On Health Care, Half A Repeal Is No Repeal At All


Man against the mandate.

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.