One Republican talking point about the Congressional Budget Office score showing that the GOP health plan would cause 24 million people to lose health insurance is this: A large chunk of that coverage loss is because the new plan would repeal the individual mandate.
Under Obamacare, those people will be forced to buy health insurance. Under the Republican plan, they have the freedom not to buy insurance they don’t like. Aren’t they better off?
This is a bad argument. And it’s an argument Republicans make because they know the individual mandate is the most unpopular part of Obamacare but don’t understand why it is so unpopular.
People don’t want to be forced to buy health insurance, but that’s not because they want the freedom to go uninsured.
People want to be offered health insurance that they’re happy to buy. And the Republican plan, which would leave 52 million Americans uninsured by 2026, fails to do that in lots of cases.
Now, that’s partly because in a lot of cases, the only way you’re going to get Americans to happily buy health insurance is to price it far below cost. This is how the Medicare prescription-drug benefit works: It’s not mandatory, but participation is near universal because premiums cover only about 14% of the costs, and the government picks up the other 86%.
Republicans might protest that’s not what “choice” means. You might like the choice of heavily subsidized housing or heavily subsidized restaurant meals, but that doesn’t mean the government should give them to you.
But this often is what “choice” means in the political context. “School choice” is a policy of giving children free or heavily subsidized education. And healthcare, like education, is a sector of the economy in which voters have come to expect the government to pick up part of the tab – whether through Medicare, Medicaid, the enormous tax subsidy for employer-sponsored insurance, or the Obamacare subsidies that have proved surprisingly popular once you try to repeal them.
Republicans got mileage for years by talking about choice in healthcare. Now that it’s time for them to actually make law, they are poised to learn that most voters who wanted choice did not mean “a system where 52 million Americans will make the ‘choice’ to be uninsured.”