Obamacare: Forcing Soufflé on Everyone


Allen in "Love and Death

Film Friday

Like many liberals who were excited when Congress passed something approaching comprehensive healthcare, I have been riveted over whether the Supreme Court will find Obamacare’s public mandate unconsitutional. There is irony in the fact that conservative justices may throw it out since the mandate was originally a conservative idea designed to involve private insurance companies (not just the federal government) in making sure that all Americans are insured.

Another irony is that, if the justices do find the mandate unconstitutional, then an alternative is doing what liberals have wanted to do all along: expand Medicare to include all Americans and cut out private insurance companies altogether. Timothy Noah of The New Republic, who likes this idea, invoked a scene from Woody Allen’s Love and Death at the thought:

The professional Obama-hater Dick Morris said today on Fox News that if President Obama is elected to a second term after the Supreme Court strikes down Obamacare (as is looking more likely) then “he’ll move to a single payer system.” Morris elaborated: “I think the Supreme Court decision—that I expect—will throw out this mandate, but single payer of course is legal under the taxing authority. Total socialized medicine….”

Jeez, that would be terrible! Morris reminds me of the Russian sergeant in Woody Allen’s Love and Death. “Imagine your loved ones conquered by Napoleon and forced to live under French rule!” he exhorts.
“Do you want them to eat that rich food and those heavy sauces?”
“No!”
“Do you want them to have soufflé every meal and croissant?”
“No!”

Ezra Klein of the Washington Post strikes a more serious note.  Even if we evolved to a single payer system, he writes, it would be years away and in the meantime those thirty million who were about to get insurance would instead remain uninsured.  Furthermore, those with preexisting conditions would again lose out, as would twenty-somethings on their parents’ plans.  The way insurance works, if the companies can’t get everyone into the pool, they can’t afford to cover these cases. The Solicitor General tried to argue this throughout this past week’s hearings but the conservative justices seemed unmoved.

Antonin Scalia, who led the charge against Obamacare, appeared at times to question whether society had any obligation at all to society’s poor and sick, sounding a bit like Scrooge or like Potter from It’s a Wonderful Life.  When the Solicitor General noted that society currently allows people to get health care whether or not they have paid for it (emergency rooms are not allowed to turn patients away), Scalia retorted,”well, don’t obligate yourself to that.” (I guess this means he is saying hospitals should start turning people away.) Anthony Kennedy, meanwhile, said that we have no obligation to stop a blind man from walking in front of a car.

From a financial point of view, those of us who are healthy and insured would benefit if we stopped looking out for these others. After all, our premiums would go down.

Then again, under Obamacare, the rising costs of health care would slow because emergency room free riders would be removed from the equation.

I can’t help but see Obama as George Bailey in It’s a Wonderful Life. He thought he had passed legislation that would serve millions of Americans while cementing his legacy (for George, his legacy is the way his bank helps his town), only to run up against a miserly old man. When things go wrong and George turns to Potter for help, the banker gloats,

Look at you. You used to be so cocky. You were going to go out and conquer the world. You once called me a warped, frustrated, old man! What are you but a warped, frustrated young man? A miserable little clerk crawling in here on your hands and knees and begging for help. No securities, no stocks, no bonds. Nothin’ but a miserable little $500 equity in a life insurance policy. You’re worth more dead than alive! Why don’t you go to the riffraff you love so much and ask them to let you have $8,000?

I don’t know if the Obama administration was cocky going into the Supreme Court hearings, but the Solicitor General certainly seemed unprepared for the questions he got. There he was, without much leverage, trying to save Obama’s signature accomplishment as the conservative justices raked him over the coals.

In the miraculous end of the movie, George Bailey’s community does what America, at its best, has always done: it comes together and helps out one of its members who is in trouble. That’s what Obamacare is really about: helping those who need help. The Supreme Court could uphold the spirit of community by ruling in favor of the mandate.

If it doesn’t, Potter will have won.

Addendum – Here’s another film allusion, this one to Star Wars, where Jonathan Chait looks for silver linings for liberals should the mandate be struck down. He doesn’t find any and is less optimistic than Noah:

A somewhat more plausible source of comfort is the prospect that, with the moderate, Republican-designed plan now off the table, Democrats can focus on the one remaining legal avenue to solve the health-care crisis: a single-payer system, like Medicare. This is sort of the liberal Obi-Wan Kenobi option [where, in his duel with Darth Vadar, he says, “If you strike me down, I will become more powerful than you ever imagined.”]

In assessing this option, it’s worth bearing in mind that the dead Obi-Wan did not, in fact, become more powerful than Darth Vader could possibly imagine. His new powers seemed limited to appearing as an apparition offering inscrutable advice to Luke Skywalker, whereas the previous, alive version featured the power to slice people’s arms off with a light saber.

So liberals definitely don’t want the Supreme Court to strike down the law. If the Court strikes down just the individual mandate, the best option is to find a way to patch up that feature over time, which would involve Obama winning reelection and gaining some leverage over the Republicans in Congress.

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