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What is Wrong With the Individual Mandate?
| ParisParamus: Again, why is a mandate like Romneycare less conservative than raising everyone’s state income taxes to pay for the free riders? Or, why isn’t Romneycare fundamentally different than having raised everyone’s state income taxes and then offering a credit if you get private health insurance for not being less of a potential burden on the state? WHY? · Dec 28 at 10:28am |
There is a simple answer to the question posed by ParisParamus. Government exists first and foremost for the sake of our protection. Without it, our lives and our property would not effectively be our own.Government exists also to promote our well-being. For its support, however, taxation is necessary, and we have tacitly agreed that, to be legitimate, these taxes must be passed by our elected representatives. By our own consent, we give up a certain proportion of our earnings for these purposes.
The money left in our possession, however, is our own — to do with as we please. It is in this that our liberty largely lies. Romneycare and Obamacare, with the individual mandate, changes radically our relationship vis-a-vis the government. The former presupposes that state governments have the right to tell us how we are to spend our own money, and the latter presupposes that the federal government has that right as well. Both measures are tyrannical. They blur the distinction between public and private and extend the authority of the public over the disposition of that which is primordially private. Once this principle is accepted as legitimate, there is no limit to the authority of the government over us, and mandates of this sort will multiply — as do-gooders interested in improving our lives by directing them encroach further and further into the one sphere in which we have been left free hitherto.
Managerial progressives see only the end — preventing free-riders from riding for free. And they ignore the collateral damage done by way of the means selected. Mitt Romney and Newt Gingrich have no understanding of first principles. For both of these social engineers, citizens are subjects to be worked-over by the government for their own good. Both men are inclined to treat us as children subject to the authority of a paternalistic state under the direction of a benevolent and omniscient managerial class.
There is, however, this difference between Romney and Gingrich. The latter may or may not fully grasp why the Tea Party rose up against the individual mandate, but he recognizes that they did so, and he knows what is good for him — so he has now backed away from the fierce advocacy of this despotic measure that once characterized his posture. The former is more stubborn. Politically, he is tone deaf. He seems constitutionally incapable of grasping the argument, he insists that the individual mandate is consistent with conservative principle, and he will not back off.
Raising taxes to reward free riders is, of course, objectionable. We should oppose it on principle. But it does not in and of itself narrow in any significant fashion the sphere of our liberty. It is a question of the proper use of the public purse. The individual mandate sets a new precedent. It extends government control to the private purse.
Back in May, in a post entitled The Last Man Standing, I wrote, “Frankly, I shudder at the prospect that Mitt Romney will gain the Republican nomination.” And I offered the following as an explanation:
As I argued in my book Soft Despotism, Democracy’s Drift, there is built into liberal democracy a natural tendency to drift in the direction of the administrative state with its concentration of power in the executive branch of the central government and its entitlement programs. This propensity can only be successfully resisted if we understand its origins and if we take cognizance of the manner in which the American regime, as envisaged by the Founding generation, was designed to stand in its way. This propensity has been systematically and quite effectively exploited by the Progressives and their heirs now for something like a century. What they understand that we need to understand is that a reversal of the trend is well nigh impossible – well nigh, let me add, but not quite. Well nigh because those in possession of entitlements will scream bloody murder if they are threatened. And not quite because, thanks in part to our unwitting benefactor Barack Obama, we no longer have the resources to support the entitlements state. We can certainly raise taxes, as President Obama and the Democrats intend to do, but that does not mean that in the long run we will take in more revenue – and it is massively increased revenue that the entitlement state needs. The Progressives are banking on the unwillingness of a considerable part of the electorate to give up the subsidies on which they live, and on this they have always to date successfully banked. Right now, however, the fiscal crisis of the welfare state offers us an opening, and I am confident that Mitt Romney will miss it. He is the sort of man who never misses an opportunity to miss an opportunity.
