Simon Lazarus thinks that Rep. Paul Ryan’s (R-WI) proposal to require future retirees to purchase coverage from an exchange of private insurers is reminiscent of the dreaded individual mandate in the Affordable Care Act. “[T]he Republicans’ proposal to replace Medicare with partially subsidized private insurance also operates to ‘compel’ people to pay for private health insurance policies. Moreover, this mandate is not even a pay-or-play option; Medicare taxes are mandatory, whether workers want to buy eligibility for old-age vouchers or not.” As Ezra Klein explained it, “If you decide not to use the voucher, or the voucher is insufficient, all the taxes you paid into the system are forfeit. Either you buy insurance as a senior, or you face a tremendous lifetime tax penalty.”
Some conservatives have tried to defend Ryan’s plan from the comparison, but it turns out that the congressman agrees with it. During a town hall in Racine, Wisconsin on Friday, Ryan — who has previously opposed the measure — admitted that his plan includes a mandate:
Q: If Medicare becomes a voucher program, would you require seniors to purchase private insurance and if so isn’t that an individual mandate? If you will not require them to purchase insurance how do you propose to prevent a situation where the costs of uninsured seniors is very expensive and gets passed on to me as a private policy holder? [...]
RYAN: Its mandate works no different than how the current Medicare law works today, which is you just select from a wide range of different plans. It literally would be like Medicare Advantage…
All this tells us is that the mandate isn’t some horribly coercive policy aimed at usurping individual freedoms. Rather, it is a mechanism by which government attempts to encourage more individuals to purchase coverage and expand the size of the health care risk pool, thus spreading the costs and risks of insurance across a larger population (and bringing down health care costs). It’s simply asking able individuals to take personal responsibility for their health care expenses and it’s something Republicans have supported in the past and (apparently) still favor.