01/19/2011 01:58 pm ET | Updated May 25, 2011

Health Reform's Mandate -- What Doesn't Meet the Eye

The House is to take up this week repealing health reform enacted into law last March. What irks most of those who seek repeal, besides the (supposed) issue of cost, is the mandate requiring all Americans to purchase insurance. A majority of voters also do not like any government telling them what they have to do. But when asked why we have a mandate, most of us don't have a clue. The answer may be surprising, for it was not the government's first choice; it came about because of the insurance industry which opposed real health reform from the beginning.

First off, a couple of lower federal courts have found the mandate an unconstitutional exercise of Congressional authority; a couple have found what Congress created to be lawful. Without getting into the legalese us lawyers are used to reading, the Congress can create a mandate as here so long as it affects interstate commerce. One would posit, how can buying an insurance policy affect what goes on beyond state borders? The answer is quite simply this: multiply the country's population of 308 million or so by the cost of one policy's premium and you have a bundle of mullah. According to the insurance industry, it needs the mandate because it must spread the risk across the entire population, from the young, healthy folks who probably would not purchase insurance until they got sick to those who are ill, aged or infirm now. What the industry does not tell us is that the new benefits in health reform, i.e., paying for pre-existing conditions, cost money, and without requiring every American to have insurance, the industry cannot maintain its present profit margin and still cover these new benefits. Also without a mandate, health reform will not be able to provide benefits for the millions more Americans now and to be covered. Without being so covered, the cost to treat and care for them will be even more costly to a health care industry and burdens a nationwide economy, both that clearly go beyond one state's border.

Again, a mandate was never the government's first choice; competition was, notably in the form of a public option. Insurers did not want competition, so the public option was struck from the legislation in the last hour. Neither did insurers want to lose its exemption from the federal antitrust laws. Perhaps we see the reason for the latter by looking at a 59% premium increase proposed by a major California insurer effective this coming March 1. We also know that insurers are balking at having to pay 80-85% of a premium dollar on health care coverage, as imposed on them by the health reform law, starting this year. Is there a picture developing of what is going on?

Atop this post I said the reason for the mandate would surprise you. It should be clear now---the insurance industry wanted it so it can maintain its level of profitability. This is the same industry that backs those who wish to repeal health reform. Thus, Americans must realize why keeping reform, including the mandate, is the lesser of two evils: with a mandate, Americans receive benefits never before allowed by law. If the health reform act is repealed or if the mandate is eliminated (also ensuring defeat of health reform), we will have no new benefits to enjoy. Concomitantly, though while health care will be insurmountable for millions of Americans without present reform in place---more so than now--- insurers will still reap huge profits as in the days before the present bill was enacted. Which "evil" do we want to see maintained?

How about every American waking up to realize that the health reform act needs to be kept, and that there are no objective, credible facts any member of the House majority can assert to base a vote to repeal it, certainly not the mandate. The health care act can be amended or modified so that concerns about accessing and affording health care for all can be ones we speak about as if looking through a rear view mirror.