Mandate is linchpin of health reform; Romney can't keep pieces of law

Most Americans tell pollsters they oppose the Affordable Care Act while strongly supporting individual pieces of what's been dubbed "Obamacare."

Republican Mitt Romney apparently falls into this category, or at least has been reading the polls.

Romney has been promising to repeal the health care reform law on Day 1 if he is elected president. But during an interview on Meet the Press on Sunday he tempered his opposition.

"I'm not getting rid of all of health care reform. Of course, there are a number of things that I like in health care reform that I'm going to put in place," Romney said.

"One is to make sure that those with pre-existing conditions can get coverage. Two is to assure that the marketplace allows for individuals to have policies that cover their family up to whatever age they might like."

Romney's campaign quickly backpedaled, so stay tuned for further clarifications.

The important point is this: Romney can't pick and choose among the health insurance reforms.

He can't guarantee affordable coverage to uninsured people who have pre-existing medical conditions without also enacting the individual mandate, which is the linchpin.

Unless everyone, or almost everyone, especially healthy and younger adults, is covered and paying into the system, the popular pieces of reform will be unaffordable to those who need them.

That's why the law requires everyone to obtain health insurance by 2014 — by buying it if they can afford it, or through government subsidies and assistance if they can't. Also, in 2014, insurance companies no longer will be able to refuse people with pre-existing conditions or limit their benefits or jack up their costs. This protection already has taken effect for children.

Conservatives now revile the individual mandate even though they invented the idea as a logical extension of personal responsibility.

The operative principle, the one that gave birth to insurance, is simple: Spreading risk across a large pool of individuals provides enough money to cover everyone who becomes sick or injured. The larger the pool, the better insurance works, in part because a big group has more clout in the marketplace.

Keep that in mind while considering the proposal by Romney's running mate, Rep. Paul Ryan, to turn Medicare, a federal health care program for Americans 65 and older, into a voluntary voucher system for those who have not yet turned 55.

Under Ryan's plan, insurers could pick off the healthiest seniors, leaving "traditional Medicare" with an increasingly older, sicker pool of patients.

We're glad Romney recognizes the plight of people who have had cancer, heart disease or diabetes and who lack access to employer-provided health insurance.

Almost a third of adults are expected to develop a pre-existing condition, and we've seen all too many examples of people losing their jobs, and health insurance, through no fault of their own.

Tackle the question of how to protect people who don't have employer-provided health insurance, and the answer inevitably leads to universal coverage and an individual mandate.

That was the solution in Massachusetts when Romney was governor and signed the health care law that became the model for Obamacare, which raises a hopeful possibility: If they win, Republicans might have no choice but to replace Obamacare with Romneycare.