Since 1928, when Calvin Coolidge relinquished the Presidency, the office has been held by a number of Republicans – Herbert Hoover, Dwight D. Eisenhower, Richard M. Nixon, Ronald Reagan, George H. W. Bush, and George W. Bush. Only one of these has displayed an understanding of the problem we face, and he was, for understandable reasons, too preoccupied with wining the Cold War, to confront that problem with all of his energy. Hoover, Eisenhower, Nixon, Bush père, and Bush fils were all what I call managerial progressives. Their claim over against the liberals was that they could manage the administrative state more efficiently and effectively than their counterparts. Rarely if ever did any of them mention the Founders. Rarely if ever did they appeal to the first principles of our form of government as they are expressed in the Declaration of Independence. Rarely if ever did they appeal to the Constitution in opposition to the jurisprudential drift of the Supreme Court. Limited government was not part of their vocabulary. They were without clue.
The reasons are simple enough. Not one of these men was properly educated in the principles of American government. They had their virtues. They were practical men, can-do sorts with a pretty good understanding of how to get from here to there. In terms of moral understanding, as it is applied to political matters, however, they were bankrupt or pretty nearly so. The ordinary senior at Hillsdale College these days has a better grasp of the Declaration of Independence, the Constitution, and the conditions of freedom than did any of these men.
The same is true of nearly all Republicans. They come into Congress, the Senate, and state government from the Chambers of Commerce. Few of them have any sort of political education. Most are businessmen. If they have something more than an undergraduate education, it is reflected by their possessing a law degree or an MBA – which is to say, they have been trained to be managerial progressives. Our law schools and our business schools owe their origins to the Progressives. They were created for the purpose of encouraging what Franklin Delano Roosevelt called “rational administration.”
The reason why I oppose Mitt Romney is simple, He was born to destroy everything that we have accomplished since the Tea-Party Movement emerged in the Spring of 2009. Romney is the very model of a managerial progressive. He has one great virtue. He knows how to run things; he knows how to organize things. He would make a good Secretary of Commerce. He has no understanding of the principles that underpin our government. And, in fact, like most businessmen, he is a man almost devoid of political principles. Give him a problem, and he will make a highly intelligent attempt to solve it. Ask him to identify which problems should be left to ordinary people and what are the proper limits to government’s reach, and he would not understand the question. He is what you might call a social engineer; and, in his estimation, we are little more than the cogs and wheels that need to be engineered.
Not surprisingly, Romney is a political chameleon. When he ran for the Senate against Ted Kennedy in 1994, he rejected the legacy of Ronald Reagan and embraced abortion. When he ran for the Republican presidential nomination, he altered his profile in both regards. It seems never to have crossed his mind when, as Governor, he confronted a Democratic legislature in Massachusetts intent on introducing socialized medicine that the individual mandate is tyrannical. Flexibility is what substitute for virtue in his case.
Romney’s political instincts are disastrous. He will betray the friends of liberty and limited government at the first opportunity. If he is nominated, the people who joined the Tea Party and turned out in 2010 to give the Republicans an historic victory are likely to stay home. If, by some miracle, the progenitor of Romneycare actually defeats the progenitor of Obamacare, he will quickly embrace the entitlement state and present himself as the man who can make it hum, as he did in Massachusetts. He is not better than Hoover, Eisenhower, Nixon, Bush père, and Bush fils. He is cut from the same cloth, and in practice he is apt to be far, far worse. The consequence will be the death in American life or at least the decay of the impulse embodied within the Tea-Party Movement.
Everything that I have learned about Mitt Romney in the six months that have passed since I wrote these words has served only to confirm my fears. I have no idea whether the Republicans will prevail in November, 2012. That they have an historic opportunity is clear. But it seems highly likely that their standard-bearer will be a man firmly and fiercely committed to the very same progressive principles that animate their opponents.
In 2002, while running for the governorship in Massachusetts, Mitt Romney said, “I have progressive views.” In the most recent Republican Presidential debate, held shortly before Christmas, he strongly denied that his views had changed in the interim on anything but abortion. For the most part, I think, we should take him at his word. He was in 1994 and in 2002 a man with “progressive views,” and he still is.
