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Ruth Marcus / Politics

Mandate's Value? Try $116 Billion

WASHINGTON -- The most compelling sentences in the Obama administration's brief defending the constitutionality of the health care law come early on. "As a class," the brief advises on page 7, "the uninsured consumed $116 billion of health care services in 2008."

On the next page, the brief drives the point home: "In 2008, people without insurance did not pay for 63 percent of their health care costs."

Those figures amount to a powerful refutation of the argument that the individual mandate -- the requirement that individuals obtain insurance or pay a penalty -- exceeds the government's authority to regulate interstate commerce. To me, $116 billion seems like a whole lot of commerce.

But let's leave the Supreme Court justices to hack their way through the underbrush of the Commerce Clause. Because those numbers are not only relevant to Commerce Clause jurisprudence -- they illuminate the fundamental irrationality of public opposition to the individual mandate.

The mandate is by far the most unpopular feature of a law on which Americans are otherwise evenly divided. A Kaiser Family Foundation poll this month found that two-thirds of those surveyed disliked the mandate. Even among Democrats, a majority (53 percent) opposed the requirement; independents (66 percent) and Republicans (77 percent) were even more hostile.

Yet this is a provision that the overwhelming majority -- those with insurance -- should support, for the simple reason that they currently end up footing the bill for much of that $116 billion.

As the government's brief notes, "Congress found that this cost-shifting increases the average premium for insured families by more than $1,000 per year."

In other words, those worried about having to pay ever-higher premiums should be clamoring for the individual mandate, not agitating for repeal.

Indeed, for all the bristling over the mandate, it will be irrelevant to the 80 percent of non-elderly Americans who already have insurance, either through their employers, government programs, or purchased on their own.

The biggest real-world risk to these people would be if the court were to overturn the mandate yet allow the rest of the health care law to remain in place, driving premiums ever upward.

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Copyright 2012 Washington Post Writers Group



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