JONATHAN CHAIT MARCH 4, 2011
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.