Health care costs are different from costs of, say, toasters or Ford trucks. Health care decisions are often made in emergency situations, require expert input and action, and are so expensive that they can only be paid for by using insurance. In fact, experience has shown that even though Americans have as much or more “skin in the game” in out-of-pocket health care costs as others, our costs are uniquely high.
Plus, unique to the industrialized world, we have a whole bunch of uninsured people dying sooner and being less productive. In order to prevent the ignominy of being the world’s greatest nation yet turning grievously ill people away from emergency rooms, President Reagan signed into law a bill requiring treatment. Where do we go from here?
Well, conservatives (and many liberals) were reluctant to move to a system of government-provided health insurance, like they have in Canada, or government-provided health care, like they have in the UK. So conservative economists came up with the idea of a health insurance mandate, on the theory that it leaves the current system of private health insurers intact, leads to better health care outcomes, and brings health care prices down by spreading risk more widely. (It’s often the young and the healthy who don’t purchase insurance). For about two decades, this was the mainstream Republican view, supported by noted not-communists like Bob Dole, Richard Lugar, Chuck Grassley, Orrin Hatch, Jesse Helms, and Trent Lott.
In August, 2009, Grassley called for health care reform “through an individual mandate,” on the grounds that ”Republicans believe in individual responsibility.” In June of that year, he told Fox that even though some might view them “as an infringement upon individual freedom,” there wasn’t ”anything wrong” with a health insurance mandate.
[ADDED: Romney wrote in the summer of 2009 that “we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages “free riders” to take responsibility for themselves rather than pass their medical costs on to others. This doesn’t cost the government a single dollar.” He said in June 2009 that Wyden-Bennett, which contained an individual mandate, was a plan “that a number of Republicans think is a very good health-care plan—one that we support.”]
Then, of course, the concept of health insurance mandates was embraced by Pres. Obama. Grassley then said it violates the Constitution.
Romney, of course, signed into law a health care bill including mandates when he was governor of Massachusetts. Now he’s on the verge of being excommunicated for his supposed sins against conservatism.
On the one hand, you kinda feel for the guy. He was at the time adhering to a standard Republican view. It’s not his fault that they all went insane.
But then, there he is, drawing weak distinctions between his accomplishments and the president’s plan, begging the Republican base to let him tell them the lies they crave.
Anyone who’s been a Republican politician for more than about a year and a half has taken positions that the Party now claims are not merely inadvisable, but tyrannical and unconstitutional. Tactical imperatives, resentment of the president, and a few sentences worth of talking points, have undone decades of policy research and proposals. Their only answers to the policy challenges of unemployment and lack of insurance are, “wait for things to get better.”
It’s hard to see how this irrational, tribal rage subsides anytime soon, or how a party without policy views can contribute anything constructive to governing.