Democrats should welcome reform of the reform
Responding to the moderate Democrats who are proposing alternatives to the individual mandate, Greg Sargent says "all they're succeeding in doing is undermining one of the Democratic Party's signature domestic accomplishments." I disagree. I think they're separating politicians engaged in good-faith discussions about how best to reform the health-care system from those involved in a bad-faith discussion that attempts to claim the mantle of reform while being interested primarily in a return to the status quo. This somewhat dovetails with my column today, which argues:
Replacing the individual mandate wouldn't be particularly hard. All we need is another policy that does the same thing -- specifically, discourages free-riders who don't want to buy insurance until after they get sick and thus leave the rest of us paying for them.
In fact, I can give you four credible alternatives in four sentences:
l We could limit enrollment changes to once every two years, so people who decide to go without insurance can't buy coverage the moment they get a bad report from their doctor.
l We could penalize those who wait to buy coverage with higher premiums, which is what we do in the Medicare Prescription Drug Benefit.
l We could have a five-year lockout, in which people who decide to go without coverage wouldn't be able to access the subsidies or insurance protections for five years, even if they decided they wanted to buy insurance.
l We could raise taxes by the same amount as the individual mandate penalty and give everyone who showed proof of insurance on their tax forms a "personal responsibility tax credit" of the same amount.
The danger, as I say at the end, is not that the law does get changed, but that it doesn't. That the GOP won't let it thrive and the Democrats won't let it die and so it just limps along.
Crucially, however, that's not a popular position, Poll after poll shows reform -- or, if you prefer, some sort of "replace" -- to be more popular than repeal. What the moderate Democrats are doing is making it harder for Republicans to hold the line on straight repeal. You don't usually see Ben Nelson spitting fire, but his messaging on this is exactly right. "What’s their plan?" He asked. "Is their plan, 'hope you don’t get sick?'”
And you're already seeing some cracks in the Republican ranks. Mitch Daniels has a plan to reform the bill. Scott Brown has partnered with Ron Wyden on a waiver allowing states to go their own way. Rep. Sean Duffy said his preference was "reform the reform or repeal and replace," and he almost voted against the GOP's repeal effort. Eventually, Republicans are either going to have to actually bring out a plan of their own -- and that hasn't worked very well for them any of the other times they've tried it -- or they're slowly going to lose ground in this debate, and as we get closer to the next election, more and more Republicans will begin looking for an out.
Democrats should be willing to give it to them. Will they love the policy? Probably not. But policy isn't the only ingredient in the law's success. Buy-in matters, too. If Republicans make peace with the law and become more willing to participate constructively in its implementation and perfection, that's worth a lot in terms of how well it ultimately works. More, I think, than will be given up by doing something like switching the individual mandate out for an open enrollment system.
Photo credit: Melina Mara/The Washington Post.
| February 8, 2011; 3:00 PM ET
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