Supreme Court health care ruling increases the probability of second term for Obama

The ruling is likely to make the law much more popular among dubious independent voters.

If there was news before last Thursday, no one in the United States remembers, because all we have been talking about since then is the US Supreme Court's ruling on the Affordable Care Act, which is the real name for "Obamacare". The high court, in a 5-4 decision, decided that the law affecting every single American citizen is constitutional, even the much-vilified individual mandate.

For those who have better things to do than keep track of our opaque and overly complicated debate over health care, "Obamacare," as it is widely known here, is our attempt at universal health care, a feature of every rich country that has been debated in the US since the Nixon era. We have known for a long time that the cost of health care could cripple the economy, and indeed, it has outpaced the rate of inflation by double digits. Other than education and housing, no other cost of living has grown so rapidly over the past decade, but no one had been willing to bear the political risk, especially after the beat-down suffered by Bill Clinton in 1993 when he tapped his wife, that wonky First Lady Hillary Clinton, to devise a way forward.

Broadly speaking, there are two ways of achieving universal care. One is to tax people and give the money back to them in the form of health care. The other is to force them to buy health care or pay a penalty. Either way, you pay. The only difference is you pay for something (that's good for you) or pay for nothing. In procedural terms, there is no difference between these, and the end is the same — everyone is put into a risk pool so that the healthy are underwriting the sick and the sick are not subject to the inhumane whims of the free market.

The means to that end, however, are laden with politics. Because Republicans are usually allergic to the idea of taxes, they hated the Clintons' proposal, and countered with a proposal of their own that avoided the appearance of a new tax. Instead they preferred a method that forced people by law to buy health insurance — and that became known under President Obama as the individual mandate.

Yes, the individual mandate that was embraced by a Democratic president, and passed by a Democratically-controlled Congress, was originally conceived by Republicans who were countering proposals made by a Democratic president. And that's not all.

Obama had wanted to put in place a "public option," which meant more or less greater access to Medicare (old-age health insurance). But that, too, was blocked by Republicans. So Obama, being the deal-maker that he is, put on the table something he thought even the Republicans couldn't turn down — their own policy idea. He was wrong, of course, and for the past two and a half years, we have seen an enormous effort on the part of Republicans and conservatives to show they never liked the individual mandate even though they were once its most vocal champions.

Since the late 1980s, the legal test of the mandate had always been assumed to be a slam dunk. Forcing people to buy health insurance was believed be lawful as it fell under the Commerce Clause of the Constitution, which gives Congress the power to regulate interstate trade. A health care market already existed, many reasoned, so Congress would be regulating a market that was already there.

But after Obama championed, and Congress passed, the individual mandate, Republicans and their libertarian allies, some of whom are billionaires and heads of health insurance corporations who spent millions fighting the law, essentially moved the goal posts, as we say here. No, they said, a health care market does not already exist (never mind that everyone needs health care), so making people buy anything is unconstitutional or un-American. In fact, that sounds like something only an Islamist-communist-fascist dictator like Barack Hussein Obama would do.

In the end, the ruling came down to Chief Justice John Roberts, who was nominated to the bench by President George W. Bush. It had been assumed that Roberts would side with the court's conservative wing who had determined that the Commerce Clause argument vis-à-vis the individual mandate was invalid. Even though Roberts agreed, he found that the individual mandate could stand under Congress's undisputed power to tax. If you don't buy health care, you pay a penalty. Roberts reasoned that this is a tax, whether you call a tax or not.

As I said, this was the very thing Republicans wanted to avoid: universal health care that relies on a universal tax. Republicans don't like to go on record as having voted in favor of a new tax. So the individual mandate was from the start an ingenious way to avoid the appearance of a new tax even though the money people would spend on insurance would be in effect the same money they would pay in a new tax.

This, again, is why there is no difference between these methods. So it is ironic that a conservative judge nominated by a conservative president has declared that a conservative idea meant to avoid looking like a tax says, um, it looks like a new tax.

It is doubly ironic, because Mitt Romney, the Republican presidential challenger, is now using that conservative judge's opinion against the president even though Romney, when he was the governor of Massachusetts, implemented the ingenious Republican idea of an individual mandate in that state.

If your head is swimming, hold on. It gets worse.

Romney's record on health care in Massachusetts, however admirable, is a liability among the GOP's conservatives, who already believe universal health care is code for "creeping communism". That Obama modeled his health care legislation on Romney's has always carried the unfair implication that Romney wasn't a real conservative. Obamacare, rightly or wrongly, has been very unpopular, mostly because most people don't understand it and the president has done a poor job of selling it. Romney can satisfy his base while making a legitimate bid for independent voters by vowing to repeal Obamacare.

But the Supreme Court ruling complicates matters. First, its seal of approval is likely to make the law much more popular among dubious independent voters, especially as its components become better understood, so that the more Romney vows to repeal it, the more he seems to be rehashing a settled issue.

Second, the Republican leadership is making a lot of noise over mandate as a tax, claiming that Obama has just pushed through the largest tax increase in American history (which is patently false). The more they push the tax message, the more Romney has to defend his record so that he doesn't appear to be a tax-and-and spend politician much like the president.

