No portion of the law can stand if the individual insurance mandate — which requires all Americans to secure private insurance policies by 2014, or face an annual penalty — is removed. Doing so is like removing the central pillar of a tower: Take out that piece, and the whole structure comes crashing down. This includes, but isn't limited to, the following provisions aimed at insurance providers:
- The ban on denying coverage on the basis of pre-existing medical conditions, or dropping coverage when a policyholder becomes sick;
- The ban on imposing annual or lifetime caps on essential benefits;
- The ban on imposing co-pays or deductibles on preventive care;
- The stipulation that young adults can stay on their parents' coverage until age 26.
It's politically profitable for Republicans to wage the infantile, vacuous, "but we don't wanna and you can't make us" tantrum that riles up the base in regard to the mandate. Profitable for them, maybe, but costly beyond measure for everyone else — most of all, for Americans who stand to gain the most from a law designed to protect them against the abusive, exploitative practices of the players in a for-profit industry.
Ultimately, we need to remove that profit motive, because access to affordable health care is a hallmark of a civilized society, and as long as there's an incentive to take advantage of other people to make lots of money, that objective will never be achieved. To do so, we need a single-payer, universal-access system that's funded by taxes — just like so many of the other civil and social services we enjoy without regard for our ability to pay for them individually.
Understandably, supporters of the individual insurance mandate never want to advertise it as a tax, because we all know how much Americans hate taxes. But if it helps to frame it that way to make sense of what's at stake here, try this on for size:
Imagine that paying taxes was optional, and you paid yours without hesitation because you felt that it was your civic duty. But others who freely use the services and enjoy the benefits that those taxes help fund don't pay theirs. After all, there's no law saying they have to, and they're not about to let the government tell them how to spend their money — or where.
As a result, your taxes increase each year to compensate for the freeloaders. Eventually, they get so high that you can't possibly afford them, even if you want to. You become a freeloader yourself, despite your sincere desire to do the responsible thing. So do countless others for the same reason.
Is this a sustainable system? Would it be long before the services that those optional taxes funded became unaffordable to all but the wealthy?
So it is with our health care system. Every single American will use it at points throughout his or her life — but not everyone will pay into it, and it's largely unregulated (up until now), so it's become an unaffordable mess that will ultimately bankrupt this country if the reform bill is not kept intact.
Again, we need to take the profit motive out of the equation altogether. But I'm a big believer in the politics of the possible — and if the current law represents that, then I'm on board with it 100 percent.
The Supreme Court will be doing a terribly destructive disservice to this nation if they compromise the Affordable Care Act this month, as I expect them to do.