The Corner

The Conservative Case for Universal Coverage

There’s been a lot of talk on the right about the importance of having a policy agenda that addresses the challenges of poverty and economic mobility. A neglected aspect of that discussion, however, is the degree to which access to health coverage is a part of the problem facing lower-income and middle-class Americans today. Medicaid is a basketcase of a program that leaves poor people no healthier than they were before — though it spends trillions on their behalf. And, thanks to Obamacare, one of the biggest economic challenges facing the middle class — the rising cost of health insurance — is getting significantly worse.

While “repealing and replacing” Obamacare is one way to address this problem, its political viability in 2017 — when tens of millions of Americans will be on Obamacare-sponsored coverage — is far from guaranteed. What will repealers-and-replacers say to Americans who like their Obamacare plans, and want to keep them?

The good news is there is an alternative approach, one that would achieve similar – if not better – fiscal results to repeal-and-replace, but with less disruption to existing coverage arrangements. I’ve discussed that approach previously in these pages, and I have a new article discussing the idea today in the Washington Examiner.

To summarize, it would nearly fully privatize Medicare and Medicaid; reform the employer-sponsored insurance market in a market-oriented direction; and deregulate Obamacare’s exchanges so that individuals could enjoy a broader choice of plans at lower cost.

In today’s piece, I argue that no Republican health-reform plan will get anywhere until Republicans come to agree that it’s a legitimate goal of public policy to ensure that all Americans have access to quality health care, just as we agree that all Americans should have access to a quality education:

To credibly advance this approach, conservatives must make one change to their stance: They have to agree that universal coverage is a morally worthy goal. No conservative politicians oppose universal public education; instead, we champion reforms that improve the quality of public education that poor Americans receive. Ensuring that every American has access to quality health coverage is a legitimate goal of public policy, and it can be done in a way that expands freedom and reduces the burden on American taxpayers.

The Left believes that the only way to expand opportunity is to expand the scope and scale of government. Our broken patchwork of health care entitlements gives us the opportunity to prove otherwise. And we can do so while bequeathing to our children and grandchildren something that is almost impossible to imagine: a fiscally sound country.

It has always been a mistake to cede this moral ground to the Left, and not only because it has resulted in the mess of a system we have today. Take the example of a pregnant woman whose baby has been diagnosed with Down syndrome. More than 80 percent of all prenatal diagnoses of Down syndrome end in abortion. If we want to address this problem, one route is of course to abolish abortion. But another – complementary — one is to ensure that these expectant mothers don’t face penury for bringing a child with Down syndrome into the world. 

UPDATE: I’ve noticed that a lot of the conservatives who most passionately object to universal coverage are less aware of the fact that the scope of U.S. government health care already far exceeds that of most European countries, as described in the chart below. As Switzerland and Singapore show, it is possible to achieve universal coverage while spending and taxing far less than we do.


Avik Roy — Avik Roy is the President of the Foundation for Research on Equal Opportunity (, a non-partisan, non-profit think tank.

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