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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Disarming the Attack on the Individual Mandate

In the wake of the Missouri referendum drubbing the individual mandate, TNR‘s Jonathan Chait makes a couple of insightful points and provides an interesting suggestion in his post “What the Individual Mandate Vote Means.” First, on the Missouri vote:

…First of all, Missouri is not a “bellwether” state right now. It (narrowly) supported John McCain in 2008 when the country as a whole backed Barack Obama by 7 percentage points. Second, Tuesday’s election was a low-turnout primary with a massively disproportionate Republican electorate, accounting for two-thirds of all voters.

Chait says the assault on the individual mandate of the health care reform act is the thread which conservatives hope can be tugged to “unravel the whole structure of health care reform” and he designates it “the Leninist plan to collapse the system.” But Chait also explains that conservatives and insurers don’t really want to pull the plug on the individual mandate, which is the financial foundation of the act, and leave everything else in place, in which case the reform law would likely morph into a single payer system.
Chait also suggests that reform supporters consider an interesting proposal in a New York Times op-ed by Paul Starr, author of The Social Transformation of American Medicine. As Starr Explains, quoted by Chait:

…Let individuals opt out of the new insurance system, without a penalty, by signing a form on their tax return acknowledging that they would then be ineligible for federal health insurance subsidies for a fixed period — say, five years.
During that time, if they had second thoughts and decided to buy health insurance, they would have no guarantee that they could find a policy or that it would cover pre-existing conditions. In other words, they would face a market much like the one that exists now. And while that’s hardly a desirable position to be in, they would have made the decision themselves, and the option to step outside the system would relieve Republican concerns about government mandates.

As Chait concludes, “Democrats should work on implementing Starr’s idea. It’s better than having endless political fights over the single least popular aspect of the Affordable Care Act.” Looking at an even bigger picture, it’s a great example of the type of thoughtful modification of a progressive reform that does no damage, but minimizes public resistance. Dems need more of this kind of thinking.

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