Obama’s victim in this drama is a near-mythical figure: The American free-rider, that rugged individualist who doesn’t want health insurance and chafes at the government order to get it. It’s like being forced to eat your broccoli, he scowls, when steak and a beer are plenty.
Public policy doesn’t fit on a bumper sticker.
But most people don’t get fired up by in-depth discussions of insurance exchanges, payment reform and health economics. Believe me, I’ve tried.
Politics runs on emotion and the invocation of values. Thus, a complicated rearrangement of health insurance regulations has been turned into a simple contest between freedom and tyranny.
Tyranny, of course, appears in the person of Barack Obama, who has been painted for years by the opposition as a usurper of the Constitution and a threat to individual rights.
Obama’s victim in this drama is a near-mythical figure: The American free-rider, that rugged individualist who doesn’t want health insurance and chafes at the government order to get it. It’s like being forced to eat your broccoli, he scowls, when steak and beer are a plenty.
His motto: Live uninsured or die.
I haven’t met the free-rider. The people I’ve known who couldn’t get or couldn’t afford health insurance considered it a scary problem, not a badge of honor.
But I’ve heard from plenty of people who wouldn’t think of going a day without health insurance, yet they are caught up in the free-rider’s struggle to stay uninsured. I’ve argued with people on Medicare –– whose access to subsidized health insurance is secure for the rest of their lives –– who talk like they are ready to overthrow the government on his behalf.
Tyrant Obama wields either a penalty or a tax — neither Obama nor Mitt Romney seem to be able to make up their minds on which it is, though Chief Justice John Roberts seems pretty sure it’s a tax.
Before I go further, I’d like to say that the kerfuffle over whether it’s a penalty or a tax is one of the sillier of many silly health care reform arguments. You can call it a tax, a penalty or a rutabaga — not so far off, since many confuse it with broccoli — and the individual mandate is the same thing. It’s what people must pay if they can afford to purchase health insurance but refuse to pony up.
Compulsory insurance isn’t exactly a radical concept. Most states require auto insurance because it’s the best way to make people responsible for the damage they can do behind the wheel. But the opposition has turned the battle against the individual mandate into a matter of truth, justice and the unalienable right to not purchase health insurance and let the taxpayers pick up the free-rider’s emergency room bills.
The opposition could have come up with other victims of the Affordable Care Act. The individual mandate penalty, projected to bring in $27 billion over 10 years, is one of the smaller of the new taxes in the ACA. There’s a tax on medical equipment sales, a tax on “Cadillac” health plans, a Medicare tax increase and higher taxes on investment income for high earners, a tax on health insurers. There’s even a 10 percent tax on indoor tanning salons.
The opposition could have made “Tanning Mom” the face of Obama’s health care tyranny, but the mythical free-rider got the job.
Maybe it’s the name. “Free-rider” has a romantic feel to it. He rides through the West on his Harley, fearless and free, unconcerned about the cost of putting him back together when his Harley meets a tree.
Thanks to the tyrant Obama, he’ll find out that freedom isn’t free. Under the ACA, he’ll have to pay at least $95 extra on his taxes the first year. By 2016, the penalty rises to $695, or 2.5 percent of his income, whichever is greater, with exemptions for various special circumstances. Try getting that on a bumper sticker.
The opposition is billing the mandate as a huge tax on the middle class, but few in the middle class will have to pay it, with estimates running from 4 million to 8 million free-riders.
Most of the new taxes in the ACA aren’t aimed at the middle class at all. Altogether, they add up to $525 billion over 10 years, the Congressional Budget Office estimates. A lot of money –– and, no, it’s not the biggest tax increase in U.S. history, as some in the opposition have claimed. As a percentage of GDP, it’s the 10th biggest since 1951, about the size of the tax hike Bill Clinton signed in 1993.
Reasonable people of all political persuasions see the individual mandate in moderate terms. Here in Massachusetts, where those who refuse to buy insurance have been subject to a small penalty tax for years, it’s generally seen as no big deal.
The health care “takeover” the rest of the country seems so worried about has worked pretty well here in the Bay State. Most of us have the same insurance and the same doctors we had in 2006. About 98 percent of residents now have health insurance, and the folks I know who got coverage through health care reform are pretty happy about it. The program’s costs have come within expectations, and premium increases here have trailed the national average.
By about a two-to-one margin in the polls, Massachusetts residents like health care reform, a number that would likely be higher if it weren’t for the polarization over the issue in national politics. Even the free-riders aren’t complaining.
“Using tax penalties, as we did, or tax credits, as others have proposed,” the governor who signed that legislation wrote, “encourages ‘free riders’ to take responsibility for themselves rather than pass their medical costs on to others.”
That would be the former Mitt Romney speaking. The current Mitt Romney is the champion of the free-riders. If he’s elected president, he says at every opportunity, he’ll “repeal” (presidents can’t really repeal laws, but it fits better on the bumper sticker) the individual mandate and everything else in Obamacare.
Romney says he’ll “replace” the ACA with something, but he refuses to say with what. There is no Republican plan for universal access to health care, and there never was one. That leads to the conclusion that Romney’s top priority, if elected, would be taking health insurance coverage away from millions of Americans.
The individual mandate, you see, is not about being forced to eat your broccoli. It’s about who pays for your emergency appendectomy. The ACA is about extending health insurance coverage to between 30 and 60 million Americans, about sick kids being eligible for high-risk insurance pools, about affordable alternatives for people who lose their jobs, and the health insurance that comes with it. It’s about making prescription drugs more affordable for seniors, about getting a handle on Medicare costs, about 100 ways of making the world’s most expensive health care system work better for everyone.
See, it doesn’t fit on a bumper sticker. But most voters ought to be able to see past the emotional slogans and think about what’s in the ACA for their health and the health of their families.
Rick Holmes, opinion editor for the Daily News, blogs at Holmes & Co. He can be reached at email@example.com.