Kevin Williamson’s Principled Stand on Mandates

There’s nothing really coherent here in terms of policy or principle.

Reading the National Review‘s Kevin Williamson discuss healthcare is like reading a koan designed to make you understand the essence of modern-day conservatism by demonstrating the weakness of rational thought.

The topic is a bill under discussion in Texas that would require insurance companies to cover the cost of hearing aids for children who are born with impaired hearing.

Williamson sets up the debate his way:

The case for the bill is exactly what you would expect, presented in exactly the way you would expect…For newborn children who can benefit from hearing aids, sooner is better: The sooner the hearing aids are in use, the better the child’s chances of normal language development.

The case against the bill is exactly what you would expect, presented in exactly the way you would expect: Business groups oppose the mandate, as they oppose all additional mandates, arguing that such mandates increase the cost of health insurance for all Texans and for employers who provide insurance.

This is seemingly a straightforward debate about values. Should children get hearing aids as soon as possible so that they have a good chance of normal language development, or should they be denied this health care so that Texans as a whole can enjoy slightly lower costs?

But Williamson is too clever to debate on those terms. For him, it’s wrong to mandate that insurance plans cover anything, but it’s also wrong to deny children the opportunity to hear and develop normally. So the solution is to have the State of Texas man-up and offer to provide these hearing aids directly to the kids who need them. The state can budget for this (it would be expensive but not that expensive) and they can stop pretending that a mandate to an insurance company is anything other than a disguised social-welfare program.

What motivates Williamson to take this stance?

If you want to provide the benefit, then, for Pete’s sake, write the damned check. The alternative is not — no matter what our Democratic friends insist — getting insurance companies to pay for children’s hearing aids out of their profits and the bonuses of their fat-cat executives.

What offends him isn’t the cost, since he’s happy to have Texas pay it. He’s not really concerned about the premiums people will have to pay, since that’s just a laundered way of paying the taxes that Texas would need in his preferred scenario.

No, what bothers him is that when the state mandates something be covered in an insurance plan, it comes out of the “profits and the bonuses of their fat-cat executives.”

Insurers might simply try to pass those costs along to subscribers in the form of higher premiums, but, contrary to the economic model that exists in the head of Bernie Sanders, companies do not have the power to unilaterally set prices. Companies in very competitive and price-sensitive businesses (think McDonald’s or Walmart) cannot simply raise consumer prices.

And here I thought the problem with Obamacare was that there wasn’t enough competition to keep premiums low.

In any case, I’d actually be fine with Texas paying for kids’ hearing aids instead of having it all washed through a for-profit insurance industry. It’s just that it’s kind of crazy to me that the motivation for doing that wouldn’t be to reduce cost by cutting out the middle man and instead would be to avoid cutting into the profits and bonuses of insurance executives.

But it gets even more confusing, because Williamson certainly doesn’t want Texas to pay directly for kidney dialysis or chemotherapy or separating conjoined twins. That would destroy the health insurance industry and take socialism to level not seen outside the Veterans Administration.

So, why hearing aids but not birth control pills or hysterectomies?

There’s nothing really coherent here in terms of policy or principle. The only consistency is that Williamson thinks that health insurance executives shouldn’t suffer from anything that will interfere with their compensation, and that means that they should be able to sell crap insurance of any kind that they want with no regulation.

If some benefit must absolutely be provided because the people in need are so sympathetic, then let the state do socialism in just those cases but no others.

Doesn’t this make you want to donate to the National Review?

Martin Longman

Martin Longman is the web editor for the Washington Monthly and the main blogger at Booman Tribune.