"Everyone" is familiar with the fact that Republicans can't agree on an alternative to the Affordable Care Act, commonly known as Obamacare, which is on life support. But after ending it, is there anything to be done to help people afford medical care? Even with Obamacare, 29 million Americans aren't insured.
Economist Michael Strain makes the case that conservatives should support a universal requirement for health insurance because everyone will need medical care at some point and Republicans claim to be big fans of "personal responsibility."
Each of us is in the market for medical care, whether we have insurance coverage or not: We all face the risk of acquiring a devastating disease, or of suffering a terrible accident. Those who don’t have insurance against that risk create the possibility that the cost of their medical care will be passed on to the rest of society in the form of higher premiums or higher taxes. Conservatives, who value personal responsibility, should be the first to argue that individuals should be covered by health insurance. And in a nation as wealthy as ours, a medical emergency should not leave anyone broke. We should have a safety net so that no one falls too far. Universal coverage advances both personal responsibility and social assistance for those who need it. Conservatism is consonant with this objective.
Strain isn't trying to convince conservatives to support a centralized, government-backed single-payer system, something no one on the right would back. He also acknowledges that lower income Americans cannot afford their own insurance, and the open market is certainly plagued with its own frailties, not to mention that healthy people just aren't interested.
So what's his answer?
Taxing employer-provided health insurance would (among other good things) reduce health care costs and create a pool of money to fund subsidies, in the form of refundable tax credits, available to low-income Americans for the purchase of health insurance. Deregulating the individual market for health insurance -- allowing insurance companies to offer plans that cover only catastrophic medical events, not routine medical care -- would make insurance more affordable and expand consumer choice. Funding high-risk pools would provide access to medical care for people with pre-existing medical conditions who might otherwise struggle to get insured in a deregulated market.Under this framework, there would be a strong incentive to purchase health insurance even without the ACA’s individual mandate: Catastrophic coverage would be less expensive, both to the government and to the consumer, than comprehensive coverage. A sufficiently generous tax credit would provide added motivation, as only those who actually purchased insurance would be able to claim it.
Pie in the sky? Perhaps, but catastrophic coverage only is how the auto insurance market works. Insurance won't pay for an oil change, but it will pay for car repairs if a vehicle and its occupant gets banged up. Isn't that kind of protection what most people need?