The experiences in my home state of Tennessee illustrate the danger of trying to transplant Massachusetts's ongoing experiment to a national level. We came close to achieving the goal of universal care under the much heralded TennCare program, begun in 1994. But cost inflation caused the system to implode, and it was junked 10 years later. It would have been disastrous to the American people if the program had been adopted federally based on its initial success.
But that does not mean some lessons cannot be learned. The Massachusetts experience thus far, I would argue, suggests that mandated coverage would enhance health and improve equity. But because it is costly, it should be considered nationally only when we are confident that the economy can sustainably withstand the added burden and when appropriate restraints on the rate of healthcare inflation are simultaneously adopted.
A mandate's details are critical. Too large a benefit package and it will be unaffordable; too small and it will be meaningless. Since we have no national experience and the results in Massachusetts are incomplete, we should begin smaller rather than larger, with catastrophic coverage. In a time of recession and historically high national debt, we can't truly afford a rich benefits package like that of the Massachusetts plan. But with catastrophic coverage, no American would fear illness-induced bankruptcy.
As other states experiment with Massachusetts-type plans and as our economy strengthens, other innovations could be incorporated at the federal level in a way that minimizes risk.
It is a conservative approach that would affordably achieve necessary goals.
Read why a mandate would not do what it promises, by Dick Armey, Texas Republican, former U.S. House majority leader and chairman of FreedomWorks.
What do you think? Should Health Insurance Be Required of Everyone?