Ezra Klein, the Washington Post's blogging wunderkind, is a smart guy. He made his name becoming the go-to pundit for health care policy. He understands health care policy as few do in D.C. But if you're looking for an unvarnished opinion about the political realities of Obamacare, he's the last guy I would read.
Since the Patient Protection and Affordable Care Act begin winding its way through Congress last year, Klein has been almost unrelentingly supportive of every proposed version of the legislation. Now that the legislation is in place and we're discovering all kinds of problems with the bill -- everything from how it kills drug discounts for Children's hospitals to eliminates tax deductions for cancer patients -- he's still cheerleading.
So after a federal judge struck down the legislation's "individual mandate" -- the requirement that Americans purchase health insurance up to a government standard -- Klein was up on his blog quickly with a post titled, "Is the Hudson ruling good news for health reform?" The answer to that question is quite obviously no, but I think you can guess where Klein comes down on the issue.
Klein expanded his thoughts on the decision for the print edition. He is understandably happy that Hudson's ruling concludes that the legislation's lack of a "serverability clause" doesn't mean if the mandate gets struck down the whole legislation is invalidated. But Klein is unjustly dismissive of the idea that the individual mandate is Obamacare's "linchpin," despite the fact that the administration used that very word to defend it in the court case.
Klein appears to understand that if you can't force everyone to buy insurance, that makes the legislation's mandate that insurance companies cover preexisting conditions unworkable. Bizarrely, Klein thinks that this looming problem becomes a political plus for proponents of government-run health care:
The individual mandate was created by conservatives who realized that it was the only way to get universal coverage into the private market. Otherwise, insurers turn away the sick, public anger rises, and, eventually, you get some kind of government-run, single-payer system, much as they did in Europe, and much as we have with Medicare.
If Republicans succeed in taking it off the table, they may sign the death warrant for private insurers in America: Eventually, rising cost pressures will force more aggressive reforms than even Obama has proposed, and if conservative judges have made the private market unfixable by removing the most effective way to deal with adverse selection problems, the only alternative will be the very constitutional, but decidedly non-conservative, single-payer path.
Klein assumes that the reform here will only head in one direction -- toward more government control. He fails even to consider the possibility that when everyone's insurance premiums suddenly quadruple, voters will riot in the streets and demand immediate repeal of the law that made their once-affordable insurance premiums quadruple.
From the beginning, Klein has consistently offered up some variation of the following arguments: Health care would get more popular once it passed; certain esoteric indicators show it's more more popular many people realize; if you break it into its parts people like them; to the extent that it's unpopular, Americans just don't understand the bill, otherwise they would like it.
This interpretation flies in the face of the available data. A poll released by the Washington Post's yesterday found support for the legislation was at an all time low, with a majority of the country opposed. And that's a poll of adults -- likely voters have been even more strongly opposed all along.
If America doesn't like heightened government control of health care, what makes Klein think that when Obamacare causes premiums to spike dramatically, Americans will clamor to effectively eliminate private insurance? (What's more, isn't he giving credence to everything conservatives said during the debate last year, that this was a stalking horse for a single-payer system?)
Klein also tosses out the idea that the court case puts egg on Republican faces. Or something:
It might, however, be a worse world for Republicans. The individual mandate began life as a Republican idea. Its earliest appearances in legislation were in the Republican alternatives to the Clinton health-care bill, where it was co-sponsored by such GOP stalwarts as Bob Dole, Orrin G. Hatch and Charles E. Grassley. Later on, it was the centerpiece of then-Gov. Mitt Romney's health-reform plan in Massachusetts, and then it was included in the Wyden-Bennett bill, which many Republicans signed on to.
It was only when the individual mandate appeared in President Obama's legislation that it became so polarizing on the right. The political logic was clear enough: The individual mandate was the most unpopular piece of the bill (you might remember that Obama's 2008 campaign plan omitted it, and he frequently attacked Hillary Clinton for endorsing it in her proposal).
Brilliant! So, how many billion dollars do you suppose Obama would have to spend on advertising to convince the public that Republicans, who all voted against his health care bill, were responsible for his health care bill? It would be nearly as great a waste as the stimulus package.
It is also at least worth noting the Republicans Klein calls out. Bennett just suffered a stunning loss of his seat this year, in no small part because of Wyden-Bennet. Hatch is scrambling to avoid the same fate, and Dole and Grassley -- especially Dole -- are surely best described as old-bull moderates. As for Romney, even if he is running from RomneyCare as if it were a rabid, syphilitic bear, there is nothing in this court ruling to prevent states from imposing an individual mandate. Moreover, that's irrelevant anyway, because the Massachusetts "mandate" is actually not a "mandate" at all but a tax credit.
Klein helpfully reminds us that Obama viciously attacked Hillary during the election for proposing an individual mandate, only to embrace it later out of necessity. Without it, the system cannot work -- something Obama probably understood even as was attacking her. He did so because it's a massively unpopular provision, and it has probably done more than any other provision to turn Obamacare into a massively unpopular bill.
Klein seems to think that Republicans, now controlling a legislative chamber by a very large margin, will simply fix Obamacare by letting the mandate expire, and otherwise let it stand. The more likely outcome is that they will repeal the mandate legislatively, with broad public support, and attach to the repeal several other provisions as well. They will gut whatever they can, then slowly walk the rest to its grave by refusing to provide funds for bureaucracy and enforcement.
To sum up, the fact that the individual mandate might not survive a legal challenge is a very big deal, no matter how much spinning Klein tries.
UPDATE: Klein's new Washington Post colleague Jennifer Rubin also observes that fixing the problem of the indidividual mandate might be more difficult than Klein suggests. Aside from the political problems, Rubin is a former lawyer and notes that the legal issues at play are tricky.
In particular, Rubin makes this very interesting observation about the fate of the individual mandate:
I agree with Ezra, however, in that this is not the final word on the subject. That likely will rest with the Supreme Court, whether the case goes directly there, as Republicans are urging, or whether it stops first in the 4th Circuit (which, I would venture, is very likely to uphold the district court ruling). But here's the tricky part: Justice Elena Kagan, having served in the Obama Justice Department, is surely to recuse herself. With the "liberals" one judge down, even a Kennedy vote to uphold the individual mandate would presumably result in a 4-4 tie. And guess what? If there is a tie, the lower ruling stands. In other words, this is really bad for ObamaCare advcoates.
