Political problems with private insurance mandates
The author's question about Medicare is pretty easy to answer. It is financed by a tax, and the benefits are the same for everyone. You have surely all noted the massive unpopularity of Medicare privatization via vouchers. ACA is essentially a voucherized "Medicare" for people under 65, who don't like it any better than the over 65 crowd does.
http://www.tnr.com/print/article/politics/99072/the-health-care-mandate-really-was-mistake
I understand the impulse to defend the Affordable Care Act when it is under unrelenting attack. But a mistake is a mistake, and supporters of the law—particularly Democratic candidates facing tough races in 2012—need to think through alternatives to the mandate in view of both the upcoming Supreme Court ruling and this fall’s election.
Whether the Court will overturn the mandate, we don’t know. But in drafting the Affordable Care Act, Democrats put at unnecessary risk their most significant domestic achievement of the past three years. Keeping the same policy, they could have framed the mandate so it fell unambiguously under the government’s taxing power. Even just labeling the penalties for failing to insure a “tax” would have strengthened the argument for upholding the law and greatly increased the odds that the Court would invoke the 1867 Anti-Injunction Act, deferring the case until 2015, when the penalties would first be imposed. And Democrats could have avoided any constitutional challenge by adopting the alternative that I proposed, which eliminated the mandate by providing for a long-term (five-year) opt out from both the law’s benefits and its penalties.
That the mandate was a political as well as a legal miscalculation should also now be clear. When Congress passed the Affordable Care Act, many observers expected that controversy would die down, and the law would soon be as widely accepted as Medicare is. That hasn’t happened. Why not?
The mandate is one reason why the law’s opponents have been able to sustain their cause. No other provision could have provided as effective a basis for both the legal challenges to the law and the political campaigns against it; voters in 14 states have passed amendments to their state constitutions prohibiting an individual mandate. Even though such amendments have no legal force, the campaigns and court cases have kept public opinion focused on the least popular aspect of the Affordable Care Act, dragging down overall support and maintaining the high-intensity opposition to the law on the right (in contrast to the tepid and ambivalent support for it on the left).
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