‘It’s all about the mandate’

From Day One, the debate surrounding health care reform has always been about the individual and employer mandate. The public option? A sideshow. Medicare cuts? A red herring. Tax increases? Merely bait and switch. The mandate is and has always been the thing, the Holy Grail for Big Insurance. And honestly, who can blame them?

Who wouldn't want a captive audience of 300 million, an entire nation forced by law to buy your product? These groups even weathered attacks by the Obama administration while they were sharpening their pencils. They knew the payoff.

Americans are reeling from the housing meltdown, when tens of thousands of us signed mortgages which promised great things in the contract's big print, but resulted in ruin when the type grew small. American families who pay their own bills every month -- the cable bill, the cell phone, credit cards, utilities -- too often find themselves on the wrong end of terms and conditions that require a magnifying glass to read and a law degree to comprehend. Health care is no different: Nowhere do Americans feel more burned, more often, than with their health insurance, including Medicare and Medicaid.

Medicare has more than 100,000 pages of rules and regulations. Medicaid is a nearly unintelligible tangle of state and federal rules. Private health insurance contracts, mere pamphlets by comparison, seem full of loopholes the insurers seem to relish in exploiting.

Is it any wonder then that Americans of both parties have been abundantly clear to members of Congress, federal and state bureaucrats and private insurers? We do not trust you, their message goes, and certainly not enough to accept a mandate. Because it is not what you say we will GET when we are forced into any public or private health plan, it is that we will be signing on to all the rules, regulations and RESTRICTIONS that come with being a part of such a plan. That part (maybe the worst part) is yet to come.

Some restrictions will be explicit: Medicare will not pay for the virtual colonoscopy that President Obama was able to get. Other rules Americans will learn about the hard way, like restrictions on cost-sharing for some tests. Those limitations will mean that if a plan does not authorize a treatment course, patients will be restricted from spending their own money to get it.

The insurers' main complaint about the bill that just passed is that the PENALTIES for not buying their product are not enough! Let me reiterate -- for the first time you, as a citizen of the United States, are required by that citizenship to buy a product ... hmm.

If you're the entity controlling what the "mandate" will look like every year -- from benefits to costs to new regulations -- then forced purchasing of insurance is a pretty good deal. No wonder Congress loves the thought. How better to increase control over constituents and business than to have the power over that which is most personal … Americans' health. The one-sixth of the economy health care represents, the 12 percent of all jobs it supplies, and the $2.5 trillion per year in spending is the single most highly sought after piece of our new, service based economy.

Special interest groups shelled out $600 million in 2009 alone trying to influence the health care debate -- a huge sum until it's held up alongside the potential return on investment.

American families, focused on keeping or finding jobs, do not have the resources to compete. Thus, they see the mandate as one more way in which control over their lives is being stripped away and handed to others, both inside and out of government.

At the state level, where elected officials are still more responsive to the unwashed masses of the electorate, steps are being taken to protect Americans from a special interest complex gone wild: the Health Care Freedom Act. The act -- born in Arizona, where it's on the ballot this November to amend the state constitution -- and making progress in more than three dozen other states, including Virginia, where a version has already passed as a law, says yes to reform, but no to mandates and no to taking control over every health care dollar spent away from families.

In Florida, Attorney General Bill McCollum has readied a suit against the feds to keep their hands off Floridians. It is just now beginning.

Well, we now know what the "endgame" was on health care -- ignore your constituents, vote in a highly partisan manner and slander and libel the opposition. But the focus of our ire now, and come next November, should be directed, finally, where it deserved to be all along.

On the mandate.

J.C. Watts) JCWatts01@jcwatts.com) is chairman of J.C. Watts Companies, a business consulting group, and former chairman of the Republican Conference of the U.S. House, where he served as an Oklahoma representative from 1995 to 2002. He writes every other week for the Review-Journal.