Some of us simply don’t believe that the way to fix our health care system is for the government — whether at the federal or state level — to mandate, regulate and subsidize the purchase of health insurance.
Frum then goes on to list all the ways government at all levels has subsidized and regulated health insurance for a long time. But it’s pretty obvious Phil is arguing that a new patchwork of mandates, regulations, and subsidies won’t solve the health care system’s biggest problems right now rather than calling for the repeal of every single health-related law ever enacted. Creating a freer market in health care doesn’t mean absolutely zero government role any more than a free market in food means absolutely zero regulations or subsidies.
Frum’s own post suggests this isn’t as radical a proposition as he makes it out to be. Despite his laundry list of government regulations and subsidies, the health care system still has problems with cost and access right now. Noting the tax expenditure on behalf of employer-provided health care benefits, Frum writes that the “ill effects of this subsidy are pretty notorious by now.” But somehow the solution to this notorious problem can only be found in the thin space between Romneycare and Obamacare.
It’s true that many conservative health care policy wonks supported an individual mandate, and some center-right politicians went along. But the idea that there was a widespread conservative commitment to the mandate is largely a fantasy. The most conservative alternatives to Hillarycare in 1994 did not include a mandate. Conservative advocacy of the mandate outside health care wonk circles was relatively rare. It might never have left the realm of privatized lighthouses if Bob Dole hadn’t been allergic to policy and Newt Gingrich hadn’t been erratic.
Most of the Republican politicians who signed on did so only because they didn’t think seriously about health care reform and were grasping for some alternative to the Democratic proposal du jour — which they would immediately drop once the latest health care debate was over. Even the most significant exception to this rule, Mitt Romney, originally proposed a bond rather than a mandate.
Finally, Frum bizarrely implies that Phil is among a group of conservative writers who “espouse positions much more radical than they held four years ago.” I was working with Phil four years ago when he wrote this:
[S]ome Republicans have decided to enact essentially liberal reforms, arguing that this is the only way to stave off more intrusive measures. Along these lines, President Bush signed the largest expansion of entitlements since the Great Society in the form of the Medicare prescription drug bill. As governor of Massachusetts, Mitt Romney imposed mandates requiring every citizen to purchase health insurance, creating a state-managed system that is wildly over budget just two years after being signed into law. And in spite of such compromises, the liberal charge for national universal health-care legislation is fiercer than ever.
We both opposed Romneycare at the time it was enacted and Phil was writing against mandates before Obamacare was a gleam in Nancy Pelosi’s eye — and back when Barack Obama still agreed with us about the individual mandate rather than David Frum.