Crook on Health Care Reform

The ever-thoughtful Clive Crook opines on the recent health care initiative in Massachusetts and what it takes to reform health care more broadly. An excerpt:

How to do national health reform worthy of the name? First, and most important, create a level playing field tax-wise for individuals and firms, so that nobody has a financial incentive to prefer employer-provided insurance to the individually purchased kind. You could do this by extending Connector-style tax relief to all taxpayers, or by abolishing it for employers. Abolition would be better. It would raise a lot of revenue (which will be needed in my plan) and would jolt people into changing their insurance arrangements.

Second, the free-rider problem makes the case for an individual mandate compelling, in my view. Massachusetts is right about that. And the mandate, in turn, makes health subsidies for the poor, which would be desirable in any case, unavoidable. Massachusetts is right about that, too. But to avoid the enormous problems of enforcing and administering the mandate (all in return for less-than-universal coverage in any case), turn this logic around and give everybody a voucher sufficient to buy stripped-down, Connector-style coverage.

These two ideas--scrapping the subsidy for employer-provided insurance and instituting an individual mandate--make sense to me. The individual mandate turns the traditional liberal idea on its head: Health insurance is not a right but a responsibility.

I see the appeal of the voucher idea, but I would like to see the numbers before I sign on. I am apprehensive about expanding entitlements, as we haven't figured out yet how to pay for those we have already promised.