JONATHAN CHAIT MARCH 4, 2011
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Matthew Yglesias tweets a link to a 2004 Reason article advocating... an individual health insurance mandate:
Why not just tell Americans they are responsible for buying their own health insurance from now on? If people couldn't pay for medical care, either through insurance or out of pocket, they wouldn't get it. "After people begin to notice the growing pile of bodies by emergency room entrances," Tom Miller wryly suggests, "they will quickly get the message and go get medical coverage."
But that's not going to happen, says Mark Pauly, a health care economist at the University of Pennsylvania's Wharton business school. "Americans don't want to see their neighbor dying bleeding in the street," he says. "Therefore we already make sure that everyone gets some medical care when they need it. The alternative would be a world in which voluntarily uninsured people wore a bracelet that read: 'In case of an accident, do not take me to the nearest hospital. I've made my choice.'"
Since it's unlikely that Americans will allow their improvident neighbors to expire without medical care in the streets, is there a politically palatable alternative that can preserve and expand private medicine in the United States? Yes: mandatory private health insurance.
The article proposes a plan centered around an individual mandate as a private insurance alternative to the "creeping socialism" proposed by John Kerry, who was then running for president. Now, of course, Reason considers an individual mandate a massive imposition upon freedom and even unconstitutional. (Indeed, Roger Vinson's ruling that the individual mandate was unconstitutional cites a segment on Reason TV.) Now, the plan as a whole is far from identical to the Affordable Care Act. But its defense of the individual mandate is virtually identical to the case liberals have been making, and which conservatives and libertarians have been angrily dismissing.
How to explain this? Well, health care policy is complicated. And the role of the market and government policy are so difficult to separate, meaning the same policy can easily be framed either as more socialism or as more free market. The upshot is that right-wingers tend to view whatever health care reform proposed by Democrats as socialism, but they also see the need to rally around an alternative. Yet when Democrats embrace such policies, it's very easy for people on the right to interpret those as socialism, too.
In any event, watching the right decide a policy it once advocated is not only unwise but a threat to freedom itself is a fascinating episode of ideological hysteria.
5 comments
If conservatives or libertarians propose an individual mandate, it is compatible with freedom. If liberals propose it, it is socialism and freedom-destroying. So, editors over at Reason, observing the ants way down below you, which is it? Y'all are high-minded and you bristle when it is suggested that David Koch acts primarily on interests rather than principle. This looks like naked politics to me, the kind that you Platonists abjure every other hour or so. So Matt Welch, are you going to cut out the bs and come clean and be philosophically consistent at your august publication? Oh sure you will, as soon as I become a libertarian.
- liberalref
March 4, 2011 at 7:30am
Lawyers are allowed to plead alternative, even inconsistent, theories of the case, something learned early in law school and not considered the least bit hypocritical. Political strategists are in much the same position as lawyers (i.e., they are advocates), so I see nothing hypocritical about them arguing alternative, or even inconsistent, positions on policy. It just seems that, on the right (some "libertarians" included), there is no distinction between advocacy and policy, that being an advocate for the cause trumps every other consideration, policy included. Chait makes this point often, comparing the Republicans and the Democrats, the latter more often choosing policy over advocacy, for which they often suffer politically (at least in the short run). Of course, this isn't the first time in history that the cause has trumped all other considerations, but in every instance those drawn to the cause because of policy can suffer the humiliation and the failure of the cause to achieve the desired policy for just so long, leaving the cause with only the most dedicated advocates to pursue the most extreme means to achieve uncertain ends for the cause.
- rayward
March 4, 2011 at 8:08am
Politics makes strange intellectual mattress companions.
- Nusholtz
March 4, 2011 at 8:18am
Yes it does, nush. Could this be an FND?
- liberalref
March 4, 2011 at 8:47am
I think I can explain it. It's shoving those two words for Insurance so close together -- MANDATORY, and PRIVATE. The Republicans are for forcing people to buy PRIVATE insurance, thereby guaranteeing the Private Health-Insurance Industry a captive audience without cost controls. Because the current cost controls on Private Insurance have worked so well, which they haven't. And it's even better when you force INDIVIDUALS to "buy their own", because then they lose all bargaining power. BUT, when you force Private Insurance to have to compete with Mandatory Government policies, including rules about universal coverage and explicit cost controls -- THAT is anathema. You've put their tame herd of MANDATORY victims under PUBLIC limitations, and THAT is what they can't stand.
- AllanL5
March 4, 2011 at 8:51am