March 29 2017
Last week, Republicans failed to pass a major health reform bill out of the House. The bill, according to a disputed estimate from the Congressional Budget Office, would have caused millions of Americans to lose health coverage.
But President Trump, as recently as January, vowed "insurance for everybody," suggesting this is one of his goals. Other Republicans like Rep. Charlie Dent, R-Pa., seem to share this view; he bemoaned this loss of coverage and opposed the bill.
Speaker of the House Paul Ryan, on the other hand, has said that "universal access to care" is one of his main goals in health reform, saying nothing about "universal coverage." Other Republicans responded to the CBO's score of the House GOP bill by similarly pointing out that it's access to care, not coverage, that matters more.
These conflicting signals might leave some Americans scratching their heads. Do Republicans want all Americans to have health insurance coverage? Or not?
Conservatives recognize that bad things — a major accident or illness — could happen to anyone, and a catastrophic hospital bill could imperil many Americans' financial security. Therefore, the wise and prudent thing to do is carry a health insurance policy.
Yet conservatives also recognize that, given the choice, some people will always choose not to buy insurance.
This means universal coverage — which implies every single person — can't be achieved without coercion. Some people make a personal cost-benefit analysis and decide they would rather spend their dollars on other things besides health insurance premiums from month to month, even if this means they imprudently go without financial protection against a health catastrophe.
It's a free country, right?
Even in the face of Obamacare's mandate, some choose to pay a fine instead of getting insured. In fact, even with all of Obamacare's mandates and subsidies and fines designed to force people to get covered, 6.5 million people paid a penalty for going uninsured last year, and a total 29 million still lack health insurance today.
A more accurate term for what limited-government conservatives want would be "optimal coverage," but that certainly doesn't sound as appealing as "universal." Some conservatives may still use the term, perhaps with the caveat that they mean "every single willing person."
The problem with the word "coverage" is that it means different things to different people.
Here's an analogy: While 82 percent of Americans believe in equality of the sexes, only 20 percent call themselves "feminists." Like the term "feminist," the term "coverage" often needs defining.
Democrats would seemingly have everyone believe that health coverage must always be comprehensive, and that if people have to pay out of pocket for even routine, affordable health services, that coverage isn't good enough ("Junk plans!").
That's why at the state and federal level, they've pushed mandates that require insurers to cover more and more benefits, even if it would be simpler, more transparent, and ultimately more affordable for us to pay for those services directly.
Insurance coverage, however, shouldn't really work this way. Restoring insurance to its proper use (only for unexpected expenses) would lower premiums and make it so that more people could afford to become truly "covered."
After all, there's more than one way to measure the quality of an insurance plan. One way is to look at the list of services covered. This seems to be Democrats' favored way, but they often ignore that not all Americans want the same list of services or the same comprehensive coverage.
The other way to measure insurance plans, perhaps even more important, is to look at the access that patients have or don't have to providers, the hospitals and professionals who actually deliver healthcare. This metric is at the heart of disagreements about the value of Obamacare plans and Medicaid, which, as conservatives point out, aren't accepted by as many providers as other private plans.
The bottom line is that those who believe in maximum freedom and limited-government in healthcare want all Americans to have the opportunity to buy a true insurance plan, and we want Americans to be able to actually depend on those plans when the rubber of the ambulance tires hit the road.
This may not be as a politically popular a slogan as supporting universal coverage… But it's better.
Hadley Heath Manning (@HadleyHeath) is a contributor to the Washington Examiner's Beltway Confidential blog. She is a senior policy analyst and director of health policy at the Independent Women's Forum, and a Tony Blankley Fellow at the Steamboat Institute.