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The Campaign Spot

Election-driven news and views . . . by Jim Geraghty.


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The GOP’s Mandate Temptation

Why have so many conservatives and Republicans endorsed, or praised, an individual mandate for health care in the past? Today Rush Limbaugh hit upon it:

RUSH: Now this mandate business. This has gotten out of hand, too, ‘cause it’s out there now that Newt supported the individual mandate as recently as 2009. It’s being reported that Newt supported Obamacare, the individual mandate and Obamacare in 2009. Some people are saying, “Well, he couldn’t have done that because Obamacare didn’t exist in 2009. It hadn’t been written yet.” That’s a bit of a stretch. The fact of the matter is that the Heritage Foundation at first (and Newt and Romney) are all on record, at some point in their careers, as supporting the individual mandate which is what the lawsuit against Obamacare is about. But of the three, only Romney has actually enacted it into law, supported it to the point that he’s put it into law.

Now, I know why. I know exactly — and for the life of me, I can’t figure out why one of these guys hasn’t tried this as an explanation. I know exactly why Heritage supported it. (I’m guessing, but I know. Don’t doubt me.) I know why Heritage, I know why Newt and any other Washington, DC-ite saw that individual mandate and glommed onto it. You want to know why? It’s very simple. They are conservatives, and the first thing they saw in an individual mandate for people to get their own insurance is individual responsibility, and what do we as conservatives believe? We believe in individual responsibility; we believe in self reliance.

So if somebody proposed, “Hey, you know what? We got too many free riders. Everybody ought to have their own health insurance.” So conceptually it sounded good. It sounded conservative. So you could say, “I support that because that makes me conservative.” Only later when it’s too late, you figure out it’s nothing about individual responsibility. It’s a violation of the Constitution, because the thing comes about by virtue of the government demanding that you buy it or you go to jail or pay a fine. Now, why somebody hasn’t said, “You know what? I goofed up.” Well, the Heritage Foundation has.

They have distanced themselves from their original support of the health care mandate a long time ago. I don’t know why one of these guys hasn’t said this.

Back on January 11, in a chat with the Guardian, I said:

Why do you think the GOP candidates haven’t used “Romneycare” as the cudgel to beat Romney? It seems that would be a better line of attack than Bain, but in all of the debates no one has strongly and effectively used this line of attack.

Jim Geraghty replies:

That is a great question.

One minor complication is that Gingrich, and a bunch of Republicans have at one point or another in the past decades expressed something supportive, or at least not hostile, to the concept of the individual mandate. There is something of a conservative argument that the individual mandate is fostering individual responsibility – ie, while we want to have a merciful and generous society, it’s not fair to take no steps to protect your own health and expect everyone else in society to foot the bill when you suddenly require expensive treatment. To provide free healthcare for those who refuse to purchase insurance amounts to a form of welfare.

But once the concept of the individual mandate was enacted, conservatives (and more than a few independents) saw it through the lens of expanding government power. If the federal government has the power and authority to make you buy health insurance from a private company, what don’t they have the power to do? Who works for whom in this circumstance?

Romney’s defense on the individual mandate is that he opposes the one in Obamacare as unconstitutional (a question the Supreme Court will take up later this year) but that the one enacted by the state government of Massachusetts does not violate the state constitution. Legally, he may be perfectly right, but it makes for an awful rallying cry for conservatives: “Let’s get rid of that terrible FEDERAL-LEVEL individual mandate . . . so that each state can enact it’s own STATE-LEVEL individual mandate!”

The gripe about the Obamacare mandate isn’t that the federal government is making people buy health insurance . . . it’s that anybody is making people buy health insurance.

The U.S. has a broad, general tradition that if someone needs emergency life-saving care, they’re given it, regardless of their ability to pay. Thus, many Americans receive often expensive care regardless of their ability to pay and “others” make up the difference — thus the “free rider” problem.

But as Phil Klein notes, the math on Romneycare isn’t working:

In fact, Massachusetts collects a small amount in penalties from the individual mandate, and what little money is raised pales in comparison to how much free care (typically called “uncompensated care”) is still being provided by hospitals and how much money the state is spending on health care subsidies under Romneycare.

In fiscal year 2010, according to the Massachusetts Division of Finance, the state government collected just $17.8 million in fines from people not complying with the mandate. But uncompensated care was a stubborn $475 million, according to the state’s Division of Health Care Finance and Policy. (The state could only pay $405 million, with shortfall cost falling on hospitals.)

Under Obamacare, by 2016, those without health insurance will have to pay $695 or 2.5 percent of household income, whichever is greater.

The “free rider” problem is a genuine problem. But giving government the authority to require citizens to purchase anything* is a greater one.

* Mandate defenders inevitably bring up the requirement to purchase car insurance, but that is requiring a purchase for a privilege (owning a car) not a right. The state requires quite a few things from citizens to drive a car — passing the driving test, corrective lenses if needed, carrying the license while driving, etc. None of those are required for the exercise of a right.

Tags: Mitt Romney, Newt Gingrich, Rush Limbaugh

New on The Campaign Spot. . .


COMMENTS   10

EXPAND  

   01/30/12 15:49

As far as I know, you don't need auto insurance to own a car. You need insurance to get a registration, which you need to drive on public roads. You can drive an uninsured and unregistered car as much as you want on private property. I think this is an important distinction.

I could be mistaken.

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   01/30/12 16:11

You can't square the circle of conservative support for a mandate, there just isn't any explanation that works.

If they had said something along the lines of 'buy insurance or we won't take care of you when you're sick, you're on your own', that would be quite a change in social policy (and would have left them open to charges that they were 'uncaring'), but it would at least been OK from the perspective of a mandate.