I would like to believe that, if Romney is the Republican nominee (as I have long believed he will be), conservative voters will hold their noses and vote against Barack Obama (as I will do). The support that Ron Paul is now drawing in Iowa and elsewhere suggests, however, that this is in no way certain. Even, however, if Romney and the Republicans win an historic victory in 2012, I doubt that anything will be done by this managerial progressive to roll back the administrative entitlements state. If I am right in my fears in this regard, the Tea Party impulse will dissipate; the Republican party will split; the Democrats will return in 2016; and 2012 will be seen in retrospect as just another bump in the long, gentle road leading us to soft despotism.
Published in General
The King Prawn
I’m against social security as well because it is a lie a engenders dependence on government. Single payer would do exactly the same thing. The court made clear that government is allowed to tax and provide wealth transfers but cannot mandate retirement savings. Under that precedent the government could tax and transfer wealth in the form of health care payments but it could not actually offer an insurance program, at least not one as the concept is normally understood.
Look, as far as I’m concerned, providing emergency services to poor people is a humane and wonderful thing to do. Fine. But let’s cast it as charity (or better, let charitable organizations provide the services).
I don’t like the idea of government portraying people who don’t buy insurance as “free riders,” as if they’re moral lepers leeching off the rest of us – – thus justifying the government confiscating funds from everyone else, and the price going up for everyone.
Where I come from, we call that a racket. ·Dec 28 at 4:35pm
I think free riders in this sense are only those who could otherwise afford to cover themselves but deliberately choose not to. Dealing with these specific people is where the moral quandary lies. No one (none that I know anyway) want the poor and indigent to go untreated. Indeed, the more conservative and historical position is the one you lay out of having it done through charity. I’d feel a lot better (happy, even) about fixing someone’s broken leg through a charity hospital than through my taxes.
Thanks for all the responses on my FICA comment. Yes, I knew that FICA was a tax even though they call it insurance — as is Medicare. Governments have a long-standing habit of calling things the exact opposite of what they really are!
The other chuckle is the Social Security Trust Fund — it does not exist. It is neither a fund nor is it held in trust.
free riders in this sense are only those who could otherwise afford to cover themselves but deliberately choose not to.
Understood, but only if they use the services – otherwise, they’re refusing to pay for a service they don’t use … which is prudent, not malicious.
Indeed, the more conservative and historical position is the one you lay out of having it done through charity.
And it’s not as if there is some severe shortage of charity organizations, which requires government to make up the difference. There are plenty of charities, religious and secular, who are happy to provide service for the poor.
The only thing standing in their way is a government that wants to dictate how the charity is dispensed.
Power is jealous. The ever-growing federal bureaucracy cannot bring itself to accept a rival for its affection.
Uh…. no, because there is a large set of people who can afford insurance premiums, but could never afford to pay for catastrophic medical expenses out-of-pocket; that’s why there is insurance!!!
Your reply doesn’t answer the question. If you incur medical expenses but don’t buy insurance, you still must pay for them. They don’t lay that off, as they do for indigents. It isn’t the same thing.
So, why the bandwagon for the mandate? What was the real fiscal problem they were trying to solve?
It wasn’t a practical solution to an immediate problem. Instead, it was an ideological “solution” (i.e., a singe-payer system, which is a euphemism for government healthcare). What drives that ideology is the assumption that government is mandated to provide all of FDR’s four freedoms – including freedom from “want.” If anyone is suffering in any way, government is required (and therefore, empowered) to fix the problem.
The command that government must provide our most basic needs is, I argue, a runaway assumption. It’s a political bandwagon, that few have stopped to reflect about. It’s a group-think assumption without foundation.
James Of England
Can you quote any informed source for,…. constitutionality of MassCare?
If I can’t prove the nullity, could I at least ask you to stop raising the lack of clarity as though you have some support for the claim?
And here we find the heart of the problem. The government sells us a social program as a way to assist us in taking care of ourselves but what they are really doing is confiscating our property and the fruits of our labor for a personal slush fund with which to buy off constituencies.
