As evidenced by a recent CNN interview with Rep. Mo Brooks, mainstream Republicans believe that poor health is predominantly caused by bad voluntary lifestyle choices, and that wealth redistribution to address the needs of unhealthy people is consequently inappropriate and downright immoral. That said, even the GOP would admit that luck–genetic and otherwise–plays a major role in one’s health, which is why they have never seriously attempted to repeal the emergency room mandate. And, in addition to that, they have an alternative to community rating: high risk pools.
High risk pools have existed in many states, beginning in the 1970’s. As a solution to the problem of people with pre-existing conditions, they have, by all accounts, been a dismal failure. Since they violate the Republican non-redistribution principle, and they haven’t worked, you might well ask yourself why the GOP supports them today. The answer is simple: community rating is effectively an entitlement program, but high risk pools are a welfare program.
Community rating is essentially driven by opacity and ignorance; since the insurance companies can’t require people to take physicals and do surveys, no one knows who is being subsidized, and by how much; the process just happens invisibly through the operation of the market. As a result, the beneficiaries of the system do not feel like charity cases. With high risk pools, on the other hand, the physicals and the surveys would return, the identity of the charity cases would be known, and the government would be free to attach whatever conditions it wants on people in the pools in order to reduce its liabilities, including work requirements, drug tests, high deductibles, and very low overall limits on expenditures.
That, in a nutshell, is what this debate is all about; the GOP wants recipients of medical subsidies to feel the shame attached to accepting government benefits, and to keep those benefits as low as possible. Otherwise, how can we afford all of those juicy new tax cuts?