Thursday, December 08, 2005

Romney's Revolutionary Idea

Not long ago, I posted a scathing indictment of a bill passed by the Massachusetts House attempting to create a big new universal medical coverage entitlement in the state. Time magazine's Joe Klein (bias beware) takes note of these goings on in Massachusetts, in the context of Mitt Romney's own health care plan.

"I don't like calling it universal coverage," he told me last week. "That smacks of Hillarycare. But I do think we've come up with a way to get everybody covered through the free-market system." Romney's way is not new: policy wonks call it an "individual mandate" system, but the Governor doesn't like that term either. "I call it a personal responsibility system," he said.

What could this be? Read on.

Here is how it would work. Massachusetts now spends about $1 billion a year to provide emergency health care for at least 500,000 uninsured citizens. About 200,000 of those are young people, predominantly male, who are making enough money to buy health insurance but figure they don't need it. They would be required to buy a relatively inexpensive health insurance policy, with higher deductibles and co-pays—that's where the "mandate" comes in. Another 100,000 are extremely poor people who are eligible for Medicaid; a concerted effort would be made to bring them into the system. The remaining 200,000 are the people who have been most neglected by the system in the past: the working poor, people who have low-end service jobs or work part time for employers who don't offer health coverage.

Romney's gamble is that Massachusetts can take the $1 billion it spends on the uninsured and use it to subsidize coverage for the working poor. The Bush Administration will kick in another $1 billion, over three years, to make the experiment work if Romney can get a suitable proposal through his state legislature.


I admit, I found this shocking at first. I'm not a giant Romney fan, but I like him enough. I expect him to hew to Republican principles of small government and low taxes. And now he is proposing some form of attempted universal health care - not only that, but also requiring people to buy insurance that they might not otherwise choose to! It can't be!

Upon further reflection, I have found many redeeming qualities in this plan. First off, we have to accept the reality of the status quo: taxpayers are already paying for people who don't buy insurance. In pure libertarian principle, no one should be forced to buy anything, and no one gets any free stuff on anyone else's dime either. Sure. But this is reality, and everyone gets free health care if they are in massive need.

Because we can't possibly change this fact, it does make some sense to charge everyone for it. In scenario A we have a free entitlement. In B we have a forced, paid entitlement. Which is better? I'm going to go with B, Bob. Several reasons: 1. giving something away free means you took it from someone else, that is unacceptable. 2. If you force people to pay for what they get, then they might just vote your butt out of office and get rid of the entitlement! This may not be the case for emergency health care, but certainly when we start giving away free TVs and cars and whatnot. Its a better precedent. And on the downside, you have the fact that your government is forcing you to pay for something against your will. Not good, but less insidious than grabbing it through income taxation (for example) where an entitlement injustice might never be specifically seen or felt, and thus never remedied. Finally, the idea of having the working poor pay at least *some* of the tab is a shot at the head of progressive socialism. I'll accept a small evil (government makes my buy insurance) as the price of battling a giant evil (free entitlements).

In either case, we also have the freeloaders at the bottom of the spectrum, and that is unfortunate. But making people pay for their entitlements may actually be a huge step in the right direction.

Bravo, Mitt.

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