The conservative legal brief against the Affordable Care Act rests heavily on a simple proposition. Government can’t make us obtain private insurance because, as the argument goes, that would be forcing us to buy a private product.
Politically and constitutionally, it may be an effective argument. But do the law's harshest critics, the ones screaming about tyranny, actually believe that? In particular, do they think it's even scarier than a single-payer, government-run program, as they argue in their briefs and Judge Roger Vinson suggested in his Monday ruling?
I have my doubts. And while I offered some of my reasons yesterday, I left out a big one: Social Security privatization.
You remember privatization, don’t you? The idea was to take Social Security, a mandatory public pension program, and turn it into a system of mandatory personal investment accounts. The schemes evolved over time, with different details, but the gist was always the same. During your working years, you’d make contributions into the accounts, just like you currently pay taxes that fill the Social Security Trust. Over time, you would invest the money in your private account—that is, you’d buy stocks, bonds, and so on—typically within certain guidelines set by the government. Once you hit retirement, you’d start to withdraw from the accounts or perhaps purchase an annuity, relying on subsequent payments for your financial security.
Conservatives presumably thought privatization was constitutional; otherwise, they would not have worked so feverishly to enact it. But if the principle holds for old-age insurance, it ought to hold for medical insurance, too. In other words, if it’s ok for the government to make you pay for regulated private investments, then it should be ok for the government to make you pay for regulated private health insurance. Yet, as far as I can tell, the folks who spent all of those years promoting Social Security as an all-American, free market innovation are the same ones that now insist the Affordable Care Act is an unprecedented threat to liberty.
What's going on here? The truth, I think, is what I said yesterday: Some of the Affordable Care Act's critics are mere opportunists, while the rest are more extreme libertarians who oppose all mandatory schemes of social insurance. But even the hard-core libertarians understand political reality. Social Security is too sacrosanct to attack, politically and constitutionally, so they will make do with privatizing it. The same goes for Medicare, which they dare not challenge directly. But the Affordable Care Act is vulnerable, so they trying for full repeal, making whatever arguments necessary to achieve that goal.
Strategically, it makes perfect sense. But intellectually and morally, it's inconsistent at best.