A Way Out of the Mandate Morass

Mark Kleiman cites the following remarks from the old Mitt Romney as big trouble for his future prospects:

With private insurance finally affordable, I proposed that everyone must either purchase a product of their choice or demonstrate that they can pay for their own health care. It’s a personal responsibility principle. Some of my libertarian friends balk at what looks like an individual mandate. But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on the taxpayers is not libertarian.

Obviously Romney’s various flip-flops over the years are a problem for him. But this paragraph also indicates a possible “escape hatch” whereby less-rabid Republicans can come to accept the basic structure of the Affordable Care Act without crossing key taboos. This morning on NPR Rep David Dreier was asked about whether he really wants to repeal subsidies for small businesses that provide insurance to their employees or regulatory bans on rescissions and he said “well, we’ve said all along that the good parts like that we don’t want to repeal.” Obviously that’s not what people have been saying all along, but it’s the reality—there are big portions of this bill that many Republicans won’t want to repeal. But the mandate is necessary to make the contraption work, and the mandate is anathema.

Romney’s old idea of letting people “demonstrate that they can pay for their own health care” as an alternative to buying insurance could be a way out. The way this worked was that to escape from the mandate, you were going to have to post a bond with the state demonstrating that would be used to pay for your health care if you got sick. If you design this in a sensible way, it has the exact same effect as an individual mandate. But of course it’s not an individual mandate. It’s just an effort to halt freeloaders. Meanwhile, one somewhat justified complaint insurance companies will have with the Affordable Care Act is the idea that the penalty for non-compliance with the mandate is too low. But getting the penalty made tougher is a total political non-starter, and Republicans would really like to say they repealed the individual mandate. Romney’s idea could offer a way out of the trap.

And I think this is the spirit in which you should understand the Brown/Wyden idea—sensible conservative politicians need an exit strategy from “repeal and replace” that doesn’t constitute surrender, and it’s fitting that the MA GOP should lead the charge.