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steate
   01/30/12 16:33

We already have a nationwide mandate. Instead of mandating that you buy your own health insurance, we mandate that you buy your neighbor's emergency room care.

Please explain to me which is preferable.

1. Allowing dumb or poor people to suffer and die without treatment.
2. Requiring people to buy their own insurance and take responsibility for themselves.
3. Requiring people to buy emergency care for those who need it (and can't pay on their own).

Option 1, seems to be the way many conservatives idealize things. But not only will it never happen, no one is suggesting it! So we have to live in a world of option 2 or option 3.

Given those two options, option 2 is fundamentally the more conservative choice. But there is a HUGE "but" here... it's one thing to have the states decide to do this. It's a whole 'nother thing to require it across the entire United States by the federal government. The individual states can and should be able to make this decision.

So ironically, Mitt's defense really is the best. MA can do what MA wants, PA can do what PA wants, etc. But Obama can't make everyone do what he wants.

It doesn't satisfy the craven desire to rally against the loss of freedom from a mandate. But it's strange we'd be rallying against that when it's already mandated we pay for the uninsured, poor person's emergency care anyway.

Better for states to decide how best to handle this question!

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   01/31/12 10:38

You leave out option 4, which is for those who feel the most strongly that irresponsible and clueless people should be helped anyway, to contribute something voluntarily to an organization that provides free care. I'm not opposed to helping those who need it, of course. But in this scenario the sympathetic would take on the task of squaring compassion with irresponsibility and learning for themselves that a line has to be drawn--and demonstrating to everyone that it's better for everyone, including the dumb and poor, to let this line be drawn by someone other than the government.

I should also stipulate that under the system I advocate--call it "mandate or waiver"--the poor wouldn't be left out of insurance unless they wanted to be. I would include means-tested premium subsidies for basic insurance. Or they could opt to go with the voluntary "free" collective if they found it more attractive.

I'd be for allowing states to include this alternative to a mandate. I'd be even more for federally mandating allowing the mandate alternative.

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   01/30/12 17:06

The following, while a simplification, is accurate and still makes my point. And my point about what irritates me about the auto insurance argument that liberals like to make is that in most, if not all states, one is only required to be insured for damage you cause to OTHER persons or their property. You are NOT required to have insurance for your OWN loss.

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StephenK
   01/30/12 19:01

The problem with this critique of the individual mandate is that you could accomplish the same goal through different, unobjectionable means.

For example: let's say that tomorrow the government raises everyone's income taxes by 2.5%. But it simultaneously enacts a tax deduction equal to 2.5% of income if you purchase health insurance. [For those who think this is a slight-of-hand, the government is already effectively doing the same thing by allowing you to deduct things like mortgage interest expense ... it's encouraging/subsidizing the purchase of a good or service via means of tax policy.]

The net effect of this is the same. Whether it's "buy this, or else pay this penalty" or "buy this, and save this much" - the end result is the same. If we agree that we have a free rider problem and that the solution is everyone owning health insurance, then criticizing the method by which we induce people to buy health insurance is a bit pointless.

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StephenK
   01/30/12 19:02

The problem with this critique of the individual mandate is that you could accomplish the same goal through different, unobjectionable means.

For example: let's say that tomorrow the government raises everyone's income taxes by 2.5%. But it simultaneously enacts a tax deduction equal to 2.5% of income if you purchase health insurance. [For those who think this is a slight-of-hand, the government is already effectively doing the same thing by allowing you to deduct things like mortgage interest expense ... it's encouraging/subsidizing the purchase of a good or service via means of tax policy.]

The net effect of this is the same. Whether it's "buy this, or else pay this penalty" or "buy this, and save this much" - the end result is the same. If we agree that we have a free rider problem and that the solution is everyone owning health insurance, then criticizing the method by which we induce people to buy health insurance is a bit pointless.

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   01/30/12 19:14

Here's my solution to the free rider/mandate problem.

Everyone has a choice: Get insurance, or sign a waiver.

Requirement for Insurance is coverage for catastrophic or major medical. Deductibles and what sort of regular and optional health expenses are covered is the individual's business.

If you sign the waiver, medical providers are not responsible for taking care of you free of charge. You pay, whatever it might be.

But if you can't afford to pay, you can go to the Che Guevara Memorial Free People's Heath Care Collective which will be funded by leftist billionaires and well-off liberals who don't want anyone to go without. And if they don't fund them, then we have a right to ask why they don't actually care as much as they said they did. It's a safety net, but it's all theirs--free from the influence of those dreaded right-wingers and their lobbyists and insurance companies.

By the way, if it's an emergency or hospitalization, the CGMFPHCC will pay the charges if they don't want to run their own hospitals. The CGHFPHCC will soon find it expedient to have representatives on hand at emergency rooms to certify that there will be payment. After a while the CGMFPHCC will begin asking families to sign up in advance and pay $20 a month to be precertified. And then they will start taking other measures to encourage responsible consumption and reasonable doctors' fees, because they can't go to the government about it. Pretty soon...people are paying what they can, and a competing organization will spring up, and the next thing you know there will be more and more low-cost medical choices, and then one of these companies will decide to start offering insurance for middle-income folks. And as far as I'm concerned, the CGMFPHCC will be welcome to take credit for inventing the new model of affordable, choice-based, free-market health care.

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   01/30/12 20:44

Rick Santorum never supported the individual mandate. Barack Obama once opposed it vs. Hillary Clinton.

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   01/31/12 08:31

More to the point, with car insurance, you're not required to have collision or comprehensive, in order to cover your own loss. You are required to have Liability, in order to cover the loss to the OTHER guy whom you hit. We're all at risk from drivers who don't carry liability coverage, where folks who don't carry health insurance or collision auto are only risking their own health and assets. Thus, the difference.

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