Last week, David Frum argued that Mitt Romney should embrace Romneycare, and I critiqued his argument. Frum has now fired back, claiming it’s “breathtaking” that I would oppose the mandate/regulate/subsidize approach to health care reform pursued by Romney in Massachusetts and President Obama at the national level. Bizarrely, in the process of making his argument, Frum accuses me of having shifted my views on health care policy as a result of the Obamacare debate.

He writes:

The debate over Obamacare has driven many conservative writers to espouse positions much more radical than they held four years ago—very likely, much more radical than they will hold four years from now—and certainly more radical than anything a Republican majority in Congress would ever actually do. I think Philip’s words provide an almost laboratory-pure example of just such a polemical tendency.

Frum may find my positions on health care policy “radical,” but if he really thinks I’m a “laboratory-pure example” of a conservative writer who has changed his views as a result of the Obamacare debate, then it’s a good thing he didn’t pursue a career as a chemist.

As it turns out, four years ago, in the July/August 2008 issue of the American Spectator, I wrote a 6,500-word feature on health care espousing the same views I hold today about the mandate/regulate/subsidize health care model.

In the piece, I argued that conservatives needed to pay more attention to health care policy, critiqued mandates and regulations and outlined free market alternatives. I criticized the tendency among Republicans to accept the false choice between doing nothing on health care and agreeing to expand government, and cited Romneycare as a cautionary tale. I wrote that:

(S)ome Republicans have decided to enact essentially liberal reforms, arguing that this is the only way to stave off more intrusive measures. Along these lines, President Bush signed the largest expansion of entitlements since the Great Society in the form of the Medicare prescription drug bill. As governor of Massachusetts, Mitt Romney imposed mandates requiring every citizen to purchase health insurance, creating a state-managed system that is wildly over budget just two years after being signed into law. And in spite of such compromises, the liberal charge for national universal health-care legislation is fiercer than ever.

I insisted, “It is important for conservatives to point out that far from having a free market, America is a nation whose health-care system is suffering from ham-handed government intrusions into the free market.”

Throughout the piece, I detailed those intrusions. I explained that, “Most free market critics of the U.S. health-care system trace our problems back to 1943, when the Internal Revenue Service ruled that workers did not have to pay taxes on health benefits purchased through their employers.” I wrote that, “While the federal government, through the tax code, makes it difficult for individuals to purchase health coverage on their own, some state governments make it close to impossible. The reason is that many states impose onerous regulations on insurers requiring them to provide certain benefits.”

Feel free to read the whole thing.

I’m not going to recount all of the pieces I’ve written over the years espousing similar views on health care policy, but I would note that specifically with regard to the individual mandate, you will never find an instance of me expressing anything but contempt for it. In July 2007, for instance, I wrote of the Massachusetts mandate that, “It is hard to imagine anything representing a greater affront to conservative principles than using government to coerce private citizens into purchasing healthcare.” At the time I wrote that, I would add, Obama himself opposed an individual mandate.

It’s not surprising to me that David Frum holds different health care policy views than I do. But he should have done his homework before accusing me of being disingenuous.

UPDATE: David Frum has graciously apologized, and I accept. But he still misunderstands my point that, “Some of us simply don’t believe that the way to fix our health care system is for the government — whether at the federal or state level — to mandate, regulate and subsidize the purchase of health insurance.”

I thought in the context of my post, it was pretty clear I was using shorthand to describe the structure of Romneycare and Obamacare. By “mandate” I meant the individual mandate that forces individuals to purchase insurance, by “regulate” I was referring to, among other things, the fact that under this approach government defines what constitutes acceptable insurance, and by “subsidize” I meant that both laws expand Medicaid and provide subsidies for individuals to purchase government-run insurance on government-run exchanges.

The American Spectator’s Jim Antle was clear on what I meant, as he wrote that, “it’s pretty obvious Phil is arguing that a new patchwork of mandates, regulations, and subsidies won’t solve the health care system’s biggest problems right now rather than calling for the repeal of every single health-related law ever enacted.”

Exactly. Before Obamacare, government at all levels was responsible for nearly half of all health care spending in the U.S., and other government policies had tremendous influence on the rest of the spending. The debate, as I see it, has been between those who believe that additional government action is necessary and those who believe that the answer is to reform the system in a more market-oriented way.

Supporting market-oriented reforms doesn’t mean repealing Medicare and Medicaid, for instance. It means opposing the further expansion of Medicaid and block granting funds to the states, and transitioning toward a premium support model for Medicare.

As far as the distortion caused by the employer tax exclusion for health insurance, even Frum acknowledges that, “The ill effects of this subsidy are pretty notorious by now.” There are multiple ways to address this. The purist free market approach would be to simply eliminate it, which would raise people’s salaries and encourage them to spend their health care dollars more wisely, helping to drive down health care costs. The more politically achievable approach would be to take the money raised by eliminating it to finance tax credits for individuals to purchase insurance or simply allow them to deduct the purchase. The exact details are subject to a debate that’s beyond the scope of this post, but either of those options would be preferable to the current system or Obamacare. And the idea of tweaking the tax code is not as outside the mainstream as Frum suggests. It was part of Sen. John McCain’s health care policy platform in 2008 and Jon Huntsman, the supposed moderate in the 2012 race, supported eliminating it. Though Romney’s current health care proposal is admittedly vague, what we have of it does call for “End(ing) tax discrimination against the individual purchase of insurance.” I’m not oblivious to the political challenges inherent in doing something about the employer tax exclusion, but it’s clearly part of the national conversation. It’s not as if I’m calling for privatizing the Department of Defense.