A year and a half ago I wrote two posts (part 1, part 2) that discussed then Massachusetts Governor Mitt Romney’s statewide universal health coverage plan. In the first part I derided Romney’s proposal as being akin to Hillary-care. In the second part, I discussed a rebuttal that claimed that Romney’s plan worked within the realities of Massachusetts politics to bring about a health care clearing house that would simply offer residents a broad variety of health care products without regulating the products themselves.
Supporters claim that this is very similar to car insurance. We require all vehicles operated on public roads to be insured. In Massachusetts, they are simply requiring all human bodies operated in the state to be covered by medical insurance. Now that Romney’s health insurance plan has actually been in place for a while, we can take a look to see how like car insurance it really is. And from my analysis, it isn’t like car insurance.
Why do we require all vehicles operated on public roads to be insured? We don’t require you to buy auto insurance to protect your car; we require you to buy auto insurance to protect the property of others who might be impacted by your use of your car. If you fully own your vehicle, we do not require you to buy collision coverage. That’s optional. If you have a loan on your vehicle, your agreement with the lender requires you to buy collision coverage. But that’s to protect the lender’s interests, not yours.
By law we require that you buy only liability coverage to cover others’ potential property loss should you be negligent in causing such. We also require a certain level of injury coverage. You can buy more than the minimum coverage and you can buy a variety of other options as well. And you can buy your policy from any licensed insurer. If you have a claim, that’s between you and your insurer.
But automobile insurance does not pay for your oil changes, registration fees, new tires, or maintenance repairs. However, Massachusetts’ health care insurance does require coverage for the human equivalents of these things.
The underlying premise behind a requirement that each person have medical insurance is that your physical condition is public business. Why is your physical condition government’s concern? Only due to socialism. Since the public pays for a portion of your health care, your health issues impact the public’s pocketbook, so the public can tell you what you must do to minimize their costs.
Do you see the basic problem here? Car insurance does not assume that the government holds any ownership in your car; only that government has an interest in protecting public and private property. Government mandated health care, on the other hand, assumes a certain level of public ownership of your physical body. Or else why would government have any purpose in mandating health care coverage?
You can say that it is because government cares that everyone has access to needed care — that the unfortunate are cared for. OK. Is there a way that can be accomplished without forcing all citizens to participate in a centrally planned system? Perhaps through a voucher system for the underprivileged? And what about people that don’t want the care? A recent study found that 62% of America’s uninsured can afford health insurance but have opted not to buy it. Most of these folks are young adults. In Massachusetts, these people are coerced by law into paying for a product they feel they do not currently need. And they can’t even buy a minimal package. You can’t buy a policy with a high deductible. You can’t buy a policy that doesn’t cover prescriptions.
Whenever we employ government to accomplish something, we are in essence employing coercive power over our neighbors. Sometimes that makes sense. But we ought to be extremely careful about what we choose to force our neighbors to do or not to do.
Romney’s health care plan is a big government program. As Michael Tanner argues in this article, the GOP must decide in the upcoming primary which philosophy will guide the party for the next few years. Is it going to be small government or big government? The big government crowd had their turn at the helm. It cost the party big time in the recent elections. When Republicans came to look like Democrats, middle of the road voters had little reason to let them remain in control. Tanner notes that “on election night 2006, 55 percent of voters said that they thought the Republican Party was the party of big government.”
So, what is the small government approach to health care? A significant move would be to change tax law to decouple health insurance from employment. Although Romney’s plan did that, it created other significant problems that should have been avoided. Another step is to deregulate the overregulated health insurance industry. Despite claims that it would not do so, Romney’s plan increased government regulation of the industry.
Michael Cannon says in this article that good public health policy must include a focus on “creating a vibrant, competitive medical marketplace that puts constant downward pressure on prices while striving to improve quality.” He says, “Such a marketplace would be a better guarantor of quality, affordable health care (and coverage) than anything likely to emerge from focusing solely on expanding coverage.” Cannon says that two assumptions that thwart good health policy are that everyone must have coverage and that government must grow for markets to work.
As we struggle to discover how to deal with increasing health care costs, perhaps we should properly assess the underlying problems. How can we expect to develop a proper solution if we don’t understand why the problems exist? The authors of Healthy, Wealthy & Wise say that the real problem is “not that market forces cannot work in health care. Rather, public policies have prevented health-care markets from functioning properly.” So the solution is to get government out of health care and health care insurance. Romney’s plan did the opposite.
Since Massachusetts’ universal coverage plan went into effect, Romney has quietly distanced himself from it. He found that it didn’t play well on the campaign trail. But unlike his stance on the abortion issue, Romney hasn’t announced a complete abandonment of big government ideology. When Romney is asked about Massachusetts’ universal health coverage plan, he responds that it was the best that could be accomplished given the state’s heavily Democratic political landscape. And while he isn’t very forthcoming about what he plans to do about health care as president quite yet, the things he has said don’t sound at all like a small government approach. With the daily clamor for the government to do something about health care, Romney seems to be holding his big government ideas back for after the primary election.
Look at President Bush, and then ask yourself whether we need another big government ‘compassionate conservative’ in the White House.