On Health Care, Repeal or Reform Lead to Same Result

Heading into the 2014 elections, some Democrats think they have found a way to minimize the political fallout from the president’s health care law. They have convinced themselves that voters are more interested in fixing the law rather than repealing it. A few even believe that Obamacare may someday be popular with voters.


Rhetorically, they may be right (if a bit overoptimistic) in the narrow setting of midterm elections.

It is certainly true that a Democrat calling for mending the health care law rather than ending it will fare better than one who enthusiastically supports the status quo. In some states and districts, the mend-don’t-end approach will be more appealing than the repeal-and-replace rhetoric coming from the Republican Party.

Substantively, however, a Democratic campaign based upon fixing the health care law is a white flag of surrender acknowledging that Obamacare will never go into effect the way the president dreamed. Other than rhetoric, there is little difference between GOP calls for repeal and the kind of fix that would make the law popular and workable.

The key is the individual mandate.

It’s the most unpopular part of the law mainly because most Americans instinctively feel that there’s something wrong with the government forcing citizens to buy something. That’s especially true when they’re forced to buy from a large insurance company that helped write the rules.

Defenders of the law prefer to call it an “individual shared responsibility payment.” In their framing, it’s not so much a mandate as a way of treating your neighbors fairly. The thinking goes that if someone without insurance gets in an accident or is diagnosed with cancer, the rest of us get stuck with the tab.

That sounds pretty reasonable. Being responsible for paying your bills is all-American and something to be encouraged. If that were what the law actually did, it wouldn’t be so hated.

Unfortunately, instead of sticking to that basic concept, the president mandated all kinds of things beyond what is necessary to protect society from irresponsible neighbors. For example, it’s a bit bizarre to force people without children to pay for pediatric care insurance. Those add-ons to the mandate limit personal choice and dramatically drive up the cost of insurance.

It is on this point that the difference between mending and ending the health care law fades away.

The law will never become popular and workable until the individual mandate is fixed or repealed. Fixing it would mean stripping away all the add-on requirements in the current law. A minimal mandate, requiring purchase only of an inexpensive catastrophic care plan, would protect society at large but give individuals many more options.

The problem for President Barack Obama, however, is what will happen after the mandate is fixed. Essentially, it would remove both insurance companies and the government from the driver’s seat to put consumers in charge. As consumers exercised their power, it would spur innovation in the health care field and undermine the top-down control at the core of Obamacare.

That’s the dilemma facing the Democrats. To survive the election, they will call for fixing the health care law rather than repealing it. After the election, they will have to deal with the reality that there is little difference between fixing and repealing. Substantively, mending Obamacare will end it.

Also see,

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