(Robert Reich predicts that, if the Court rules against Obamacare's individual mandate, the ultimate outcome may be enactment of the public option. Problems: (1) The health insurance lobby doesn't want to compete in the market against the public option and will use its clout to block it. (2) Obama wasn't serious about the public option, he used it as a bargaining chip in talks with lobbies and discarded the idea in 2009. I'm not sure we can trust Democrats to reintroduce it. (3) If the Supremes rule against the mandate (which we should hope for, contrary to Obama supporters & most progressives), it might be seen as a death knell for health care reform, unless there's strong popular demand for better reform than Obamacare. If so, why bother with the public option when we can demand more comprehensive, far superior Medicare For All? For-profit health insurance companies hate Medicare For All because it puts them out of business; Big Pharma hates it because the Medicare For All administration would have the power to negotiate and bring down drug prices. Who will lead the popular movement for Medicare For All? Certainly not the Democratic Party, which is addicted to money from these lobbies. -- Scott McLarty, Green Party Media Coordinator)
A Back Door to the Public Option
Any day now the Supreme Court will issue its opinion on the constitutionality of the Accountable Care Act, which even the White House now calls Obamacare.
Most high-court observers think it will strike down the individual mandate in the Act that requires almost everyone to buy health insurance, as violating the Commerce Clause of the Constitution — but will leave the rest of the new healthcare law intact.
But the individual mandate is so essential to spreading the risk and cost of health care over the whole population, including younger and healthier people, that some analysts believe a Court decision that nixes the mandate will effectively spell the end of the Act anyway.
Yet it could have exactly the opposite effect. If the Court strikes down the individual mandate, health insurance company lobbyists and executives will swarm Capitol Hill seeking to have the Act amended to remove the requirement that they insure people with pre-existing medical conditions. They’ll argue that without the mandate they can’t afford to cover pre-existing conditions.
But the requirement to cover pre-existing conditions has proven to be so popular with the public that Congress will be reluctant to scrap it.
This opens the way to a political bargain. Insurers might be let off the hook, for example, only if they support allowing every American, including those with pre-existing conditions, to choose Medicare, or something very much like Medicare. In effect, what was known during the debate over the bill as the “public option.”
So in striking down the least popular part of Obamacare - the individual mandate - the Court will inevitaly bring into question one of its most popular parts - coverage of pre-existing conditions. And in so doing, -open alternative ways to maintain that coverage - including ideas, like the public option, that were rejected in favor of the mandate.
The fact is, there’s enough the public likes about Obamacare that if the Court strikes down the individual mandate that won’t be the end. It will just be the end of the first round.