2012 is turning out to be the year of looking-glass politics. Romney once took credit for Obama's decision to bail out the auto industry when he had nothing to do with it. Now he could legitimately lay claim to having influenced the greatest piece of domestic legislation since the Great Society of the 1960s, but he wants nothing to do with it. Such are the times for a Republican presidential hopeful and such is the rising probability of second term for Obama.
 

Obamacare supporters react to the US Supreme Court decision to uphold President Obama's health care law. Photograph: Getty Images

John Stoehr teaches writing at Yale. His essays and journalism have appeared in The American Prospect, Reuters Opinion, the Guardian, and Dissent, among other publications. He is a political blogger for The Washington Spectator and a frequent contributor to Al Jazeera English.

 

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Winning Scottish independence will be even harder than before - but it may be the only choice

Independence campaigners will have to find answers on borders, currency and more. 

The Brexit mutiny has taken not just the UK economy and its relationship with Europe into uncharted waters. it has also imperilled the union between Scotland and England. From Sir John Major to the First Minister, both Unionists and Nationalists had warned of it. The outcome, though, has made this certain. The Leave vote in England and Wales contrasted with an overwhelming Remain vote north of the border.

That every region in Scotland voted to stay In was quite remarkable. Historically, fishing and industrial communities have blamed the European Union for their woes. That antagonism was probably reflected in lower turnout - an abstention rather than a rejection. 

The talk now is of a second referendum on independence. This is understandable given the current mood. Opinion polls in the Sunday Times and Sunday Post showed a Yes vote now at 52 per cent and 59 per cent respectively. Moreover, anecdotal evidence suggests even arch No vote campaigners, from JK Rowling to the Daily Record, are considering the option.

The First Minister was therefore correct to say that a second referendum is now “back on the table”. Her core supporters expects no less. However, as with the economy and Europe, the constitutional relationship between Scotland and England is now in uncharted seas. Potential support for independence may be higher, but the challenges are arguably bigger than before. The difficulties are practical, political and geographic.

Of course the Little Englanders likely to take the helm may choose a velvet divorce. However, given their desire for the return of the Glories of Britannia that’s improbable. They’re as likely to wish to see Caledonia depart, as cede Gibraltar to Spain, even though that territory voted even more overwhelmingly In.

Ticking the legal boxes

Practically, there’s the obstacle of obtaining a legal and binding referendum. The past vote was based on the Edinburgh Agreement and legislation in Westminster and Holyrood. The First Minister has indicated the democratic arguments of the rights of the Scots. However, that’s unlikely to hold much sway. A right-wing centralist Spanish government has been willing to face down demands for autonomy in Catalonia. Would the newly-emboldened Great Britain be any different?

There are no doubt ways in which democratic public support can be sought. The Scottish Government may win backing in Holyrood from the Greens. However, consent for such action would need to be obtained from the Presiding Officer and the Lord Advocate, both of whom have a key role in legislation. These office holders have changed since the first referendum, where they were both more sympathetic and the legal basis clearer. 

Getting the EU on side

The political hurdles are, also, greater this time than before. Previously the arguments were over how and when Scotland could join the EU, although all accepted ultimately she could remain or become a member. This time the demand is that Scotland should remain and the rest of the UK can depart. But will that be possible? The political earthquake that erupted south of the Border has set tectonic plates shifting, not just in the British isles but across the European continent. The fear that a Brexit would empower dark forces in the EU may come to pass. Will the EU that the UK is about to leave be there for an independent Scotland to join? We cannot know, whatever European Commission President Jean-Claude Juncker may be saying at the moment. The First Minister is right to start engaging with Europe directly. But events such as elections in France and the Netherlands are outwith her control. 

Moreover, currency was the Achilles heel in the last referendum, and hasn’t yet been addressed. George Osborne was adamant in his rejection of a currency union. The options this time round, whether a separate Scottish currency or joining the euro, have yet to be properly explored. A worsened financial situation in the 27 remaining EU members hampers the latter and the former remains politically problematic. 

The problem of borders

Geography is also an obstacle  that will be even harder to address now than before. Scotland can change its constitution, but it cannot alter its location on a shared island. In 2014, the independence argument was simply about changing the political union. Other unions, whether monarchy or social, would remain untouched. The island would remain seamless, without border posts. An independent Scotland, whether in or out of the EU, would almost certainly have to face these issues. That is a significant change from before, and the effect on public opinion unknown.

The risk that's worth it

Ultimately, the bar for a Yes vote may be higher, but the Scots may still be prepared to jump it. As with Ireland in 1920, facing any risk may be better than remaining in the British realm. Boris Johnson as Prime Minister would certainly encourage that. 

David Cameron's lack of sensitivity after the independence referendum fuelled the Scottish National Party surge. But perhaps this time, the new Government will be magnanimous towards Scotland and move to federalism. The Nordic Union offers an example to be explored. Left-wing commentators have called for a progressive alliance to remove the Tories and offer a multi-option referendum on Scotland’s constitution. But that is dependent on SNP and Labour being prepared to work together, and win the debate in England and Wales.

So, Indy Ref The Sequel is on the table. It won’t be the same as the first, and it will be more challenging. But, if there is no plausible alternative, Scots may consider it the only option.

Kenny MacAskill served as a Scottish National MSP between 2007 and 2016, and as Cabinet Secretary for Justice between 2007 and 2014.