The former Senate Majority Leader wrote:
The argument for an individual mandate centers on three principles.
First, it would achieve fairness. No family in America should fear bankruptcy because of an accident, a child's cancer, or a heart attack. That is the purpose of insurance. An individual mandate is the only way to achieve affordable insurance coverage for every American in a pluralistic, public-private sector.
Second, it would eliminate wasteful cost-shifting. Though many uninsured people do eventually get care in emergency rooms, the $30 billion to $50 billion in bills for "uncompensated care" or "bad debt" they generate are inefficiently shifted to the privately insured, wasting scarce health dollars. These economic distortions are behind the dollar aspirin tablet and the $10 Band-Aid you discover on your hospital bill. No one knows the real price of anything. Such lack of transparency destroys any hope for true market forces, like prudent purchasing by the consumer, which would normally hold the "health spending curve" in check.
And few today who remain "voluntarily uninsured" fully appreciate the risks they would face in the case of a catastrophic event.
Third, it would reduce adverse selection. When healthier people opt not to carry insurance, only those with poorer health, and thus higher costs, remain in. This leads insurance prices to spiral up. And it further impedes markets' ability to mitigate risks and prevent personal economic catastrophe. The "free-riders" who do not purchase insurance and the "voluntarily uninsured" who depend on emergency room care paid by others would then pay their fair share for services received.
Indeed, some of my conservative commenters have mentioned over here that if you are going to ban “pre-existing conditions,” you must have an insurance mandate. Otherwise, people would go without insurance until something catastrophic happened, and the insurance pool would be dominated by sick people, without a balance of healthy people.
Of course, liberals are all over the fact that the mandate started as a Republican idea:
"The truth is this is a Republican idea,'' said Linda Quick, president of the South Florida Hospital and Healthcare Association. She said she first heard the concept of the "individual mandate'' in a Miami speech in the early 1990s by Sen. John McCain, a conservative Republican from Arizona, to counter the "Hillarycare'' the Clintons were proposing.
McCain did not embrace the concept during his 2008 election campaign, but other leading Republicans did, including Tommy Thompson, secretary of Health and Human Services under President George W. Bush.
Seeking to deradicalize the idea during a symposium in Orlando in September 2008, Thompson said, "Just like people are required to have car insurance, they could be required to have health insurance.''
Among the other Republicans who had embraced the idea was Mitt Romney, who as governor of Massachusetts crafted a huge reform by requiring almost all citizens to have coverage.
"Some of my libertarian friends balk at what looks like an individual mandate,'' Romney wrote in The Wall Street Journal in 2006. "But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on government is not libertarian.''
Romney was referring to the federal law that requires everyone to be treated in emergency rooms, regardless of their ability to pay.
In truth, I think it’s just as much a Democratic idea as a Republican one. Hillary Clinton embraced the mandate as a candidate for President, for example.
All of this arguing over the mandate, after the fact, is just so much Kabuki Theater and manufactured outrage. It’s dishonest for Democrats to say that this is purely a Republican idea but it’s even more dishonest for Republicans to run from the policy they once advocated--and it’s shameful that they would stoke outrage among their unhinged base for something they have supported for decades.
Just another sign of our broken system. I'm still waiting for the grown-ups to arrive.