BUT IT'S NOT PRIMARILY ABOUT PAYING FOR MEDICINE....

How Can Republicans Hate the Individual Mandate?: The individual health care mandate is a conservative concept that conservatives now say they despise. What gives? (Eliot Spitzer, Jan. 10, 2011,Slate)

Conservatives claim to be outraged that any government—federal or state—could require them to participate in the health-insurance marketplace.

Yet in a series of conversations I have had with senior Republicans—both on and off my CNN show—those individuals have conceded that the idea makes sense, and is conservative to boot.

Let's start with a couple of facts nobody disputes. Federal law requires hospitals to give emergency care to all people—regardless of insurance coverage. The annual bill for care delivered by hospitals to uninsured individuals is more than $40 billion. Those costs are reimbursed to hospitals through multiple reimbursement programs—state and federal—all designed to cover what is called "charity care." All the funds for these reimbursements come from you and me—in the form of either higher taxes or insurance premiums. Our dollars are funneled to the hospitals to cover the cost of covering the uninsured. Those who get the care yet have no insurance and pay no bills are freeloaders whose costs have been shifted to everybody else. These freeloaders are the very sorts of people Republicans usually love to deride—for they eat from the trough of public benefits yet contribute nothing.

These uninsured individuals have made an economically rational decision—but a selfish one. Why pay insurance premiums when they can rely on hospitals to provide emergency care anyway? Moreover, they may gamble that the value of the health care they consume will be less than the cost of the premiums they will pay. Shifting the cost of their care to others seems just fine to them. Those of us who pay premiums and taxes are covering the cost of these freeloaders. Not fair, we cry!

The remedy is conceptually easy: Everybody should buy some form of insurance or pay a tax whose proceeds are used to cover the appropriate health costs. That amount can be—and is, in the health care reform law—calibrated to one's income.

Nobody with whom I have spoken has any alternative idea that makes sense. A few conservatives offer a canard: the fallacy that people can "opt out" of the health care marketplace. We all participate, from the moment of birth, and we all incur and generate costs. From required life-saving inoculations to the high costs of end-of-life care, we all consume. The only question is whether we all pay.

...it's also about imposing the costs, so that the consumers of health care act like other sorts of consumers and shop around. So make the mandate HSAs.

Posted by Orrin Judd at January 20, 2011 3:27 PM