Opinion

Reihan Salam

The death of the Obamacare individual mandate

Reihan Salam
Dec 20, 2013 19:56 UTC

Obamacare is best understood as a collection of carrots and sticks designed to expand access to insurance coverage. But what happens to Obamacare if we get rid of the sticks? It looks like we’re about to find out.

During the Obamacare debate, many conservatives, myself included, warned that once the law was in place, the sticks would prove politically impossible to enforce, the carrots would have to get more and more generous to compensate, and the end result would be a fiscal calamity. We won’t know if this dire projection will be fully borne out for some time. What we do know is that at least one of the most important Obamacare sticks, the individual mandate, is already getting watered down, and it’s not crazy to imagine that it will at some point be abandoned. Before we get to the individual mandate, though, consider the carrots and sticks that apply to state governments and employers.

In the original legislation, states that agreed to expand Medicaid were promised new federal funds to help meet the cost of doing so (the carrot) while states that refused to expand Medicaid had to forsake federal Medicaid funds altogether (the stick). This combination of carrot and stick would have made refusing to expand Medicaid a very costly decision for state governments, virtually all of which are struggling to meet the high and rising cost of providing medical insurance to those who are already on Medicaid. Last summer, however, the Supreme Court ruled that the threat of removing all federal Medicaid funds from states that refused to play ball was unconstitutionally coercive, and so a large number of states have chosen not to expand Medicaid. Eventually, the holdout states might decide that the carrot of new federal money is too tempting to resist, particularly when neighboring states cash in. But for now, the all-carrot, no-stick approach has definitely held down the number of Medicaid enrollees.

Large employers, meanwhile, were supposed to be subject to an employer mandate, the requirement that all employers with 50 or more full-time-equivalent employees either had to provide health insurance benefits or pay a stiff penalty. This was a pretty big stick without much of a carrot attached. Yet the employer mandate was very important, as it was meant to hold down the costs of coverage expansion, as the federal government was expected to subsidize low- to moderate-income workers with employer-sponsored coverage less generously than similarly situated workers on the exchanges. In July, the Obama administration announced that it would delay enforcement of the employer mandate until 2015. And so, another stick was removed from the Obamacare arsenal.

The debates over Medicaid expansion and the employer mandate have been heated. But the individual mandate debate has been the most contentious of them all.

The budget deal’s central achievement: protecting America’s military strength

Reihan Salam
Dec 13, 2013 19:47 UTC

Remember 1986? Ronald Reagan was in the White House, Dionne Warwick was topping the charts, and movie audiences swooned as Tom Cruise romanced Kelly McGillis in Top Gun. Children born in 1986 are now adults having children of their own. So it is sobering to realize that 1986 was also the last year in which a divided Congress — a Democratic House and a Republican Senate, to be precise — was able to reach a budget agreement. To the surprise of many, House Budget Committee Chairman Paul Ryan, a leading light among conservative Republicans, and Senate Budget Committee Chairman Patty Murray, a savvy Democrat with a populist streak, reached a modest budget deal at the start of this week that eased the rigid caps on discretionary spending imposed by sequestration in the short term, in exchange for more mandatory spending restraint over the long term.

Almost immediately, influential conservative lawmakers, like Florida Sen. Marco Rubio and Oklahoma Sen. Tom Coburn, declared their opposition to the deal, as did influential conservative groups like Heritage Action, FreedomWorks, and the Club for Growth. For a brief moment, it looked as though the GOP’s right flank would choose another government shutdown over what many saw as a half-hearted compromise. But instead the House passed the Bipartisan Budget Act of 2013 by a margin of 332-94, with 62 Republicans voting “no.” Assuming the Senate also passes the deal, the country will be spared a government shutdown until at least the fall of 2015.

To many rank-and-file Republican members, and in particular to those representing vulnerable House seats, this must come as a relief. In recent weeks, President Obama’s approval ratings have sharply declined. A recent Quinnipiac survey finds that only 38 percent of voters approve of the president. Moreover, they prefer Republican over Democratic House candidates by 41 percent to 38 percent, a marked improvement for the GOP. It seems that while the government shutdown damaged Republicans, a steady drumbeat of negative news coverage surrounding Obamacare implementation has given the GOP breathing room. Another government shutdown could reverse these gains and give the president and his allies the upper hand.

