will be reminded that our government is in a permanent stalemate and cannot even solve our country's most basic problems.

 

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"Shock and awe" best describes the reaction of legislators and commentators upon hearing the Supreme Court's closing day of arguments on the constitutionality of Obama's health care legislation. Democ...
"Shock and awe" best describes the reaction of legislators and commentators upon hearing the Supreme Court's closing day of arguments on the constitutionality of Obama's health care legislation. Democ...
 
 
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HUFFPOST SUPER USER
mjswoosh
07:29 PM on 03/30/2012
Re: Kennedy saying that allowing the government mandate would "change the relationship" between the government and its citizens is absolute nonsense. Each time we file our taxes, we discover that we have a “relationship” (which most of us do not like) with our Government that we cannot get away from (unless we are a large corporation or the top 1/10th of 1% who don't pay taxes at all). Government imposing a tax to pay for things that ease the overall burden while improving the quality of life of its citizens is not a novel thing. The "mandate" is nothing more than a tax increase with a huge loophole to avoid it. People who elect to not have insurance will see their taxes increase on the basis of that lifestyle choice. This is no different than the government taxing us based on procreation, property ownership, or any other taxes levied for certain lifestyle choices. The fact remains, if you don't want to buy insurance, you don't have to. However, you will be financially liable to society for not being covered which not only raises the premiums of everyone else, but increases the cost of care once the uninsured actually need treatment.
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HUFFPOST SUPER USER
mjswoosh
07:26 PM on 03/30/2012
More silliness. For better and worse, the court is likely to uphold the ACA and the mandate.

Kennedy and Scalia were throwing a political bone to the wing-nuts who have absolutely no idea what is going on.

Re: Scalia comparing the health care market to broccoli is side-splittingly stupid; however wrong some of his decisions may have been over the years, he is a smart man. Scalia has used many of his own decisions to reinforce the expansion of the government's ability to regulate interstate commerce, sometimes to ridiculous extremes (such as its unlawful to grow pot in your own back yard because it effects "interstate commerce", and as such you must go out and BUY pot to maintain an illegal market. LOL)

I don't agree with many of Scalia's decisions in the past...or the past 70+ yrs of the SCOTUS setting precedent to expand its powers in such ways...but...its nevertheless precedent. If Scalia were in fact to strike down the mandate, he would show he has zero integrity and invalidate many of his earlier decisions.
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04:36 PM on 03/30/2012
Nobody has even read the bill. Nobody could Could I ask you one question, which is a practical question,” Breyer asked of Paul Clement, the lawyer representing the state of Florida in the case. “I take as a given your answer to Justice Kennedy,’ said Breyer, “you are saying let's look at it objectively and say what Congress has intended, okay? This is the mandate in the community, this is Titles I and II, the mandate, the community, pre-existing condition, okay? Here's the rest of it, you know. “And when I look through the rest of it, I have all kinds of stuff in there,” said Breyer. “And I haven't read every word of that, I promise. “As you pointed out, there is biosimilarity, there is breast feeding, there is promoting nurses and doctors to serve underserved areas, there is the CLASS Act, etcetera,” said Breyer. “What do you suggest we do?” said Breyer. “I mean, should we appoint a special master with an instruction? Should we go back to the district court? You haven't argued most of these. As I hear you now, you're pretty close to the SG [the Obama administration’s solicitor general]. I mean, you'd like it all struck down, but we are supposed to apply the objective test. I don't know if you differ very much. “So what do you propose that we do other than spend a year reading all this and have you argument all this?” said Breyer.
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Helzapoppin
Don't Piss Down My Back And Tell Me It's Raining.
03:50 PM on 03/30/2012
Had Obama and Dems listened to progressives at the time, this wouldn't even be an issue.
03:49 PM on 03/30/2012
Overthrowing the entire law is going to be hard because parts of it have already taken effect and the entire medical industry has re-vamped itself to accomodate the law.

In my opinion, the conservatives on the court would love to overturn the entire thing, but the won't. And, only overturning the mandate would make everyone except the insurance industry happy....so I don't see them doing that either.

