Thursday, December 16, 2010

ObamaCare and the individual mandate

Ben and I wrestle with the lawsuit against the health reform bill in our Scripps Howard column this week. My take:

Let's be clear: Conservatives didn't think the individual mandate was unconstitutional in the 1990s -- when the conservative Heritage Foundation came up with the idea, then pitched it as an alternative to President Bill Clinton's health proposals. No Tea Partiers shouted about "tyranny" just a few years ago, when GOP Gov. Mitt Romney made the requirement a centerpiece of Massachusetts' health law.

While some conservatives sincerely see the mandate as an intolerable infringement upon American freedom, it's not unreasonable to think the GOP is cynically moving the goalposts in its never-ending opposition to Democratic policy ideas -- even if those ideas were originally Republican.

The irony: The mandate was an effort to leave health insurance in the hands of private industry and avoid a true government takeover of the health care system.

During the 2009 debate, after all, many Republicans agreed reform should include a rule that insurance companies couldn't deny coverage to customers with pre-existing conditions. But that left open the likelihood people would wait to get sick before buying insurance -- saddling companies with the costs of sick patients without enough healthy customers to help pay the way. That would've driven the companies into bankruptcy and, in all likelihood, triggered the rise of a government-run "socialized" health insurance system.

So there are good policy reasons for the individual mandate. But as a political matter, many liberals recognize that the mandate is a particularly ugly way to make the sausage of health insurance reform -- more likely to trigger protests against the bill rather than make Americans grateful for the welfare state.

There less-burdensome ways to replace the individual mandate. Insurers could offer financial incentives for early sign-up and penalties for late arrivals, the way parts of Medicare work now. Other, market-friendly ideas abound. But never fear: Republicans would certainly oppose those ideas, too. They always do.


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