Mandela’s heirs face a rocky economic future

Reihan Salam
Dec 6, 2013 16:20 UTC

The death of Nelson Mandela is being mourned across the world, and for good reason. As the first president of post-apartheid South Africa, he served as a symbol of national reconciliation and as a defender of South Africa’s new and fragile liberal constitution. It is also true, however, that the movement he led, the African National Congress, has not lived up to lofty expectations, and that at least some of the responsibility lies with the great man himself.

Before we turn to what has gone wrong with post-apartheid South Africa, it is worth briefly rehearsing what has gone right, thanks in no small part to Mandela. During the apartheid era, South Africa’s Afrikaner-dominated ruling National Party warned that majority rule would bring violent reprisals against the country’s white minority, a Marxist revolution that would mean the end of private property, and an alliance with the Soviet bloc that would threaten the free world. None of that ultimately came to pass, for a variety of reasons. As the Soviet threat receded, and as anti-apartheid activists pressured governments in the U.S. and Western Europe to isolate the South African government, elements within the governing National Party sensed that the days of minority rule were numbered, and that some accommodation with the ANC was the only way to prevent a bloody denouement. And Mandela, to his great credit, proved a willing partner. Having established his moral authority within the liberation movement as a champion of armed insurrection against the apartheid government, he committed himself to a path of non-violence. One shudders to think of what might have happened had Mandela chosen differently. Mandela’s fateful decision to work with his former enemies paved the way for the ANC’s extraordinary political success.

Since 1994, when South Africa held its first authentically democratic and multiracial national elections, the ANC has won every national election by substantial margins, and there is good reason to believe that it will win the election that will be held next spring. Yet after almost two decades of ANC rule, the country suffers from shockingly high levels of poverty, unemployment, and violent crime. Hundreds of thousands of educated South Africans — white, black, and Asian — have emigrated in search of opportunity in Britain, Australia, the U.S., and elsewhere. Many middle-income countries that were in the same economic ballpark as South Africa in 1994 in terms of GDP per capita — like Poland, Malaysia, Chile, Mauritius, and neighboring Botswana — have raced ahead in the years since. When we compare South Africa to China or South Korea, the contrast is more dismal still.

When progress trumps privacy

Reihan Salam
Dec 2, 2013 14:47 UTC

In 1890, two of America’s leading legal minds, Louis Brandeis and Samuel Warren, published an article called “The Right to Privacy” in the Harvard Law Review. Scandalized by the rise of a gossip-mongering press that intruded on the lives of prominent citizens, they called upon the courts to recognize a “right to privacy.” Their fear was that new technological and commercial innovations — in this case photography and the mass-circulation gossip rag — would cause the rich and famous untold mental pain and distress. As Stewart Baker observes in his provocative book Skating on Stilts, the substance of Brandeis and Warren’s argument now seems rather quaint, as a gossipy news media has become a central part of our public life. In Baker’s telling, “the right to privacy was born as a reactionary defense of the status quo.” And even now, he argues, privacy campaigners often overreact against new technologies they fear but do not understand.

Baker’s argument has been panned in civil libertarian circles. When he suggests that societies eventually adapt to new technologies — that “the raw spot grows callous” as we grow accustomed to invasions of privacy — privacy campaigners reply that it is Baker who has grown callous to the harms in question. Baker’s central goal is to convince Americans to accept that government must use new technological tools, like the data mining programs used by the National Security Agency, to combat mass-casualty terrorism. His critics maintain that he is far too glib about the potential that government might abuse these new tools, and indeed too dismissive of the notion that it has already done so.

I’m torn on the question of whether the national security state has overstepped its bounds, and there are people I respect on both sides of the debate. Civil libertarians like Ben Wizner of the American Civil Liberties Union and Julian Sanchez of the Cato Institute see the new Leahy-Sensenbrenner USA FREEDOM Act– which would end the dragnet collection of Americans’ phone records under the PATRIOT Act, and limit other surveillance — as an important step towards reining in a bureaucracy run amok. Baker fears that it will cripple the ability of U.S. intelligence officials to prevent future terror attacks. I couldn’t tell you which side is closer to the mark.

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