One thing that has happened as a result of the recent Massachusetts "individual mandate" bill is that the opinions of the numerous free-market think tanks have been widely circulated online and in print publications. The new law, of course, is newsworthy. But because its passage was a bipartisan effort, reporters cannot play to the traditional Republican-versus-Democrat storyline. The result is that the controversy between supporters of big government and supporters of limited government actually gets heard for a change.

Because all free-market advocates do not come from the same premises, the overall quality of the free-market commentary has been mixed. Some critiques require a detailed understanding of the healthcare system and do not lend themselves to excerpting. But the philosophic arguments on points of ethics, politics, and economics do.

First, some good examples:

From the Pacific Research Institute: "The Massachusetts bill perpetuates what we've seen for decades in America—laying down bad laws to turn back the effects of previous bad laws, so that we can barely tell where the whole twisted ball of yarn begins. In this case, the state becomes the bill collector for the health provider, and the patient loses the due process that is his right with respect to any other debt."¹

From the Council for Affordable Health Insurance: "This program is being sold by the governor as a 'free market' proposal, but this plan is a roadmap for a single-payer system that will be a disaster for Massachusetts taxpayers and residents."²

From Consumers for Health Care Choices: "This thing will be a massive failure. The benefits are too rich, the incentives too small, the bureaucracy too huge and intrusive, and the penalties are small enough to keep people from participating, but large enough to infuriate them. It does nothing to fix Massachusetts' underlying problems, like community rating (when the same rate is charged to everyone in the group, regardless of age, gender, or health status), mandated benefits, and outrageously high health care costs. Having it fail wouldn't bother me, except many people would conclude, 'Well, we tried individual responsibility and it failed, so the only thing left is single payer.'"³

From the Cato Institute: "Individual mandates cross an important practical and philosophical line: once we accept the principle that it is the government’s responsibility to ensure that every American has health insurance, we guarantee even more government involvement with and control over large portions of our health care system. Compulsory, government-defined insurance opens the door to even more widespread regulation of the health care industry and political interference in personal health care decisions. The result will be a slow but steady spiral downward toward a government-run national health care system."⁴

From the Bluegrass Institute: "Romney may think his plan will be politically profitable for any future presidential campaign he pursues. Instead, it's likely to be a potential disaster. Just ask Kentuckians. During the 1990s, our state experimented with Kentucky Kare, a disastrous universal health-care policy that implemented price controls and drove many insurance companies out of the state. As a result, it was dropped from Kentucky's statutes. Instead of relying on universal health-insurance schemes, Massachusetts and the other states considering such ploys should instead learn from the failure of Kentucky's ploy and embrace health-care policies that are free-market friendly."⁵

Other organizations claim that there is good to be found mixed in with the bad:

From the Heritage Foundation: "While many oppose a mandate to buy insurance—even basic catastrophic insurance to protect the community from individuals not paying their bills—on philosophical grounds, they should still have a firm factual understanding of the Massachusetts mandate, which may be less problematic than they realize. Thanks to regulatory changes that are a part of the Massachusetts plan, residents will be able to satisfy the mandate merely by purchasing catastrophic coverage through a high-deductible health plan or a Health Savings Account (HSA). With this regulatory change, the plan will promote HSA/high-deducible plans and make health care coverage more accessible and somewhat more affordable for individuals. The state will also provide lower-income individuals with a subsidy (essentially a voucher) to help them purchase health insurance, an approach similar to the refundable health tax credits that many support at the federal level. These changes make the mandate far less of a burden on individuals than it otherwise would have been."⁶

Also from the Heritage Foundation: "Ironically, Massachusetts—a state not known for its embrace of business interests—points the way to a better solution [than Maryland's fair share employer mandate]. Its governor, Mitt Romney, wants to require individuals, rather than businesses, to buy health insurance. In a neat twist, he would finance the poor uninsured with the $1 billion now used to subsidize health care providers that today deliver 'free' care. Switzerland, too, has long relied on a legal requirement for individuals to buy coverage. The Swiss government subsidizes those who cannot afford to buy it and enables the sick to pay the same price as everyone else for health insurance by risk-adjusting insurers. Consumers, rather than businesses or governments, are thus the primary financiers of the Swiss health care system. The results speak for themselves: Health care costs that are about a third less than in the U.S., universal coverage, and world-class medical outcomes."⁷

And again from the Heritage Foundation: "We are behind the insurance market reforms. We don't like the employer mandate parts, and we are not happy they did not deregulate the health insurance system in Massachusetts as much as we would like. ... [T]here is a need for people to recognize that you are going to have to have trade-offs."⁸

The commentary is indeed mixed. For starters, it is important to distinguish between the free-market movement and the conservative movement. They are not the same, and nor is each homogenous. Even within the free market movement, people hold a wide variety of premises, some of which are in fact incompatible with the consistent protection of individual rights.

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¹ Dial, K. "Massachusetts Plan Denounced as Imminent 'Disaster'," Published by the Heartland Institue, May 2006

² "CAHI Urges Gov. Romney: Don’t Sign It! Massachusetts Health Plan Is No Model for Reform," Council or Affordable Health Insurance (press release), April 10 2006

³ Dial, K. "Massachusetts Plan Denounced as Imminent 'Disaster'," Published by the Heartland Institue, May 2006

⁴ Tanner, M. "Individual Mandates for Health Insurance Slippery Slope to National Health Care," Cato Institute Policy Analysis No. 565, April 5 2006

⁵ "Romney’s slippery slope," Bluegrass Institute, Bluegrass Digest Vol. 4 No. 4, April 16 2006

⁶ Moffit, R., and N. Owcharenko, "Understanding Key Parts of the Massachusetts Health Plan," The Heritage Foundation, Web Memo #1045, April 20 2006

⁷ Herzlinger, R., "Health Policy in Maryland and Massachusetts: A Study in Contrasts," The Heritage Foundation, Web Memo #1037, April 13 2006

⁸ Lambro, D. "Universal health care law enacted in Massachusetts," The Washington Times, April 13 2006

©2005-2010 The Lucidicus Project, all content unless otherwise noted.