James Of England
If Obamacare insisted you paid to a government insurance program (grandfathering in currently sufficient private schemes), single payer, would there be a difference, to your mind, between that and this? Do you thus view single payer as less problematic? ·Dec 28 at 4:44pm
Would “MassCare is terrible, but less bad than Medicare” be a reasonable portrayal of your position?
I’m hoping you included an implied “federal” between “the” and “government” regarding the ruling, btw. I’d imagine you did, but thought it worth checking.
The King Prawn
free riders in this sense are only those who could otherwise afford to cover themselves but deliberately choose not to.
What is the right thing to do with those who roll the dice and lose? Are they to not seek treatment? Are we as a society to refuse treatment if sought?
The only thing standing in their way is a government that wants to dictate how the charity is dispensed.
Power is jealous. The ever-growing federal bureaucracy cannot bring itself to accept a rival for its affection. ·Dec 28 at 5:31pm
Indeed. Limited and enumerated. That’s the key.
It’s worth considering that those who can pay but refuse to pay for health insurance are issuing their own mandate – for the government to cover their health care costs. Knowing the charitable nature of people in general, it’s a safe bet that the uninsured, i.e., free-loaders, know they will be cared for.
As for medical costs bankrupting someone faced with expensive treatments – well, if one budgets prudently, i.e., a realistic and prudent allocation of earnings – car, rent/mortgage, vacation, etc. within limits that allows also buying some level of health insurance, – the chances of bankruptcy can be significantly reduced. But, that’s not the way we’ve been taught to live.
Mandates work both ways.
Paul A. Rahe
James Of England
If I can’t prove the nullity, could I at least ask you to stop raising the lack of clarity as though you have some support for the claim? ·Dec 28 at 5:40pm
You can ask, but I will not comply — because I know a thing or two about eighteenth-century American political thought, and I doubt very much that the Constitution drafted by John Adams would sanction the individual mandate.
Would “MassCare is terrible, but less bad than Medicare” be a reasonable portrayal of your position?
I’m hoping you included an implied “federal” between “the” and “government” regarding the ruling, btw. I’d imagine you did, but thought it worth checking. ·Dec 28 at 5:43pm
I am speaking of the federal level of government. Massachusetts is much easier to opt out of than the nation.
Mark Steyn recently made a pithy observation (can’t remember where) that Masscare provided equality in New Hampshire by providing southern NH doctors and hospitals as many socialized medicine refugees from Mass. as northern NH doctors receive from Canada.
Wow. I go out for a few hours and get Ricochet-famous…
Raising taxes to reward free riders is, of course, objectionable. We should oppose it on principle. But it does not in and of itself narrow in any significant fashion the sphere of our liberty. It is a question of the proper use of the public purse. The individual mandate sets a new precedent. It extends government control to the private purse.
Wait. In MA, if you don’t get your own insurance (or offer it for your employees, I believe), you pay more taxes. How do you square that with what’s written above? How is this tax increase fundamentally different than any other, because it’s labeled differently? I know if MA instituted a tax/fee for being, say a blogger, that would (hopefully!) violate the First Amendment, but what does this “tax” infringe upon that was not already being infringed upon (a right to be free from taxation to pay for free riders? The right to be free from excessive taxation?–no such right…)
I’m sorry, Professor Rahe. Massachusetts was paying for free-riders befor Romneycare, and it would still be paying for it if the pre-Romneycare tax regime was still in place.
My beef with you (and others here) isn’t that Romneycare, or even otherwise paying for free-riders is a good thing. My beef is that you saddle Mitt Romney with taking Massachusetts a quantum leap into statism, and away from American notions of limited government, something he did not do. At worse, Romney perpetuated what was already in place; he may have made it a bit more or less objectionable, but he didn’t make it fundamentally worse. Romneycare amounts to nothing more than an increase in state income tax (for individuals and companies, I believe); that’s not good, or to my liking, but it’s not what Romneycare is hyped up to be.
