Jenkins: ObamaCare—Upheld and Doomed
Regardless of the Supreme Court, fiscal reality will prevail.
Fans
of ObamaCare must be busting a gut three times over. The mandate that
conservatives now hate was originally a conservative proposal. In
upholding it, Chief Justice John Roberts followed President Obama's Rose
Garden instructions to the letter: The Court must find an act
constitutional if it happens to be the signature act of a president
running for re-election.
Worse, in doing so, he may have read any constitutional limit on Congress out of the Constitution while pretending to do the opposite. Congress cannot compel you to do anything Congress wishes, but it can impose taxes on you until you finally have no rational alternative but to do whatever Congress wishes.
History will judge whether Mr. Roberts saved the reputation of the court or lost his nerve. Many conservatives obviously suspect the latter. Resolved: The government cannot make you eat broccoli, though it may levy a non-broccoli-eating tax on any who refuse.
Associated Press
What's more—and save us your constitutional brickbats—the mandate's survival could actually be a convenience to those who remain seriously interested in fixing health care.
GOPers, including Mitt Romney, immediately adopted "repeal" as their mantra. But repealing ObamaCare would just leave us with the health-care system we have, which is already ObamaCare in many respects—an unsustainable set of subsidies bankrupting the nation.
The solution is a tweak. Republicans already are lip-committed to a national health-insurance charter that allows insurers to design their own policies and market them across state lines. Republicans are also lip-committed to a tax reform to equalize the tax treatment of health care whether purchased by individuals or by employers on behalf of individuals.
Now just modify the Affordable Care Act so buying any health policy authorized by the new charter, no matter how minimalist, satisfies the employer and individual mandate.
What would follow is a boom in low-cost, high-deductible plans that leave individuals in charge of managing most of their ordinary health-care costs out of pocket. Because it would be cheap, millions who would opt not to buy coverage will buy coverage. Because it will be cheap, companies will direct their low-wage and entry-level employees to this coverage.
Now these workers will be covered for serious illness or injury, getting the rest of us off the hook. As they grow older, wealthier and start families, they will choose more extensive but still rationally limited coverage. Meanwhile, the giant subsidies ObamaCare would dish out to help the middle class afford ObamaCare's gold-plated mandatory coverage would be unneeded.
With consumers shouldering a bigger share of health expenses directly, hospital and doctors would discover the advantages of competing on price and quality. This way lies salvation. In the long run, whatever share of GDP society decides to allocate to health care, it will get its money's worth—the fundamental problem today.
Perhaps a not-discreditable sense of the political moment lies behind the chief justice's opinion after all. The court's job, he wrote, is not to "protect the people from the consequences of their political choices."
He may have meant: The chief justice's job is to get the court out of the way while the body politic still remains suspended between recognizing the unsustainabilty of the current welfare model and deciding what to do about it.
This was always the fatal problem of ObamaCare. Reality could not have instructed President Obama more plainly: The last thing we needed, in a country staggering under deficits and debt, a sluggish economy and an unaffordable entitlement structure, was a new Rube Goldberg entitlement. The last thing we needed was ObamaCare. The nation and the times were asking Mr. Obama to reform health care, not to double-down on everything wrong with the current system.
Even with this week's Court success, he failed—and it's not as if there wasn't a deep well of policy understanding in Washington that he could have drawn on to take the country in a better direction. Regardless of any Supreme Court ruling, reality will pass its own judgment on the Affordable Care Act and it won't be favorable.
Worse, in doing so, he may have read any constitutional limit on Congress out of the Constitution while pretending to do the opposite. Congress cannot compel you to do anything Congress wishes, but it can impose taxes on you until you finally have no rational alternative but to do whatever Congress wishes.
History will judge whether Mr. Roberts saved the reputation of the court or lost his nerve. Many conservatives obviously suspect the latter. Resolved: The government cannot make you eat broccoli, though it may levy a non-broccoli-eating tax on any who refuse.
Associated Press
The Supreme Court in Washington
Yet he
may also think—and would not be wrong to think—that ObamaCare is doomed
in any case. His opinion makes clearer than ever that ObamaCare is a tax
program—throwing more tax dollars at an unreformed health-care system.
ObamaCare is a huge new entitlement in a nation laboring under
commitments it already can't afford. Those who gripe that he just
authorized a vast expansion of the welfare state haven't reckoned with
this fiscal reality principle.What's more—and save us your constitutional brickbats—the mandate's survival could actually be a convenience to those who remain seriously interested in fixing health care.
GOPers, including Mitt Romney, immediately adopted "repeal" as their mantra. But repealing ObamaCare would just leave us with the health-care system we have, which is already ObamaCare in many respects—an unsustainable set of subsidies bankrupting the nation.
The solution is a tweak. Republicans already are lip-committed to a national health-insurance charter that allows insurers to design their own policies and market them across state lines. Republicans are also lip-committed to a tax reform to equalize the tax treatment of health care whether purchased by individuals or by employers on behalf of individuals.
Now just modify the Affordable Care Act so buying any health policy authorized by the new charter, no matter how minimalist, satisfies the employer and individual mandate.
What would follow is a boom in low-cost, high-deductible plans that leave individuals in charge of managing most of their ordinary health-care costs out of pocket. Because it would be cheap, millions who would opt not to buy coverage will buy coverage. Because it will be cheap, companies will direct their low-wage and entry-level employees to this coverage.
Now these workers will be covered for serious illness or injury, getting the rest of us off the hook. As they grow older, wealthier and start families, they will choose more extensive but still rationally limited coverage. Meanwhile, the giant subsidies ObamaCare would dish out to help the middle class afford ObamaCare's gold-plated mandatory coverage would be unneeded.
With consumers shouldering a bigger share of health expenses directly, hospital and doctors would discover the advantages of competing on price and quality. This way lies salvation. In the long run, whatever share of GDP society decides to allocate to health care, it will get its money's worth—the fundamental problem today.
Perhaps a not-discreditable sense of the political moment lies behind the chief justice's opinion after all. The court's job, he wrote, is not to "protect the people from the consequences of their political choices."
He may have meant: The chief justice's job is to get the court out of the way while the body politic still remains suspended between recognizing the unsustainabilty of the current welfare model and deciding what to do about it.
This was always the fatal problem of ObamaCare. Reality could not have instructed President Obama more plainly: The last thing we needed, in a country staggering under deficits and debt, a sluggish economy and an unaffordable entitlement structure, was a new Rube Goldberg entitlement. The last thing we needed was ObamaCare. The nation and the times were asking Mr. Obama to reform health care, not to double-down on everything wrong with the current system.
Even with this week's Court success, he failed—and it's not as if there wasn't a deep well of policy understanding in Washington that he could have drawn on to take the country in a better direction. Regardless of any Supreme Court ruling, reality will pass its own judgment on the Affordable Care Act and it won't be favorable.
A version of this article appeared June 30,
2012, on page A15 in the U.S. edition of The Wall Street Journal, with
the headline: ObamaCare: Upheld and Doomed.
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