Ramesh Ponnuru knows a lot more about health care policy than your garden variety conservative. But his op-ed in yesterday's The New York Times shows, I think, the difficulty conservatives have discussing this issue. Ponnuru wants to argue that "the goal should not be universal coverage. Reform should simply aim to make health insurance more affordable and portable." In other words, the 80+ percent of Americans who think the system needs fundamental changes or a complete rebuild are wrong. It's really just time for a tinker. Ponnuru's tinker would "make it easier for people to buy insurance that isn’t tied to their employment" and remove "state mandates that require insurers to cover certain conditions," both of which sound like small and inoffensive changes until you spin out their implications and realize they're actually small and very offensive changes. State mandates, for instance, sound unpopular until you get specific (pdf). Ponnuru's repeal would mean that policies in Arizona don't have to cover colorectal cancer screening and policies in Idaho don't have to cover mammograms and policies in Georgia don't have to cover bone marrow transplants and policies in Florida don't have to cover maternity stays. Repealing these laws might make health care cheaper, but the savings would come because your insurer could deny you coverage, and thus access, to a needed bone marrow transplant. Health care isn't "cheaper." You just get less of it, which in turn makes total spending go down.That, lest I obscure my point, is a pretty serious form of rationing.His tax change is little better. He says that a model built by Steve Parente, one of the McCain campaign's health advisers says "this would enable more than 20 million more Americans to get insurance," but studies evaluating that same proposal when it was in the McCain campaign also found that "the elimination of the income tax preference for employer-sponsored insurance would cause twenty million Americans to lose such coverage." In essence, what you'd have is a trade: By reducing the tax advantage for the employer-based group market, you'd move people off the group market and onto the individual market. And an analysis by Thomas Buchmueller, Sherry A. Glied, Anne Royalty, and Katherine Swartz found that "for a typical family that moves from group to individual coverage, therefore, the move to nongroup insurance will raise premiums for an identical policy by more than $2,000 per year." Would you want to make that trade? RAMESH PONNURU'S TINKER.
Ramesh Ponnuru knows a lot more about health care policy than your garden variety conservative. But his op-ed in yesterday's The New York Times shows, I think, the difficulty conservatives have discussing this issue. Ponnuru wants to argue that "the goal should not be universal coverage. Reform should simply aim to make health insurance more affordable and portable." In other words, the 80+ percent of Americans who think the system needs fundamental changes or a complete rebuild are wrong. It's really just time for a tinker. Ponnuru's tinker would "make it easier for people to buy insurance that isn’t tied to their employment" and remove "state mandates that require insurers to cover certain conditions," both of which sound like small and inoffensive changes until you spin out their implications and realize they're actually small and very offensive changes. State mandates, for instance, sound unpopular until you get specific (pdf). Ponnuru's repeal would mean that policies in Arizona don't have to cover colorectal cancer screening and policies in Idaho don't have to cover mammograms and policies in Georgia don't have to cover bone marrow transplants and policies in Florida don't have to cover maternity stays. Repealing these laws might make health care cheaper, but the savings would come because your insurer could deny you coverage, and thus access, to a needed bone marrow transplant. Health care isn't "cheaper." You just get less of it, which in turn makes total spending go down.That, lest I obscure my point, is a pretty serious form of rationing.His tax change is little better. He says that a model built by Steve Parente, one of the McCain campaign's health advisers says "this would enable more than 20 million more Americans to get insurance," but studies evaluating that same proposal when it was in the McCain campaign also found that "the elimination of the income tax preference for employer-sponsored insurance would cause twenty million Americans to lose such coverage." In essence, what you'd have is a trade: By reducing the tax advantage for the employer-based group market, you'd move people off the group market and onto the individual market. And an analysis by Thomas Buchmueller, Sherry A. Glied, Anne Royalty, and Katherine Swartz found that "for a typical family that moves from group to individual coverage, therefore, the move to nongroup insurance will raise premiums for an identical policy by more than $2,000 per year." Would you want to make that trade? 