As for Obamacare, it’s a lot more than Romneycare. It’s a huge set of regulations and controls and taxes. . Its a usurpation or state powers. It’s a lot further to single-payer. . It will take a President and an undivided Congress to eliminate–significantly harder to achieve than the mere flip of one state’s political party control–assuming MA voters want it repealed, which they clearly do not; and Romneycare was not created and signed into law via procedural tricks.
You can ask, but I will not comply — because I know a thing or two about eighteenth-century American political thought, and I doubt very much that the Constitution drafted by John Adams would sanction the individual mandate. ·Dec 28 at 5:50pm
Could I ask you to raise the topic the next time you talk to someone you trust on the subject? To cast cutting aspersions under the guise of authority while intentionally remaining ignorant of their truth seems against your general manner.
The police power is not defined narrowly; this is almost the definition of “police power”. Rather, it grants power generally and then prohibits things thought of, much of which were not thought of by Adams, but by much later amenders. Things unconsidered are therefore generally permitted (although future generations can ban them).
The fundamental question is whether the individual can do a better job taking care of himself and do it more economically than the Obamacare bureaucracy? Are these bureaucrats more concerned about your well-being than you are?
For example, current law makes employer-provided healthcare tax deductable for the employer. Thus many employees consider their healthcare to be almost free. If healthcare was tax deductable for the individual as well–including their health insurance–most employees would insist their employer deposit what they spend per employee in their personal health savings account (HSA). Then, most individuals would choose inexpensive high deductable health insurance and pay the minor healthcare expenses themselves. Most would substantially reduce their healthcare cost and accumulate the savings in their HSA for future emergencies. Individuals would learn to manage their own healthcare with a view to their own needs and priorities, since it is in their self-interest. This solution aligns self-interest (getting a tax deduction) with the virtues of moderation and prudence. It also uses the free market to efficiently allocate scarce resources.
How about this–however unlikely it was to happen–what if Massachusetts had, instead reduced it’s state income tax by a certain percentage, but then added back that percentage for everyone who didn’t have their own insurance? Would that be just as offensive and unacceptable?
When I entered the Jesuits, my novitiate class was uninsured. The Jesuits wouldn’t have accepted us in the first place unless we were healthy. So it made sense to forego insurance, because we were statistically unlikely to need any medical services.
When, on rare occasion, someone needed a hospital visit … we had to pay the full cost.
I think that part of the equation gets forgotten. When you don’t have insurance and use medical services … they DO send you a bill, and you are legally required to pay it. A wealthy person who chooses not to buy insurance but who goes to the hospital … he just has to pay the full cost by himself.
The purpose of the “must-treat” rule is to make sure that people who can’t afford it can still receive treatment. But if you can afford insurance and simply gamble against it … hey, pal, that was the chance you took, and you pay the bill.
The purpose of the “must-treat” rule is to make sure that people who can’t afford it can still receive treatment. But if you can afford insurance and simply gamble against it … hey, pal, that was the chance you took, and you pay the bill. ·Dec 28 at 6:55pm
It would appear from your description, KC, that there really isn’t a free rider problem. It looks almost like something created by government simply to justify an individual mandate.
The thought has occurred …
ParisParamus: …
… there is a large set of people who can afford insurance premiums, but could never afford to pay for catastrophic medical expenses out-of-pocket; . .
So, why the bandwagon for the mandate? What was the real fiscal problem they were trying to solve?
It wasn’t a practical solution to an immediate problem. Instead, it was an ideological “solution” (i.e., a singe-payer system, which is a euphemism for government healthcare). What drives that ideology is the assumption that government is mandated to provide all of FDR’s four freedoms – including freedom from “want.” If anyone is suffering in any way, government is required (and therefore, empowered) to fix the problem.
The command that government must provide our most basic needs is, I argue, a runaway assumption. It’s a political bandwagon, that few have stopped to reflect about. It’s a group-think assumption without foundation. ·Dec 29 at 5:33am
Nicely put.
The King Prawn It would appear from your description, KC, that there really isn’t a free rider problem. It looks almost like something created by government simply to justify an individual mandate.
