When the Obama White House set out to make the liberal dream of universal health coverage a reality, it faced two obvious political obstacles. The first was the power of the interlocking interest groups insurance companies, physician associations, pharmaceutical companies that potentially stood to lose money and power in a comprehensive reform. The second was the price tag of a universal health care entitlement, which promised to be high enough to frighten vulnerable members of Congress.
The key to overcoming both obstacles, it turned out, was the mandate to purchase health insurance.
In arguments before the Supreme Court last week, the health care mandate was defended as a kind of technocratic marvel the only policy capable of preventing the complex machinery of reform from leaking smoke and spitting lug nuts.