Political Animal


June 28, 2012 9:24 AM The Abandoned Consensus for Universal Health Coverage

By Ed Kilgore

As we await the word—or more likely, many words—from the Supreme Court about the constitutionality of the Affordable Care Act, I strongly recommend Ezra Klein’s latest Bloomberg column, which offers a poignant reminder of how quickly, massively, and recently we lost a bipartisan consensus that every American ought to have health insurance:

Democrats and Republicans used to argue over how best to achieve universal coverage, but both agreed on the goal. The first president to propose a serious universal health-care plan was Harry Truman, a Democrat. The second was Richard Nixon, a Republican. In the 1990s, when President Bill Clinton was arguing for a national health-care system based on an employer mandate, Republicans were arguing for one based on an individual mandate.
In the 2000s, Romney used the individual mandate to make Massachusetts the first state to actually achieve near-universal coverage. On the national level, Republicans as diverse as Newt Gingrich, Lamar Alexander and Lott joined him. Republicans sometimes like to present their support for the individual mandate as a youthful indiscretion, but as late as June 2009, Charles Grassley, the ranking Republican on the Senate Finance Committee, was telling Fox News that “there is a bipartisan consensus to have an individual mandate.”
Today, Romney touts a health-care plan, to the extent he has one, that would almost certainly lead to reduced insurance coverage. He wants to repeal the Affordable Care Act, cutting loose 31 million Americans who are expected to gain coverage under the law. Then he wants to drastically cut Medicaid spending by turning it over to the states and capping the growth of federal contributions. The Urban Institute estimates that such a policy would cause 14 million to 19 million Americans to lose Medicaid coverage.
This, perhaps, is one of the clearest differences between the Republicans and Democrats in this election: health insurance for 45 million to 50 million people.

Today’s decision could have, should have been of primarily academic interest, requiring at most a redesign of the Affordable Care Act, instead of representing a life-or-death turning point for millions of Americans. Thanks to the unilateral Republican abandonment of the goal of universal health coverage, we face the sobering possibility that today will be remembered as the high-water mark for the uninsured, never to be achieved again. It really didn’t have to be that way.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.


  • boatboy_srq on June 28, 2012 9:30 AM:

    It would seem that God's Own Party is rewriting Scripture again: the wages of sin is untreated illness.

    Captcha: Fare uestitis. I suppose that's the original Latin for it.

  • Peter C on June 28, 2012 9:41 AM:

    Given both their current stand and their willingness to turn against previous stands with vehemence, I think there is more support needed for the case that Republicans EVER wanted universal health care coverage. They clearly wanted something other than the Clinton plan, and back then, they needed to propose an alternative (instead of just making up 'death panels' and having tea-baggers shout "keep your hands off my Medicare"), but I think an equally strong case can be made that they NEVER wanted universal coverage; they just wanted to stop any Democratic reform. Health reform is not in the interest of the 1%; it gives the 99% too much freedom.

  • stormskies on June 28, 2012 9:43 AM:

    I would say the wages of sin are purposeful lying and baring false witness. Welcome to the Repiglican party and they cheer on and stamp their feet in agreement. The end justifies the means they squeak, and then go to their churches and cross themselves.

  • schtick on June 28, 2012 10:05 AM:

    The tealiban is no longer hiding what a selfish, greedy, and distructive party they are to get what THEY want at any and all costs. Anyone that thinks they care about this country is very very naive and the tealiban SCOTUS is a great example.

  • T2 on June 28, 2012 10:09 AM:

    if you asked Americans a straight question: Would you like free healthcare?
    I believe most would say yes...how/why do I think this? Nobody rejects Medicare - everybody signs up for it. When the GOP takes that away, lots of people are going to wake up one morning and say "shit, I shouldn't have voted for them - I"m screwed".
    Too bad.

  • c u n d gulag on June 28, 2012 10:09 AM:

    As I mentioned yesterday, 2 of the 3 defining characteristics of the base of Modern Conservatism are cruelty, and a sense of superiority.

