Sunday, February 21, 2010

Individual Mandate

I have a column in today's Raleigh, N.C. News and Observer that says the main thing Thursday's reform summit needs to focus on is the individual mandate. The actual policy details offered since the Summer by Democrats have been reminiscent of past Republican proposals. And a policy deal should be fairly straigtforward.

However, as the policy details moved toward the center during the most recent reform discussion as compared to past reform discussions, the rhetoric used by Republicans in opposition has moved toward the apocalyptic. The most fundamental argument in opposition seems to have settled on the individual mandate as a limt of freedom. Every piece of legislation limits freedom in order to achieve a goal that those who support it decide is worth it. Such a tradeoff (freedom v. policy goal) is inevitable and a legitimate discussion in a democracy.

Decisions have consequences.

There is no example of a nation with anything near universal coverage without some sort of mandate. We as a nation, of course, do not have to move in this direction. If we do not, we need to face up to the inconsistencies inherent is having legal and cultural expectations that providers still provide care to those who cannot pay, and shifting these costs throughout the system. The same sorts of freedom based arguments could be used to say why should providers have to provide the fruits of their labor to those who cannot pay?

If the Summit could focus on the issue of the individual mandate in a way that could help our nation decide whether we are willing to couple our desire for everyone to have coverage with a mix of policies necessary to move in that direction, that would be useful.

I believe the individual mandate is worth it, and have written about that here and here and in much of the content of this blog. I sincerely hope that the summit can help focus the nation's attention on the individual mandate in a way that can help us decide, accept the consequences, and move ahead.


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