I think they will reluctantly uphold the law. If they toss out the entire thing, they are going to have some po'd American's heading to the polls in November....possibly rioting in the streets. Seniors don't want the donut hole back and college kids have already been added to their parents policy. To roll all that back will be a huge mess......not likely to happen.
JackVandusen
Switched to coffee
02:52 PM on 03/30/2012
A New World Feudal System with corporations instead of lords, and employees instead of serfs.
That's our republican future.
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WeThePeople99percent
Greed is a poor substitute for intelligence!
04:25 PM on 03/30/2012
Excellent and correct point of view. F&F
07:45 PM on 03/30/2012
Hmm, but a mandate to pay a major campaign donor with the government acting as the private industry's agent doesn't sound like that to you? A precedent that it is ok to compel citizens to pay a major campaign donor merely because it enriches their bottom line and really has nothing to do with health care because said donor is a useless middleman collecting rents doesn't sound like that to you? Sure does to me.
JackVandusen
Switched to coffee
01:11 PM on 03/31/2012
I hear what you're saying. And from your perspective there's no other way of seeing it. I think what you're saying is a perfectly legitimate concern.
But what I struggle with is the fact that states have always had mandates, and the slippery slope argument has never been used with states. But suddenly with a federal mandate, everyone fears the slippery slope. What makes a federal mandate "slipperier" than a state mandate? I'd be grateful to discuss a thoughtful reply. Can you help? Thanks.
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Jody Dobis
02:40 PM on 03/30/2012
Slowly but surely, the last rungs of our safety net ladder is being sawed off. At what point, will the average middle class citizen wake up and realize that once the lower class has been cut off, they are next. Why would the republicans stop with the lower class? The answer seems obvious that they won't. Slowly but surly, they will continue up the rungs of the ladder until their supporters, the 1%, say it is safe to stop. We use to take pride in the advancement of the average citizen in this country but no more. We use to reward the average citizen's productivity in the work force but no more. We use to take pride in helping those who had less than us but no more. You either find a way to pull yourself up by your own boot straps are fall to the way side.
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HUFFPOST SUPER USER
lgillooly
01:36 PM on 03/30/2012
At least private insurers win even though the rest of us lose.I ronically, they are not even necessary in our healthcare. They provide NOTHING, not even a band aid. All they do is charge as much as they can and find any way possible NOT to pay your claims. Once you become too expensive....adios!
Thanks to talk radio and Fox news corporate propaganda, we have a country full of misinformed fools who vote against their own interests. Why? because they believe the BS about "their freedom". Freedom to what? die? go bankrupt? because you can't afford care. Geniuses, I tell ya.
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Christopher Hull
Democratic Socialist
12:49 PM on 03/30/2012
I know I will get a lot of dissent from my position but the law should be declared unconstitutional. To require citizens to buy a product from a for profit corporation is illegal. There are no "ifs" or "buts" or any other "get out of jail free cards" to be played.
IF we created a Canadian type system, with it's problems, maybe that would be legal constitutionaly. IF we first had the health care corporations become non-profits, like they are in France, which has the BEST health care per dollar spent in the world, maybe we would have some wiggle room. But there is no way, short of a an amendment, that a citizen can be forced to buy a product from a company. IF this law is upheld then the very next law Congress passes should be the Buy American Car Act or Buy American Clothes Act and so forth and so on until the unemployment rate is near zero.
There are some nice things in this bill. However, from the very beginning, people were saying parts of the bill are illegal. Even if the Court upholds this law it is still wrong and immoral.
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HUFFPOST SUPER USER
Jody Dobis
02:55 PM on 03/30/2012
You won't get an argument from me, Christopher. Even though I am for health care for all, the President did such a bad job of pre and post selling of the bill that he deserves the defeat. When you compromise to the level of the democrats and the President, you are not serving the vast majority of those that support you. When the average citizen proclaims rightly that they could have done a better job in crafting the bill, you know the democratic party has hit a new low. On the other hand, the republicans will eventually self destruct by reading more into the decision than they should and cut there own throats by becoming cost cutting extremists. Unfortunately, once cuts have cut to the bone, bringing the intensive care patient back to life may be too late. I am always amazed by those who never can imagine being on the wrong side of prosperity. I always try to remember when I get too confident the lesson of the Bible text that states "There but for the grace of God go I".
12:45 PM on 03/30/2012
We've already seen that the Supreme Court is predisposed to favor the Republican agenda. But, time has a way of correcting such idiocy. Perhaps in his second term Obama will have the opportunity to fill some vacancies on the Court.
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timm0
I'm not top 0.01% - so it must be because I'm lazy
12:42 PM on 03/30/2012
The title of the post is wrong. "Health Care Reform" wasn't present in the bill in question. The bill was a flawed effort to tweak the conduct of health insurance companies.

With the exception of Switzerland, every industrialized nation has grown up from the 1800s style of health care and placed the operation of the industry under the auspices of each nation's population - democratically elected governments. Ours has exceptionally higher costs and rampant abuses because the various service and le@ch organizations that control it have no incentive or reason to change from money-extraction goals to sensible societal goals.

Our medical outcomes are measurably worse than those other nations as well - but again there is no incentive for the le@ches to change anything. And on top of that, the majority of our personal bankruptcies are due to medical bills.

Ours is the only nation whose population is too weak, immature, selfish, and easily spooked to tackle the health care problem head on. This bill is case in point. "It's a vital first step!" was what I remember people opining when denouncing my predictions that the useful provisions of the ACA would never go into effect.

Well, the sad fact is that truly reforming health care requires FAR, FAR more than tinkering and tweaking in small steps. It requires a definitive, bold, scary jump into the cold pool.

Here in the "home of the brave," we stand quaking at the pool steps...
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12:28 PM on 03/30/2012
The press is misleading people into thinking this gets decided today. Whatever decisions get made today, the whole thing can still swing in the other direction before it's over. Past Supreme Court decisions have done that. It's not over til it's over.
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12:27 PM on 03/30/2012
if th ecourt strikes it down, after the election, the new president (or second term president) will get small incremental things passed the 26 yr old insurance thing SCHIP expansion things like that popular non controversial things. The end is not near.
12:24 PM on 03/30/2012
Reporters, commentators and Democratic legislators were stunned by the Court's turn.

No..... liberal reporters, commentators and Democratic legislators were stunned. Its because they live in lala land. There have always been powerful arguments for overturning the mandate as it expands the commerce clause FAR beyond the framers intent. I find it amusing that so many liberals were stunned by the questioning from the court.

That being said I would never even try to speculate what will happen behind closed doors, even with the tough questioning it is anyone's guess as how the ruling comes out in June.
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HUFFPOST COMMUNITY MODERATOR
Gudrun
My micro-bio is empty
02:35 PM on 03/30/2012
I'm a liberal, and I'm not stunned.
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12:24 PM on 03/30/2012
Single payer or expansion of medicare for all would be found constitutional So they picked the mandate lol good planning
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HUFFPOST SUPER USER
cheryl tobin
Alpha Dog with my pack!
01:19 PM on 03/30/2012
My thoughts exactly! F&F