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Mandate foes test GOP principles
By: David Nather
February 2, 2011
In a different context, the Republican Party might cheer one of the
fundamental tenets of the health care law, a requirement that all
Americans buy health insurance.
It’s just the sort of thing that would fit squarely within the GOP’s
bedrock principle of individual responsibility — ensuring that no one
puts a strain on the system by showing up for costly emergency room
visits, then expecting everyone else to pick up the tab.
Instead, Republicans have made the individual mandate the focus of
their attacks on President Barack Obama’s health care law, saying it’s
a dangerous overreach of government authority that sets the nation on
the slippery slope of — in the words of Judge Roger Vinson — giving
Obama the right to make us all eat broccoli.
Critics cry foul, or worse yet, hypocrisy.
But top GOP senators say there’s nothing inconsistent with their
position: It’s OK to ask people to buy health insurance, as long as
it’s not a legal mandate and as long as the U.S. does everything in its
power to help.
“There’s no question” that people have a responsibility to have health
coverage, said Sen. Orrin Hatch of Utah, who has introduced legislation
to repeal the individual mandate. “But there may be ways to provide
incentives to get people to get coverage for themselves.”
The freedom for people to make their own decisions on health care is so
important, Hatch said, that the government shouldn’t override it in the
name of personal responsibility. “That’s a tough issue because you’re
talking about American liberty — liberty to make your own choices,”
Hatch said.
The “free rider” argument was central to the Democrats’ case for the
mandate. “What it’s saying is ... that we’re not going to have other
people carrying your burdens for you any more than the fact that right
now everybody in America, just about, has to get auto insurance,”
President Barack Obama said of the individual mandate in September
2009, during the height of the health care debate.
And yet, even Obama was not always a fan of the mandate. It was one of
the few slivers of daylight between him and Hillary Clinton on the
campaign trail in 2008.
Republicans don’t argue with the point that people should take
responsibility for themselves and get health coverage. They just think
there are ways to encourage people to do that without forcing them to
buy health insurance they can’t afford.
So their message going forward will be: Make it cheaper, and people
will get it.
Sen. Lamar Alexander of Tennessee wants to find ways to sell health
insurance that doesn’t have to offer all the benefits required in every
state, which he says drive up costs. Sen. Susan Collins of Maine would
provide “generous tax credits” and let health insurers sell plans
across state lines so they can escape some of the expensive benefit
requirements.
And Sen. John Cornyn of Texas would encourage more people to buy health
savings accounts, which are linked to high-deductible plans that, in
his view, hold down costs by giving people an incentive to spend less.
“The system works better when people buy health insurance,” Alexander
said. “One way to help them do that is to lower the costs ... so that
people will want to buy it.”
The bottom line, these Republicans say, is that people want to do the
right thing and cover themselves — but the health care law will make it
too expensive to do that because it will require health insurance to
cover too many things. The law will provide tax credits and subsidies
to help low-income families pay for coverage, but most Republicans
believe those will cost the federal government too much.
“There is a personal responsibility component,” Collins said. “I think
most people want to be insured. I don’t think most people want to go
without coverage. I think that if you make it more affordable, they’re
more likely to want to buy insurance.”
Not all conservatives believe the Republicans need to worry about
encouraging personal responsibility if the mandate falls.
The problem of free riders is “overstated” because most of the people
who would gain coverage through the individual mandate would be young,
healthy people who rarely need medical care, said James Capretta, a
fellow at the Ethics and Public Policy Center. “Basically, what you’re
trying to do is get them to pay premiums without using the health care
system too much. So the idea that they’re free riders and they’re going
to save a lot of money is just not the case.”
And Michael Cannon, director of health policy studies at the
libertarian Cato Institute, says the federal government shouldn’t try
to encourage coverage at all — whether the effort is led by Republicans
or Democrats — because everything it has done so far has made things
worse.
The issue should be solved in different ways in different parts of the
country, Cannon said, and “the way you do this is to get the federal
government out of it.”
But Bob Moffit, a senior fellow at The Heritage Foundation, said the
personal responsibility issue is one that conservatives need to take
seriously. “The administration’s argument is valid. Free riders cost
40-some billion dollars a year. It’s true, and it’s a real problem.”
The answer, however, is not to force everyone to buy health insurance,
Moffit says. He says the solution is to offer “generous tax relief” to
all Americans to help them with their health insurance costs, then sign
them up automatically for a health plan — either through their employer
or through a health insurance exchange — just as many employers
automatically enroll their workers in pension plans. If someone wanted
to refuse the coverage, they would have to do so in writing.
“If they refuse the coverage, they know that they’re going to leave
several thousand dollars on the table,” Moffit said. “And they
acknowledge that they’re going to skip the coverage and go bare. And
they’d accept the consequences of that, including garnishing their
wages.”
There are other ideas for alternatives to the individual mandate, such
as letting people get coverage only during defined open enrollment
periods and not letting them sign up later if they get sick. It’s not
clear how effective any of them would be, compared to the individual
mandate. But conservatives believe there are plenty of ways to achieve
some of the same goals.
“They wanted to say, `We passed universal coverage.’ They wouldn’t get
there without the coercive step of the mandate,” Capretta said. “There
are definitely ways to get to higher levels of coverage without the
individual mandate.”
Politico
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