The Individual Mandate as Sleight-of-Hand

The individual mandate is a rhetorical device. To pay for a new health entitlement, we need to impose a tax. But to mask the cost of the new health entitlement, the president and his allies chose a more complex structure. That’s really all there is to it. The federal government can very easily offer everyone health insurance, and it can offer a choice of private insurance providers through an exchange. This is roughly what happens in a number of advanced market democracies. Yet if the individual mandate is found unconstitutional, the federal government will have to do this through a more transparent and coherent vehicle.

Richard Epstein has more on this subject here at NRO:

So the argument now has to be that the only way to fund this is out of general revenues, not out of selective charges against those who do not wish to join in the system. As a matter of political theory, there is no clear rule that says if X group is entitled to the subsidy, we can somehow identify the Y group who is duty bound to pay it. So as a normative matter, it is hard to explain why the individual mandate has to be the flip side of the subsidy when general taxes are still available.

And who believes that taxpayers, many of them stretched to the limit by the need to pay down debt, will favor the creation of an expensive new health entitlement when there are other options, e.g., channeling the employer tax exclusion towards a tax credit for the purchase of catastrophic coverage?

There are some writers, including Matt Miller of the Washington Post, who insist that the individual mandate is essential to the preservation of a private insurance system. But one wonders if a system centered around an individual mandate is any more private than a system in which public dollars are used to purchase insurance from various private providers. As I understand it, food stamps haven’t destroyed the private marketplace for foodstuffs. And it’s not obvious that a system in which the poor are subject to a “food mandate” that they’d meet with the aid of public subsidies would be any more private.

(It’s fun to think through the structure of this “food mandate.” All households would have to purchase at least $5,000 worth of food every year, with various lobbies and pressure groups insisting that $3,000 be devoted to, say, dairy or high-fructose corn syrup. Affluent “young invincibles” who would normally live on a meager diet of root vegetables would thus cross-subsidize more enthusiastic consumers of processed foods. The federal government would close the gap for low-income households. Supermarkets would come out as the big winners, I assume.)

I can’t for the life of me figure out the difference, except that one is clearer about the actual role of government.

Reihan Salam — Reihan Salam is executive editor of National Review and a National Review Institute policy fellow.

Most Popular

Immigration

My American Dream

This morning, at 8 a.m., I did something I’ve wanted to do for as long as I can remember: I became an American. I first applied for a visa in early 2011, and since then I have slowly worked my way through the system — first as a visa-holder, then as a permanent resident (green card), and, finally, as a ... Read More
U.S.

The Gun-Control Debate Could Break America

Last night, the nation witnessed what looked a lot like an extended version of the famous “two minutes hate” from George Orwell’s novel 1984. During a CNN town hall on gun control, a furious crowd of Americans jeered at two conservatives, Marco Rubio and Dana Loesch, who stood in defense of the Second ... Read More
Religion

Billy Graham: Neither Prophet nor Theologian

Asked in 1972 if he believed in miracles, Billy Graham answered: Yes, Jesus performed some and there are many "miracles around us today, including television and airplanes." Graham was no theologian. Neither was he a prophet. Jesus said "a prophet hath no honor in his own country." Prophets take adversarial ... Read More
Film & TV

Why We Can’t Have Wakanda

SPOILERS AHEAD Black Panther is a really good movie that lives up to the hype in just about every way. Surely someone at Marvel Studios had an early doubt, reading the script and thinking: “Wait, we’re going to have hundreds of African warriors in brightly colored tribal garb, using ancient weapons, ... Read More
Law & the Courts

Obstruction Confusions

In his Lawfare critique of one of my several columns about the purported obstruction case against President Trump, Gabriel Schoenfeld loses me — as I suspect he will lose others — when he says of himself, “I do not think I am Trump-deranged.” Gabe graciously expresses fondness for me, and the feeling is ... Read More