Universal Coverage: Focus on Reforms that Increase Competition

Republicans should be in favor of market reforms that engender competition regardless of health status. But they should stay out of the business of coercion and excessive government guarantees.

Tens of millions of Americans lack health insurance. Extending coverage to them has been a core goal of health reform proposals since the 1960s. President Richard Nixon offered a universal health plan in his first administration, but since then Republicans have hesitated to commit the nation to so costly an undertaking. Is it time to rethink? Should Republicans accept universal coverage as a goal?  We posed this question to NewMajority’s contributors.

I do not think that Republicans should adopt a policy of universal health insurance.  It is obvious, I hope, that health insurance is an important product and that the current markets for health insurance leave a lot to be desired.  Republicans should be foursquare in favor of major reforms.

But there are two very large problems with the idea of universal coverage. The first is conceptual – what does “universal” mean? But the second is more important. However defined, universal coverage is an outcome.  The only way to guarantee an outcome is to be willing to utilize the coercive power of the government to achieve it.  Republicans should not endorse this way of thinking.

Conservatives have correctly focused on creating opportunity, and have been guided by the notion that fairness is a concept richer than equality. Those principles should guide the health insurance debate as well. Republicans should favor reforms that eliminate unfair and preferential treatment of some (those who get insurance from their employer) over others (the rest).  They should be in favor of market reforms that engender competition regardless of health status. But they should stay out of the business of coercion and excessive government guarantees.

To read other contributions to this symposium, click here.