I assembled a team from business, academia and government and asked them first to find out who was uninsured, and why. What they found was surprising. Some 20% of the state's uninsured population qualified for Medicaid but had never signed up. So we built and installed an Internet portal for our hospitals and clinics: When uninsured individuals show up for treatment, we enter their data online. If they qualify for Medicaid, they're enrolled.Sure, it's a personal responsibility principle of the "I mandate, you pay" variety. Romney is no dummy though and he has an answer to this point.
Another 40% of the uninsured were earning enough to buy insurance but had chosen not to do so. Why? Because it is expensive, and because they know that if they become seriously ill, they will get free or subsidized treatment at the hospital. By law, emergency care cannot be withheld. Why pay for something you can get free?
Of course, while it may be free for them, everyone else ends up paying the bill, either in higher insurance premiums or taxes. The solution we came up with was to make private health insurance much more affordable. Insurance reforms now permit policies with higher deductibles, higher copayments, coinsurance, provider networks and fewer mandated benefits like in vitro fertilization--and our insurers have committed to offer products nearly 50% less expensive. With private insurance finally affordable, I proposed that everyone must either purchase a product of their choice or demonstrate that they can pay for their own health care. It's a personal responsibility principle.
Some of my libertarian friends balk at what looks like an individual mandate. 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.So why not end the free ride that government made possible in the first place and let individuals make their own healthcare choices--and live by those choices accordingly? Why not encourage people to save for their healthcare, for starters, by not taxing healthcare savings?
That option doesn't even show up on the radar. Offered instead are subsidies for the poor. According to Romney:
Another group of uninsured citizens in Massachusetts consisted of working people who make too much to qualify for Medicaid, but not enough to afford health-care insurance. Here the answer is to provide a subsidy so they can purchase a private policy. The premium is based on ability to pay: One pays a higher amount, along a sliding scale, as one's income is higher. The big question we faced, however, was where the money for the subsidy would come from. We didn't want higher taxes; but we did have about $1 billion already in the system through a long-established uninsured-care fund that partially reimburses hospitals for free care. The fund is raised through an annual assessment on insurance providers and hospitals, plus contributions from the state and federal governments.Oh, so it's not a tax--it is an "assessment" matched with a "contribution." The taxpayer can now rest easy. Romney continues:
To determine if the $1 billion would be enough, Jonathan Gruber of MIT built an econometric model of the population, and with input from insurers, my in-house team crunched the numbers. Again, the result surprised us: We needed far less than the $1 billion for the subsidies. One reason is that this population is healthier than we had imagined. Instead of single parents, most were young single males, educated and in good health. And again, because health insurance will now be affordable and subsidized, we insist that everyone purchase health insurance from one of our private insurance companies.Bipartisan market reforms? He's kidding, right? Mandating more government interference in the market is hardly a market reform. And since Romney notes the "bipartisan" support for his plan, it is interesting to note his citation of one of the architects of his plan:
And so, all Massachusetts citizens will have health insurance. It's a goal Democrats and Republicans share, and it has been achieved by a bipartisan effort, through market reforms.
We have received some helpful enhancements. The Heritage Foundation helped craft a mechanism, a "connector," allowing citizens to purchase health insurance with pretax dollars, even if their employer makes no contribution. The connector enables pretax payments, simplifies payroll deduction, permits prorated employer contributions for part-time employees, reduces insurer marketing costs, and makes it efficient for policies to be entirely portable. Because small businesses may use the connector, it gives them even greater bargaining power than large companies. Finally, health insurance is on a level playing field.Rather than craft trivial measures, why isn't the conservative Heritage Foundation blasting this proposal for its fundamental faults and arguing for the free market in medicine? Why? Because the conservatives do not stand for the free market and they never have.
The free market works because it recognizes that if we are to prosper, we must take it upon ourselves to create the values we needs in life and it leaves us free to choose our path accordingly. The free market rewards us for our wise choices and does not burden us with claims for the unearned.
The Massachusetts plan does the exact opposite. It fails to address the existing cost of government interference in medicine. It disconnects individuals from the costs they incur. It fails to properly address the problem of poor people being provided free care at the expense of others. The plan's entire premise is predicated on the argument that everyone "needs" healthcare regardless of whether they work to obtain it and thus "need" is a mortgage upon the lives of the responsible and hardworking. It mandates that an entire costly and coercive system be built under the guise of "personal responsibility" and "market reform."
At root, the Massachusetts plan is nothing less that a morally bankrupt and practically inefficient attempt to socialize medicine. That such a plan is being championed by conservatives yet again reveals just how useless the conservatives are in protecting individual rights and advancing capitalism.