More Pledge

by Rich Lowry

On criticisms of the Pledge from the right, I think the one that has the most force — made by Yuval yesterday — is that it should have included an earmark ban. The insurance regulation question is more complicated. Reihan discussed it here, with an illuminating e-mail by — yes — Yuval, who wrote:

I think you and Peter Suderman are not reading the Pledge language correctly on health care. The document says “We will make it illegal for an insurance company to deny coverage to someone with prior coverage on the basis of a pre-existing condition.” Notice the words “with prior coverage.” In other words, a person with continuous insurance coverage who has to change coverage (because he loses his job, if he had an employer plan, or because he has to move to another state if he’s in the individual market) has to be offered a new plan without a new risk rating. Especially as part of a system that includes genuine and fully funded high-risk pools (which the Pledge also proposes) this is a way to make sure that people with continuous coverage are not cut off because of changes in their circumstances. It does not create an incentive to stay uninsured until you’re sick (which would lead to the insurance death spiral scenario). On the contrary, it creates an incentive to get insured when you’re healthy, because it says that as long as you’re continuously insured, changes in your health won’t change your ability to be covered. It makes *continuous* coverage the essence of the system. That’s how insurance needs to work. Such a system would therefore not require a mandate, but would rely on a powerful incentive to get into the system when you’re healthy.

Capretta and Miller do a good job of explaining how that would all work here.

As for the balanced-budget amendment, its inclusion would have been entirely symbolic, since there aren’t the votes for it (putting aside whether it’s even a good idea).

Finally, there’s the failure to take on entitlements. Here the political calculation is understandable — you can’t be a political party just starting to win back the public’s trust and immediately take on entitlements. But they are the drivers of the long-term budget crisis and at least a little more boldness would probably have been a good thing. The history of Republicans — Reagan in the 1980s, Gingrich in the mid-1990s — trying to get savings out of entitlement programs without having prepared the public is not a happy one.

That said, I wonder if the politics of entitlements are going to be different than usual the next couple of years because: 1) the deficit and debt numbers are so huge; 2) Obama’s debt commission is going to come up with ideas for cuts that will provide some political cover for them; 3) there are roughly $500 billion-worth of liberal-approved Medicare cuts in Obamacare, and they could possibly be redirected toward intelligent savings in and reform of the program.

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