When Democrats toyed with the idea of scrapping comprehensive health care reform—with its high cost and individual mandate to purchase health insurance—in favor of a smaller bill that banned insurance companies from discriminating against those with preexisting conditions, I called it a terrible idea: "Insurance reforms without a mandate would, in their own way, be just as bad, and twice as stupid."
Now, with a comprehensive overhaul signed into law, there are signs that the GOP may pursue a legislative strategy that would leave us in much the same place. Here's Sen. John Cornyn talking to the Huffington Post on Tuesday:
"There is non-controversial stuff here like the preexisting conditions exclusion and those sorts of things," the Texas Republican said. "Now we are not interested in repealing that. And that is frankly a distraction."
Politically, there are clear short-term advantages to going after only the mandate: The preexisting conditions exclusion is popular and the mandate is not, so a repeal of just the mandate is far more likely to pick up support. But from a policy perspective, leaving the insurance-market regulations in place but ditching the mandate is a great idea only if you want to virtually guarantee that premiums will spiral out of control. The mandate constitutes the single biggest infringement of individual liberty in the bill, so I understand the appeal, in principle, of repealing it. And in some sense that would be a victory against what is arguably the bill's most egregious provision. But it's not much of a policy reform; indeed, the most likely outcome is that it would just screw up the insurance market in a different way.