Health Care Debate Flip-Flop: How the GOP Parses "Personal Responsibility"
It's a favorite Republican conceit: "Personal responsibility.'' Whether it's gun control, your financial well-being or the food your kid eats, individuals should just do the right thing, rather than freeload off others or ask the government to play nanny.
Except when it comes to health care reform. As Eliot Spitzer, the CNN host and former New York governor, pointed out in a recent Slate post, Republicans such as House Speaker John Boehner should not oppose the individual mandate to buy insurance in the healthcare reform law, because it's a form of personal responsibility, which Republicans support.
"Personal responsibility" was a favorite Republican phrase in the early 1990s, when President Clinton was pushing his healthcare reform plan. Back then, the GOP offered up the individual mandate as an alternative to the Clintonian idea of "managed competition," which depended on health plans to bring down costs. And, as Spitzer points out, it's also a key facet of the Massachusetts reform program that then Governor Mitt Romney, a Republican, signed into law in 2006.
As an AP story put it last March, "Republicans were for President Obama's requirement that all Americans get health insurance before they were against it."
So what changed their minds? Politics, of course. The individual mandate, which the Tea Partiers fiercely attacked during the 2009 reform debate, made an extremely attractive target because it was something that everyone could understand and that affected everyone. Therefore, the Republicans did an about face and decided they were against it. It didn't hurt that the individual mandate is a linchpin of the reform law, which they'd like to repeal in toto.
There are other aspects of personal responsibility in healthcare, however, that Republicans still cling to. For example, they favor consumer-driven health plans because they want consumers to have some "skin in the game" with high deductibles that are only partly covered by health savings accounts.
Another Republican fave is taking personal responsibility for one's health behavior. For example, Sen. John McCain made a big point about using wellness incentives to promote personal responsibility for health during his Presidential campaign. Many commenters on BNET Healthcare during the reform debate -- presumably Republicans -- said that if people took more responsibility for their own health, we wouldn't need reform to lower costs.
Republicans have also long disparaged "freeloaders," whether they're welfare queens or people collecting unemployment or using food stamps. So, Spitzer asks, why would Republicans let some people avoid buying health insurance and freeload off other people who have to pay their medical bills through higher taxes and insurance premiums?
Writing on National Revenue Online, Ramesh Ponnuru tells us that Spitzer "doesn't know any Republicans," so he doesn't understand their arguments about the individual mandate. Among those arguments, he says, are the following:
- The cost of hospitals caring for the uninsured raises insurance premiums only slightly;
- There are less intrusive means of reducing that cost than through an individual mandate;
- The cost of an individual mandate will be greater than the cost of not having one.
What the Republicans depend on, above all, is the short memory of the electorate. Everything old is new again in the minds of those who don't follow current events. So perhaps the GOPers will be able to sell their bill of goods. But their hypocrisy is pretty transparent.
Image supplied courtesy of Wikimedia Commons.
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