In today's Wall Street Journal, columnist Holman Jenkins engaged in an impressive about-face in a piece attacking the "individual mandate" provisions of the Patient Protection and Affordable Care Act (PPACA). After introducing the subject by claiming "Only fools and angels ... might tread forth to defend a now-embarrassing history of conservative support for the unpopular mandate," he tried to defend the history of conservative support for the individual responsibility provision by attempting to point out how it does not and never did resemble the one passed in the PPACA. His explanation is that, while the conservative model was meant to address the free-rider problem in health care, the Obama model is merely "a tax to pay for someone else's" health care costs.
The free-rider problem in health care is an issue pertaining to people taking advantage of beneficial rules when they need health care, but not paying into the system when they don't. Although free-rider problems abound in economics, in health care policy it usually manifests in one of two ways. The first case has to do with uninsured people using emergency rooms as primary-care facilities, knowing that if they are unable to pay the state will generally compensate the hospital for the care. The second issue occurs when health insurance is made affordable and accessible, which the PPACA will do. Without a requirement to purchase insurance, people can wait until they need care, then enroll in a health insurance plan which will cover the cost.
According to Jenkins, only the individual responsibility provisions previously promoted by conservatives such as GOP presidential candidate Newt Gingrich attempt to address the free-rider problem, but if you "look closely," you can tell that the PPACA's individual responsibility provision is "partly about forcing the young, healthy and otherwise uninclined to overpay for health insurance so the money can be used to pay for heavy users of the health-care system." Jenkins doesn't provide any evidence for these claims, other than asking readers to "look closely" at the PPACA provision.
But you don't need to look closely to find evidence that Obama specifically meant for the individual responsibility provision to address the free-rider problem. In remarks delivered to a town hall on August 15, 2011, Obama made the case for the individual responsibility provision by explicitly referencing the free-rider issue, noting that without the provision people would have an incentive to game the system:
They would wait until they get sick and then you'd buy health insurance, right? No point in you -- I mean, it's just like your car insurance. If you could buy -- if the car insurance companies had to give you insurance, you'd just wait until you had an accident and then you'd be dialing on the phone from the wreck, and you'd say, "State Farm, I'd like to buy some car insurance please." (Laughter.)
Obama further explained:
[T]he basic theory is, look, everybody here at some point or another is going to need medical care, and you can't be a free-rider on everybody else -- you can't not have health insurance, then go to the emergency room and each of us who've done the responsible thing and have health insurance, suddenly we now have to pay the premiums for you. That's not fair. (Applause.) So if you can afford it, you should get health insurance just like you get car insurance.
By comparison, here is Gingrich's 2009 explanation of the health care mandate, in which he points out that the individual mandate is meant to address the free-rider problem, but which Jenkins finds to be different from Obama's somehow:
The real foundation, the most important part of this, is individual rights, responsibilities, and expectations of behavior. ... We believe that there should be must-carry, that everybody should have health insurance, or if you're an absolute libertarian, we would allow you to post a bond, but we would not allow people to be "free riders" failing to insure themselves and then showing up in the emergency room with no means of payment. If you have must carry, then the insurance companies have told us that we can have must-issue, and you will therefore have a system in which you don't have to worry about cherry-picking and maneuvering. ... This is the kind of general model we will be advocating.