Conservatives: Be careful what you wish for on Obamacare
Conservatives Monday could barely contain their glee when a Virginia federal judge ruled that Obamacare's individual mandate is unconstitutional. What the right fails to grasp (as I argued in The Post in October) is that "success" in court will ultimately undermine the private-sector health care Republicans cherish. Here's a reprise of that column's salient points:
The reason the [Affordable Care Act] mandates that individuals buy health insurance is because Obama wants to reach near-universal health coverage via a private insurance system. The law bars insurers from denying coverage based on preexisting medical conditions -- a reform that Republicans, along with Democrats, say is essential. It's why Republicans who pledge to repeal Obamacare on the stump vow in the next breath to reenact this core provision.
But here's the rub: You can't force health plans to offer coverage to everyone, regardless of medical condition, if you don't make sure everyone is in the insurance pool. Without such a mandate, people have an incentive to wait until they get sick to buy coverage. Insurance can't work that way. The result is a classic insurance "death spiral" in which, on average, sicker people are in the pool, which makes premiums rise, which in turn forces healthier people out of coverage they can't afford, which then leaves the pool filled with even sicker people on average, which sends premiums higher again, and so on. This is why states that have forced insurers to accept all comers without also having a coverage mandate (such as New York and New Jersey) have seen rates soar and coverage shrink -- hardly what officials intended. This is Health Insurance 101. (The other piece is that you need subsidies for low-income folks if you're going to have the mandate, which is why Obamacare is expensive.)
Republicans used to understand these economics perfectly. That's why Bob Dole, Howard Baker, John Chaffee and Mitt Romney (among others) have all supported individual mandates. Are all these Republicans constitutional rogues? No one disputes that the federal government has the power to stop insurers from denying coverage based on preexisting conditions. Under the Constitution, the feds thus have the corresponding power to enact reasonable measures to assure that this reform actually works....
The irony is that conservatives, either from confusion or for the sheer fun of taking a political bite out of Democrats, are fighting the one measure that's essential if private insurance is to retain its central role in American health care....
So, conservatives, be careful what you wish for. By fighting the mandate needed to make private insurance solutions work and doing nothing to ease the health cost burden on everyday Americans, you'll hasten the day when the public throws up its hands and says, "Just give us single-payer and price controls." Don't think the anti-government wave this fall won't reverse itself on health care if the most private sector-oriented health care system on earth keeps delivering the world's costliest, most inefficient care.
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