Fact-checking Mitt Romney on the Massachusetts individual mandate

Jared Rhoads Director, Center for Objective Health Policy
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During Thursday night’s CNN debate — the final such event before the Florida primary on Tuesday, January 31 — Rick Santorum attacked Mitt Romney over the individual mandate contained in the health reform legislation passed by Romney as governor of Massachusetts.

Santorum said that Romney’s mandate requires individuals to buy an insurance policy “as a condition of breathing.” He called it a top-down model that is “no different than Barack Obama’s mandate.”

Romney objected to it being called a “top-down model” and contested that the logic behind the individual mandate in Massachusetts is that “if you don’t want to buy insurance, then you have to help pay for the cost of the state picking up your bill.” He noted that under federal law, hospitals are required to treat certain patients regardless of whether the patients have insurance. Romney then followed with, “… [W]e said, no more, no more free-riders. We are insisting on personal responsibility. Either get the insurance or help pay for your care. And that was the conclusion that we reached.”

Santorum pressed, “Does everybody in Massachusetts have a requirement to buy health care?”

Romney: “Everyone has a requirement to either buy it or pay the state for the cost of providing them free care. Because the idea of people getting something for free when they could afford to care for themselves is something that we decided in our state was not a good idea.”

As I noted on Twitter (@ohpcenter), this win goes to Santorum. In defending the Massachusetts individual mandate, Romney insists that the mandate is a conservative approach that zeroes in on just the free-riders — that it leaves the rights of others essentially untouched. In reality, however, Massachusetts residents are forced to buy insurance or pay a fine to the state even if they do not use any health services paid for by the public.

Romney should know that there aren’t just two categories of people in his state: those who pay with insurance and those who free-ride off the system. There are at least three categories: those who pay with insurance, those who pay out of pocket (or who do not seek care at all over the course of a given year), and those who are allowed to free-ride thanks to the federal law that Romney cites.

Some say that the individual mandate doesn’t really initiate force against people who plan to buy insurance anyway. I contest that, but even setting that issue aside, the individual mandate clearly has real and non-trivial victims. These are the people who otherwise, in a free society, would responsibly choose to live healthy, avoid risk, and buy only a high-deductible catastrophic policy or self-insure against any medical expenditures that may arise. Often this population includes young professionals who are unlikely to need expensive, lavish coverage and entrepreneurs to whom every last penny of start-up capital is absolutely dear.

Self-insurers and those who prefer to carry only catastrophic coverage are not the free-riders of society, and it is insulting to suggest that we need the heavy hand of government to cure them of their “irresponsibility.”

True individual responsibility involves risks and rewards that are borne by individuals and enjoyed by individuals. Whether at the federal or state level, individual mandates to free politicians of the consequences of earlier laws are the refuge of big government thinkers, not those who wish to return America to a free society.

Jared M. Rhoads is the director of the Center for Objective Health Policy, whose mission is to advance rational, rights-respecting ideas in healthcare. The Center provides commentary and raises money to send free books to medical students who are interested in learning about the moral and economic case for capitalism. He works as a senior research specialist in the healthcare division of a large consulting firm in Massachusetts.