Universal Healthcare: A Conservative Reform

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The Romney campaign appears on the verge of pivoting and re-embracing the candidate's most important achievement as governor. Some conservatives are already expressing dismay. They should not. To accept the ideal of universal health coverage is not to accept Obamacare in its present form. From a conservative point of view there are many, many changes that need to be made to Obamacare. The most important from my perspective (as I've often argued here) are to change the financing mechanism so that it does not entirely fall on a few people, to rely less on Medicaid, and to accelerate cost controls. (It would also be desirable to end the distinction between Medicare and health insurance for those under-65s, but that' s another story.)

For now, let's just recall why the ideal of universal coverage—Romneycare—fits well and rightly into mainstream modern conservative politics:

1) It saves money. Every other advanced democracy covers virtually all of its people at a cost relative to national income of something like 60% of what the United States pays. That's just wasted money—money that could buy other things.

2) It protects the defense budget. As we saw during the debt ceiling debate of 2011, when the pressure to save money rises, Democrats protect domestic programs as their first priority and Republicans hold the line on taxes. Defense becomes the budget-cutters' target of opportunity.

3) It supports entrepreneurship. People who don't worry about losing their healthcare are more likely to risk quitting a job with an established firm to start something of their own.

4) It provides support to the middle class in a time of anxiety. Globalization has thus far tended to enrich the rich and squeeze the middle, not only in the United States, but in almost every developed country. Many ideas for securing the middle that we hear from e.g. President Obama threaten the whole free-enterprise system. Health security puts a floor under the middle class without radical change to the rest of the economic system.

5) It enhances national unity. The existing health system disproportionately leaves ethnic minorities exposed to risks of premature death, disability, and illness. Universal health coverage makes all feel in this one respect at least equally part of society and nation.

6) It's the right thing to do. "To make men love their country, their country ought to be lovable," wrote Edmund Burke. The United States will be a better country without this unnecessary fear pressing on millions of its people—and a better country will be a stronger country.