The Road to Romneycare

This from Paul Krugman - one of the voices of reason and logic. Follow link etc., etc.
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April 25, 2011, 1:03 pm
The Road to Romneycare

Yglesias looks at calls for a return to something like the McCain health plan — subsidies for individuals to buy insurance on the open market — and gets it exactly right: once you think seriously about how this would work, you end up with something that looks very much like the health reform we have.

Suppose we give people help buying insurance. This doesn’t help people with pre-existing conditions, who won’t be able to get insurance anyway. So we add community rating: insurers can’t discriminate based on medical history.

But this leads to a problem with adverse selection: healthy young people will drop coverage, leaving behind a bad risk pool and high costs. So we add a mandate, requiring that everyone get coverage.

But some people can’t afford to do this. So we add means-tested subsidies to help lower-income citizens.

And you’ve just described the Massachusetts health reform, aka Romneycare, which in turn is basically the same as Obamacare.

There are no more conservative alternatives — not unless you give up on the whole idea that everyone should have coverage. There are alternatives to the left — single-payer, VA-style government provision — but Obamacare is already as conservative as a plan to make health insurance more or less universal can be.