It is absolutely essential that no health-care legislation pass Congress this year, in that any “compromise” that actually could get enough Democratic votes would lead inexorably toward socialized medicine. (If someone else has made this rather obvious point, I apologize.) An individual mandate is deemed necessary because of the perverse incentives inherent in guaranteed issue/community rating “reforms.” I am a bit surprised that the Left does not recognize — yet — that the individual mandate moves legislation away from their ultimate goal, the destruction of private insurance and the massive movement of the citizenry (and noncitizenry) into dependence upon the federal government. Without the individual mandate, insurance “reform” — no constraints on coverage created by pre-existing medical conditions, and a necessary corollary, price controls in health coverage — would be hugely popular politically. But those two policies would yield a rapid destruction of the private insurance market (for nonemployer policies) because of a resulting massive adverse-selection problem. From the viewpoint of the Left, the only reason, it seems to me, to support the individual mandate is fiscal: An individual mandate forces the healthy to subsidize everyone else, thus moderating the explicit tax increases needed to pay for health-care socialism.
Accordingly: All this talk of finding some compromise to satisfy Republican/conservative objections is silly. Yes, the abortion funding issue is important, as is the noneligibility of noncitizens, etc. But the central, basic, fundamental problem looming huge for the future of American culture and economic vitality — the effort by the Left to find ways to destroy capitalism in the health-care sector and beyond — cannot be avoided through compromise on such secondary issues, however important taken in isolation. It must be made absolutely clear to the opposition on the Hill and in the nation at large: If Obama signs a bill this year, we will have lost, permanently.
– Benjamin Zycher is a senior fellow at the Pacific Research Institute.