I understand that those who can afford insurance, receive treatment without it, and refuse to pay the bill pass on the cost to others by a general increase in services, but is this a big enough problem to justify government intervention? Are there enough irresponsible freeloaders to completely skew the market against those who are responsible and make indigent care overly burdensome? These are probably questions that should have been asked before the national government passed a healthcare law…
Sorry to get into this so late Dr Rahe. I read your piece and I really don’t have anything to add or subtract. Absolutely correct!! This is a question of first principles. The mandate must be struck down. A single blow could save us from decades of misery. Our front rino-runners better wake up. They can still be caught from behind or find themselves suddenly up against somebody who isa real conservative out of the blue!
Romneycare amounts to nothing more than an increase in state income tax (for individuals and companies, I believe); that’s not good, or to my liking, but it’s not what Romneycare is hyped up to be.·Dec 28 at 6:22pm
Edited on Dec 28 at 06:45 pm
It is not a tax. It is a fine — for breaking the law.
… they DO send you a bill, and you are legally required to pay it. A wealthy person who chooses not to buy insurance but who goes to the hospital … he just has to pay the full cost by himself.
Uh…. no, because there is a large set of people who can afford insurance premiums, but could never afford to pay for catastrophic medical expenses out-of-pocket; that’s why there is insurance!!!
Paul A. Rahe
You can ask, but I will not comply — because I know a thing or two about eighteenth-century American political thought,. ·Dec 28 at 5:50pm
The police power is not defined narrowly; this is almost the definition of “police power”. Rather, it grants power generally and then prohibits things thought of, much of which were not thought of by Adams, but by much later amenders. Things unconsidered are therefore generally permitted (although future generations can ban them). ·Dec 28 at 6:42pm
Sorry, James, this will not do. Technically, you may be correct. But I know enough about the thinking of people in eighteenth-century America (on which I penned a sizable tome) to be confident that it would have been simply unthinkable to propose requiring all of the citizens of Massachusetts or any other state to spend a chunk of their own money at the direction of the government.
It is not a tax. It is a fine — for breaking the law.
That’s a semantic, not substantive difference–because the government was already paying for what the new horrible “fine” now pays for. It’s not the stuff upon which to demonize a Presidential candidate.
Uh…. no, because there is a large set of people who can afford insurance premiums, but could never afford to pay for catastrophic medical expenses out-of-pocket; that’s why there is insurance!!! ·Dec 28 at 8:02pm
This sounds a bit like the nonsense peddled by Barack Obama. How many from with this “large set of people” actually encounter catastrophes? Most of those who are not wealthy but could pay and choose not to do so are quite young, and very, very few of them ever incur catastrophic medical expenses.
Nicely put.
Not really. The government of MA, all state governments, were already reimbursing hospitals (and, I assume, some other medical providers) for the medical care they were providing. Pre-mandate, your tax dollars were already paying for this.
Moreover, you haven’t proposed an alternate solution to pay for these expenses. Moreover, you haven’t, and no one here, has offered a bright-line, hard distinction between the “legitimate” notion of a state income tax, and the evil, socialist, statist concept of a a mandate-penalty–that’s because there isn’t one. It’s a question of degree. to which I agree that Massachusetts has oppressively high state income taxes. But so does New York, and arguably ten other states.
Whatever. This is not a basis on which to demonize Mitt Romney. It’s logically inconsistent, and leads to things like RON PAUL!! and a second Obama term.
This sounds a bit like the nonsense peddled by Barack Obama. How many from with this “large set of people” actually encounter catastrophes? Most of those who are not wealthy but could pay and choose not to do so are quite young, and very, very few of them ever incur catastrophic medical expenses.
So what are you implying, that Romneycare was inaugurated for purely political reasons? That there was no real fiscal problem to solve? Please explain.
They don’t lay that off, as they do for indigents. It isn’t the same thing.
If you’re saying that the free-loader’s unpaid bill doesn’t disappear? It’s a moot point. If you don’t have the cash to pay, the hospital isn’t going to get the money from you. The hospital still has the expense. And the hospital still needs to pay its bills.