Byron York thinks the sloppiness of the legislation (2700 pages that no one read and the Justices won’t) increases the odds that the government will lose the severability argument. SCOTUS would be “extreme” to try to select items one-by-one for keeping.
Philip Klein thinks the argument that the mandate is to prevent free-riders is the red herring that could ultimately doom Obamacare. “In reality, the mandate has always been about forcing healthy people into the insurance pool, to offset the distortion in the market created by the related provision requiring insurers to cover those with pre-existing conditions.”
Walter Russell Mead asks why, “given a once in a lifetime chance to pass a program that Dems have longed to achieve ever since the New Deal, did they craft a sloppy mess that nobody understands and few admire, and then leave their law so unnecessarily vulnerable to constitutional challenge?”
I can’t tell you whether the law is unconstitutional; I can’t even tell you whether the Supreme Court will uphold it — or, if the mandate goes, what else might stay.
But the health care law’s troubles shed some further light on the crisis of American progressivism and the blue social model it has built. Those who believe in the blue model and want to extend it have lost their touch; the dream machines of the blue social engineers don’t sail serenely across the azure sky anymore. Think of the various carbon exchanges and environmental planetary schemes; think of high speed rail proposals like California’s $100 billion train to bankruptcy; think of Obamacare. These days the experts, “social entrepreneurs” and smart young blue twenty somethings fresh out of the Ivy League whomp up social programs with as much verve and dedication as their New Deal and Great Society predecessors, but the new Dreamliners don’t take off. At most they roll around the runway, emitting clouds of noxious smoke; wings fall off, windows pop out, turbines misfire and the tires go flat.
Obamacare was supposed to be the capstone in the arch of a new progressive era. The Dems were going to show us all that government really does work. Smart government by smart people, using modern methods and the latest up to the minute research from carefully peer reviewed articles in well regarded social science journals can solve big social problems…
But even if the Supreme Court doesn’t pull the trigger and kill the law in June, the darn thing won’t fly. The public hates it, and the longer it’s on the books the less popular it gets. This isn’t like Social Security, a program the public fell in love with early on and still cherishes today. It isn’t like Head Start, which remains dearly beloved even though there doesn’t seem to be much evidence that it helps anybody other than the people it employs. Obamacare is only marginally more popular than the Afghan War; already its estimated cost has doubled and we all know these numbers are likely to continue to increase. Obamacare so far is a political flop and shows ominous early signs of being a policy misfire as well. The benefits don’t seem to measure up to the hype, more people are going to lose their existing insurance, premiums are going up and the impact on the deficit is going to be worse.
We don’t actually have a working, sustainable system: what we are doing now is on course to bankrupt us sooner or later as the population ages, new technologies force rapid change, and, for various hard to decipher reasons, costs internal to the system keep rising faster than the rate of inflation…
These problems all loom large in the health care reform effort, but they rear their heads almost anytime people today seek to address pressing social problems with progressive era methods. All our systems are growing more complex as time goes by, and therefore harder to regulate effectively. Lobbyists and pressure groups play an increasing role in the political process as government’s role grows and as more companies and other groups feel the need to influence Washington to protect their interests. And the IT revolution is pushing us to restructure and reform the learned professions and the intellectual guilds in the face of rising costs and low productivity.
Obamacare reveals the mismatch between the progressive imagination and both the needs and opportunities of our time. It is a 20th century solution for a 21st century society.
The question before the country isn’t whether the law will stand. It is headed for failure; the question is whether the Supreme Court will kill it quickly and at a relatively low cost, or will it impose huge costs and inefficiencies across the country as its contradictions and inadequacies are successively revealed.
I opposed the law when it was passed on the grounds that it represented another rip off of the country’s young people to lower costs for the Boomers and the middle aged. Young men (increasingly the most vulnerable people in a society that cares little or nothing about most of their issues) especially are going to be forced to pay too much for insurance they don’t need. It is their artificially inflated premiums that will provide the money that lets the social engineers of Obamacare play their complex games with the health care system.
Supporters of the program rise to argue that when the young men grow older they will need more care and then they will benefit from cheaper premiums as they in turn are subsidized by the next wave of suckers, excuse me, young people. But Obamacare isn’t fiscally balanced or sustainable; its true costs were disguised by accounting tricks like postponing some of its impacts while collecting its revenues so that the first ten years of the program looked good on Congressional Budget Office scoring sheets.
Cheap tricks might work to befuddle lazy reporters (or allow the ideologically committed to collude in the deception of readers for the greater good), but they won’t pay the bills or stop the inexorable rise in health costs. By the time today’s young people are ready to collect, without the kind of innovation that Obamacare is likely to prevent rather than encourage, the system will have to be curtailed out of financial necessity. The care they get will likely be less generous than the care the first generation in the system gets; this is wrong both from a moral and a policy standpoint.
Our health care policy today needs to begin from the understanding that the system we have today simply cannot serve us ten, twenty or thirty years into the future. In the real world it is impossible to avoid a significant government presence in the health care sector; from veterans’ care to pediatric care to the care of the poor, there are too many reasons why government at some level must ensure care to build a purely private health system.
But our approach to health care must be to create possibilities and incentives for innovation and change, rather than to keep the current system alive by pumping ever growing volumes of money into it. Developing a highly efficient health care system is more important to the country’s future prosperity than all the high speed trains and “green jobs” boondoggles ever dreamed up. It matters more than almost anything else we do. The federal government should be encouraging states to try different approaches rather than nudging them toward standard models. It should be looking to give consumers more power over (and more responsibility for) their own choices in health care. Health care reform must try to do a very short list of things very well; the longer these laws get and the more issues they try to take on, the more lobbyists and special interests are able to twist those laws toward their own limited ends.
Obamacare is not all bad, but it is not close to being an answer to this country’s present and future health care issues. If the Supreme Court finds the law unconstitutional and sends the whole thing back to the Congress to have another try, it will do us all a favor.