The policy questions behind the legal questions
By Ezra Klein
WashPost
Some of the legal questions related to the individual mandate are, at least partially, policy questions. In particular, what does the individual mandate do? And can the law stand without it?
The argument conservatives are making right now is that the individual mandate regulates "economic inactivity." That's not a description anyone had heard of it back when conservatives were co-sponsoring bills with the individual mandate, and it's not what the policy's creator had in mind when he developed it. But that doesn't make it untrue.
To believe it, however, you need to adopt a very narrow definition of what's being affected here: Namely, the decision to purchase or not purchase health-care insurance. The more traditional view is that the individual mandate is one of a slew of rules and regulations bringing order to something much broader: The American health-care system, which all of us participate in. That's the view of the 38 health economists and academics who signed this brief (pdf). "There is no such thing as 'inactivity' or non-participation in the health care market," they wrote. "As the District Court" -- which ruled for the Affordable Care Act -- "recognized, virtually all Americans will, at some time during their life, require health care, either because of illness, accident, or the wear and tear of age."
Because health services are so expensive, the costs are defrayed over many years. That's what insurance does. And because we are a humane society, we have rules and regulations in place to ensure that people can get treated even if they don't have insurance. In that way, you may not be interested in the health-care system, but if you get hit by a bus, the health-care system is interested in you -- and that's true even though you weren't making an economic choice to become "active" in the health-care system when you stepped into the street. You were, by virtue of our laws and regulations and taxes, already an active participant. The authors of the brief make this point -- and its connection to the individual mandate -- well:
(More here.)
WashPost
Some of the legal questions related to the individual mandate are, at least partially, policy questions. In particular, what does the individual mandate do? And can the law stand without it?
The argument conservatives are making right now is that the individual mandate regulates "economic inactivity." That's not a description anyone had heard of it back when conservatives were co-sponsoring bills with the individual mandate, and it's not what the policy's creator had in mind when he developed it. But that doesn't make it untrue.
To believe it, however, you need to adopt a very narrow definition of what's being affected here: Namely, the decision to purchase or not purchase health-care insurance. The more traditional view is that the individual mandate is one of a slew of rules and regulations bringing order to something much broader: The American health-care system, which all of us participate in. That's the view of the 38 health economists and academics who signed this brief (pdf). "There is no such thing as 'inactivity' or non-participation in the health care market," they wrote. "As the District Court" -- which ruled for the Affordable Care Act -- "recognized, virtually all Americans will, at some time during their life, require health care, either because of illness, accident, or the wear and tear of age."
Because health services are so expensive, the costs are defrayed over many years. That's what insurance does. And because we are a humane society, we have rules and regulations in place to ensure that people can get treated even if they don't have insurance. In that way, you may not be interested in the health-care system, but if you get hit by a bus, the health-care system is interested in you -- and that's true even though you weren't making an economic choice to become "active" in the health-care system when you stepped into the street. You were, by virtue of our laws and regulations and taxes, already an active participant. The authors of the brief make this point -- and its connection to the individual mandate -- well:
(More here.)
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