The new health care law does a lot of things. In fact, it does so many things that most Americans don’t know the majority of the things it does (or will do). But there are some things that are “hot button” issues. Things that are in the law that are easy to communicate, easy to understand, and easy to form an opinion about. One of those things is the individual mandate–the requirement that everyone have health insurance that meets or exceeds a federally defined minimum standard benefit level. Personally, I think that’s a great thing, and getting everyone into the system makes it possible to implement a wider range of much needed reforms. So long as people have the option of going without coverage, there’s a leak at the bottom of the lifeboat. First plug the hull, then focus on getting the boat to shore.
But, for many other people, the individual mandate means things like “loss of freedom,” “inability to choose,” “something else I have to figure out how to pay for,” and so on. I know plenty of people who are in this position and I wouldn’t deny the legitimacy of their concerns for a moment. I do think that the law has made provisions to minimize the burden of the mandate, but there will inevitably be people at the margins who will feel more pressure than others until Congress works out the kinks over time. That’s incrementalism, and it’s how we typically pass laws to improve programs in this country.
On the other hand, there is a non-ignorable group of people pushing for a total repeal of the health care law. Or, at the very least, a ruling by the Supreme Court that an individual mandate is unconstitutional. Drawing on the opinions of a number of Constitutional scholars, I don’t think that this is a very likely scenario, but that’s not the same thing as saying that it’s impossible. So, that raises the question of what would happen if the highest court in the land did strike the individual mandate down. Megan McArdle takes a close look at this in a piece in The Atlantic. More or less it looks like such a move would greatly polarize the debate going forward, leaving us with our hands tied as we try to fix our current system without the means of “fixing the hole in the lifeboat” or going fully in the other direction–single payer–which might be the cause of Congressional Armageddon.