    And today's Republicans have had to adapt to the Frankenstein Monster they've created - which started when they attacked Clinton over Whitewater, and tired to impeach him, then, when they attacked and occupied a county needlessly, defended torture and rendition, spied on citizens, and let loose the old John Birch and KKK elements with the Tea Partiers.

    Now, to win their primary, to even get to a general election, whether in their District, the State, or for President, they have to appeal to their cruel and superior-feeling base.

    And, that they should now be against Health Care for almost everyone should come as no surprise.
    They love to see other people hurt and in pain.
    And they love feeling superior to them.

    And if they're one of the millions of rubes, marks, dupes, gullible morons, or total feckin' idjits, who are taken in by the rhetoric but don't themselves have coverage of their own, they can always fall back on the salve that will make them feel healed, no matter how bad things are for them - the 3rd of the 3 defining characteristics of Modern Conservatism:
    "So anything and everything that pisses off the Liberals and Progressives, and the Centrist Democrats that represent them! - To be adjusted, whenever needed, so no consistency is required."

    There is more of a perverse joy in these people in keeping something from others, than in enjoying the fruits of that thing themselves.

    Conservatism is a mental disease - just one step removed from the psychology of people who commit murder-suicides.
    "HA! I killed him/her!!! Now I don't care what happens to me. I GOT MY REVENGE!!!!!"

  • jjm on June 28, 2012 10:15 AM:

    Upheld the whole thing -- this just in on SCOTUSBLOG.

  • T2 on June 28, 2012 10:24 AM:

    5-4. the vote count was what we expected. The outcome, not so much. Somewhere out there, Michelle Bachmann is melting.

  • castanea on June 28, 2012 10:26 AM:

    Hot damn. That's gotta sting the rightwing. Makes me want to ring a bell and buy a round for the house.

  • T2 on June 28, 2012 10:30 AM:

    I think we can now officially consider Justice Kennedy a rightie.

  • Neil Bates on June 28, 2012 10:53 AM:

    I'm relieved on practical grounds and basically agree with the decision, yet did respect that the constitutionality of some provisions of ACA were at least debatable IMHO ("reasonable people could disagree".)

    Some points of order, moot now but in retrospect:
    1. The penalty for not buying insurance under ACA is to pay extra tax, not a "fine". That isn't just semantics, it means you didn't violate a statute and so don't have criminal law sanction against you. That legal distinction is very relevant to the argument SCOTUS is considering.
    2. The point of targeting "health" in particular, is the liability (from basic human decency, right? So maybe even Ted Nugent could get an inkling ...) to take care of people who collapse in the street etc. That means spending money on them for that purpose, it is therefore *not* the same as just "help somebody else out in dire straights so buy yadda". In fact, the whole point is not to help the providers, but to cover *us* for being on the hook for the freeloading users of emergency health care etc.
    3. This mandate idea originally came from conservatives, it is like Romneycare in Mass. (!), and if Republicans hadn't opposed the public option, we would have had something like extended Medicare for all. Well that was their fault and that of insurance lobbyists (who wanted the business and to hell with legal principle, such as it is), not liberals; who wanted the PO.
    4. It may be that Roberts was looking out for insurance company profits and not constitutionality. Maybe cynics of left, right, and center can agree to be suspicious of his and others' motivations.

    I got tired of having to explain these key points over and over to conservatives/libertarians/Fox viewers/whomever, who don't really try to learn what's behind all this and just accept the misleading talking points of right-wing ACA critics. (The "left-wing" ones have the valid complaint, we could have gone to PO instead.)


  • tcinaz on June 28, 2012 1:03 PM:

    My hope and actual expectation is that this is just a beginning. I've lived long enough to see signature programs like Social Security, Medicare, and Civil Rights expand in positive and progressive directions once they have become embedded in the culture. And even extensive well-funded efforts on the right to reverse or retard this expansion have failed. So may it be with Obamacare. Obama's new motto should change from "Hope and Change" to "Obama Cares".

  • Samantha Prabhu on January 17, 2013 5:38 AM:

    These post seemed little bit weird to me at starting but as i have been into the post for about 2-3 lines then i found it very informative and interesting !