Mitt Romney has been stalwart in his defense of the individual mandate -- the obligation to buy health insurance that is at the heart of both the law he signed in Massachusetts in 2006 and the federal version President Obama enacted last year. Ironically, his firmness on this issue may cost him more dearly with Republican primary voters than his reputation for conveniently reversing past positions ever did.
In his Ann Arbor speech last week, the former governor declared that RomneyCare "was right for the people of my state," and that regardless of the political fallout, he was not about to "just stand up and say this whole thing was a mistake." He repeated the argument he has made for years -- that an individual mandate is a matter of "personal responsibility." Since federal law requires hospitals to provide urgent care to anyone requiring it, Massachusetts needed a way to prevent uninsured free riders from using hospital emergency rooms to get medical care at public expense. Making insurance compulsory for those who could afford it, Romney says, was the solution to the free-rider problem.
But if that theory is valid in Massachusetts, it's valid everywhere. Romney's rationale for an individual mandate is all but indistinguishable from Obama's. "There's always going to be somebody out there who thinks they're indestructible and doesn't want to get health care," the president has argued. "And then . . . they get hit by a bus, end up in the emergency room, and the rest of us have to pay for it."
On the surface, this free-rider justification for mandating insurance may sound plausible. Start digging into it, though, and it quickly falls apart.
To begin with, just because a 25-year-old law requires hospitals to provide emergency care to all comers, why does it follow that another law must force every citizen to buy insurance? Clearly there are other ways to compensate hospitals for the "free" care they supply to the uninsured. To mention only the most obvious option, the government could reimburse the cost of that care directly.