Against the health care mandate

April 5, 2012

Helen Redmond argues that those who support health care for all should be in favor of the Supreme Court striking down the health care law's individual mandate.

IN A highly charged and polarizing case, the Supreme Court heard a series of legal challenges to President Obama's Patient Protection and Affordable Care Act (ACA). The case was brought to the high court by 26 Republican-led states that are hell-bent on a showdown with the Obama administration, even though the legislation is supported by the health insurance industry.

That's right. The insurance industry is in favor of the ACA because they wrote it. Liz Fowler, a former vice president of WellPoint, wrote much of the Senate bill that became the ACA.

The insurance industry, captained by Karen Ignagni, the president and CEO of America's Health Insurance Plans (AHIP), understood that small changes to the market were unavoidable given the scale of the crisis and its impact on the economy. From the start of the health care reform debate, the industry won its most critical demand--the individual mandate that candidate Obama opposed, but President Obama fully supported.

James Morone, author of The Heart of Power: Health and Politics in the Oval Office, said of the ACA, "This is a bill that actually helps the insurance industry. It's like Franklin Roosevelt saving the banks. It's like lots of other examples in American history where the industry is actually helped and protected from some of the more outraged critics--in this case, people demanding single payer."

The individual mandate is cause for outrage. It will force millions of people who don't qualify for government-funded health care or an employment-based plan to buy coverage from the insurance industry, or be penalized with a fine if they don't. The mandate will hold millions of people hostage to the very industry that is responsible for the health care crisis that leaves 52 million uninsured, a record number of bankruptcies due to unpaid medical bills, and whose routine denial of treatment has resulted in disability and death.

The industry is drooling at the opportunity to sell unaffordable underinsurance to millions of new, coerced customers, and get $447 billion in taxpayer subsidy money to do it.

The health insurers demanded the individual mandate in exchange for selling health coverage to people with pre-existing conditions. In the Orwellian market of for-profit health care, those who need health care the most are avoided because they actually use health care services. That cuts into profit margins.

The industry's solution to this conundrum is to force younger, healthier people who use less health care to join the "pool" and buy skimpy, expensive coverage to spread the "risk" in order to ensure continued high return rates to Wall Street investors.

And the insurers will still be able to discriminate against people with pre-existing conditions because there are no cost controls in the ACA. They can charge more for a premium based on age and for certain health conditions like diabetes, obesity and high blood pressure. The unregulated, predatory pricing of insurance premiums is the way the industry will compensate for having to sell coverage to people with pre-existing conditions.

The Supreme Court should strike down the individual mandate and deprive the profit-gouging vampires of yet more victims. The justices should rule it unconstitutional to compel people to buy a private, for-profit, corporate controlled commodity.


LIBERALS AND progressives who would automatically oppose a Republican president--think Gingrich, Palin or Santorum--who gave enormous power and constitutional protection to the widely despised health insurance corporations are instead providing deep cover for Obama. Their main concern is that if the mandate is struck down, as well as other parts of the law, Obama won't get reelected.

David Cole at The Nation blames the uninsured for escalating health care costs and writes, "The uninsured shift about $43 billion in costs each year to the rest of us, increasing the average premium for insured families by more than $1,000." It's not the health insurance corporations that are responsible for rising costs, it's the "free-riders" who refuse to buy coverage.

This right-wing and victim-blaming way of framing the cause of the health care crisis is ubiquitous and accepted by the Supreme Court's four "liberal" members: Justices Breyer, Ginsburg, Kagan, and Sotomayor. Justice Ruth Bader Ginsburg said during one hearing that the mandate was needed because the uninsured get free health care that others pay for. She remarked, "They are making the rest of us pay."

Liberal columnist Paul Krugman issued a dire warning in his column for the New York Times: "What this means is that the Affordable Care Act is the only thing protecting us from an imminent surge in the number of Americans who can't afford essential care. So this reform had better survive--because if it doesn't, many Americans who need health care won't."

Krugman would have us believe that the ACA is the only thing standing between the American people and Armageddon.

Wendell Potter, the former PR executive for CIGNA who turned whistleblower, is a leading champion of Obama's legislation and is willing to make a Faustian bargain with his former employers. His book, Deadly Spin: An Insurance Industry Insider Speaks Out on How Corporate PR is Killing Health Care and is Deceiving Americans, explains that the industry can never be trusted.

In an interview on Democracy Now! that was full of sophistry, he argued in support of the individual mandate while admitting that the insurance industry "will get a new revenue stream, and they will get profits that will-that they wouldn't have had before."

Potter, a 20-year veteran in the business of spin, knows that the individual mandate consolidates the insurers' power and position in the American health care system and will make it more difficult to dislodge them--something he's argued repeatedly in favor of.

In an article for the Huffington Post, Potter depicts a dystopian health care system that resembles life in the film The Hunger Games if the individual mandate is struck down. If that doesn't scare the justices enough, he invites anyone who opposes giving the insurance industry a constitutional mandate coercing us to buy private insurance to travel to Tennessee with him to the free clinic that Remote Area Medical (RAM) will set up for thousands of uninsured.

Potter then argues that the ACA is one of the most important pieces of legislation ever and "one that will truly mean the difference between life and death for many."


THE REALITY is that the crisis in health care that claims the lives of 84,000 every year will continue if the mandate is upheld, and it is utopian to believe otherwise. By 2019, the Congressional Budget Office estimates there will still be 27 million uninsured. RAM will have plenty of patients.

Leading single-payer organizations haven't come out against the mandate, with the exception of the group Single Payer Action. The group filed a brief with the court arguing that the individual mandate is unconstitutional and made the case for implementing Medicare-for-all.

The national organization Healthcare-NOW! took a position that dodged the question with the slogan "Never Mind the Mandate." Other groups that support single-payer have avoided taking an unequivocal stand and have said only that the crisis will continue no matter what the Supreme Court decides.

But not taking a clear position in favor of striking down the individual mandate is a mistake. The single-payer movement didn't support the passage of the ACA, so why wouldn't organizations come out for the defeat of the individual mandate?

Some have argued that to be against the mandate puts single-payer supporters on the side of the Tea Baggers, the Republican Party and right-wing Supreme Court justices. That is wrong. Single-payer supporters oppose the private, for-profit insurance corporations having more control over health care because we want a government takeover of the health care system and the abolition of the insurance industry. That is something the right wing is adamantly opposed to.

Not taking a position against the mandate has caused confusion among single-payer supporters and is a missed opportunity to organize and win people to supporting the struggle for single-payer.

There is enormous misunderstanding on both sides of the debate. But millions of Americans have come out against the mandate, not because they're right wingers, but because they hate the insurance industry and don't want to be forced to buy coverage.

A national dialogue about health care has begun again and will continue until well after the Supreme Court announces their decision in June. Now is the time to relaunch the struggle to make health care a guaranteed right for all.

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