I have long joined the conservative chorus that Obamacare should be repealed and replaced prior to its full-scale implementation in 2014. However, its triggering mechanism, the individual mandate, is sound policy and should be embedded in the six-point Republican alternative I detail below.
This post is inspired by my reading and subsequent review of the most comprehensive, objective biography biography of presumptive Republican presidential nominee Mitt Romney and his most substantive policy achievement as Massachusetts governor. It also previews the Supreme Court's consideration of the constitutionality of the individual mandate during three days of oral arguments scheduled for next month.
While I have some expertise as a student of the Constitution and our courts, I'll defer to their eventual ruling on whether the individual mandate exceeds the boundaries of the Interstate Commerce Clause. It does seem to me that there is plenty of water under the bridge given the Court's eventual embrace of the New Deal during the late 1930's, but a fragile conservative majority may seek to rein in the commerce clause and thus undermine Obamacare in the middle of an election year.
My heretical embrace of the individual mandate warrants further explanation. Its presence in the Heritage Foundation's alternative to Hillarycare in the 1990's is a well-worn talking point, and Newt Gingrich is one of many prominent conservatives who endorsed the idea. I would suggest this is consistent with right wing ideology, for it places responsibility on the individual.
Americans receive health care in the country through a variety of channels. Government provides it for the elderly and poor via Medicare and Medicaid, respectively. Most of the gainfully employed receive private insurance through their employers, and the self-employed and other individuals either purchase their own plan or do without. The latter pursue catastrophic care when emergencies inevitably arise, and our hospitals pass on these costs to consumers, which are subsequently reflected in higher premiums across the board. The personally responsible majority is thus punished for the negligence of the minority.
Is it unreasonable to require individuals to purchase health insurance when we hold car owners to the same standard? True, health care premiums are far more expensive than auto insurance, but I would suggest the latter is a model for health care reform, and my six-part plan follows.
One, through cross-subsidization, car insurance is relatively cheap unless one has a reckless driving record. It eliminates the free rider problem, at least in theory. The same principle would hold true with health care. Premiums may even fall.
Two, car insurance is cheaper because it covers only exceptional circumstances like accidents and theft. Routine maintenance and fuel are not included. Real health care reform would ask consumers to foot the costs of preventative care out of pocket, drawing from tax exempt medical savings accounts. We would only tap health insurance in the case of emergencies like cardiac arrest or cancer.
Three, most employers do not offer car insurance to employees nor does our tax code subsidize its extension. We desperately need to make health insurance portable in an economy where we are increasingly free agents. Remove the tax deduction for employers who offer health care as part of their standard package of employee benefits, and provide a reciprocal, revenue-neutral deduction on individual tax returns.
Four, allow individuals to shop for insurance across state lines. The industry enjoys regulated monopolies at the state level (with favorable kickbacks for elected officials) that mandates excessive coverage, with exponential cost implications. Deregulation will lower costs
Five, rescue the health care industry from the grip of trial lawyers. Medical malpractice suits and the excessive punitive damages they encompass is passed along once more to consumers in the form of higher premiums, and our care itself suffers as health care providers logically practice preventive medicine.
Six, remove the shackles of Medicaid and allow states to experiment with more cost-effective means of providing for the health care needs of the indigent. Mitt Romney enjoyed this flexibility in Massachusetts and delivered favorable results, and the same is true of Mitch Daniels' work in Indiana.
In sum, Republicans are right to call for the abolition of Obamacare, but their hatred of the individual mandate is misdirected. A conservative alternative, representing some or all of the key tenets articulated above, would embrace the mandate as a personally-responsible means of insuring that we all pay our fair share of our health care needs. Given his health care reform record in Massachusetts, Mitt Romney is superbly qualified to make this case in November and beyond.
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