In their ongoing debate about Romneycare, David Frum has
penned a
remarkably obtuse response to AmSpec alum Phil Klein.
Frum points and sputters at
this line by Phil:
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.
