The fundamental problem with the whole healthcare debate is a lack of realism. Given the rapidly increasing costs of healthcare, some measure of reform is inevitable. People who want to maintain the status quo simply aren’t dealing with reality. The only question under consideration is *how* do we change it.

The individual mandate was historically the Republican solution to healthcare reform. This is what I as a (r)epublican find most baffling about the whole debate. The individual mandate isn’t some form of socialist conspiracy. The Democrats voted for *our* healthcare plan, but Republicans are opposing it mostly because they don’t want Obama to get credit.

The problem is, the alternative to the individual mandate isn’t going back to the status quo, because that’s never going to happen. The alternative is a single-payer healthcare system. And opponents of the individual mandate need to be crystal clear on this: if the individual mandate is struck down, Democrats only need 51 votes to ram single-payer healthcare through the budget resolution process, and the courts long ago decided that Medicare was constitutional.

And I expect single-payer healthcare to be as good for our country as single-payer education. Education can primarily be judged by a) quality and b) cost. But measuring quality is hard and takes years, while measuring cost is much quicker and easier. Given that, many politicians cut quality because the consequences won’t be evident until they’re out of office tomorrow, whereas raising taxes gets voters riled up today. That’s one of the reasons why America’s education system has dropped to 25th in the world, behind such intellectual heavyweights as Latvia and the Slovak Republic.

I don’t personally consider the individual mandate in healthcare to be any more onerous than the individual mandate in education. I can send my kids to public, private, or home school, but I don’t have the option to *not* educate my kids, because dumb uneducated kids grow up to be dumb uneducated adults, which imposes costs on our society. Similarly, I can buy health insurance from BlueCross, Aetna, Humana, any number of companies, but I don’t have the right to *not* insure myself, because if I don’t have insurance, someone else’s tax dollars will have to pay for it.

Your health is partly luck of the draw, partly your own decisions. I know people who have cerebral palsy, myasthenia gravis, brain tumors, mental illness, scleroderma, a whole host of diseases that no one asks for and that you can’t do anything to prevent. On the other hand, I also know plenty of people who smoke, eat fatty foods, don’t exercise, and consequently suffer from diabetes, heart disease, lung cancer, and other aliments.

In Mathew Binkley’s healthcare plan, everyone would be expected to save money tax-free in a health savings account to pay for minor services. If you had a friend that was sick, you could give them money from your HSA tax-free. For the things you don’t have any control over, government would mandate catastrophic health insurance over a certain level (say $10k a year or $30k lifetime). For the things you can control, government would increase taxes (a so-called Pigouvian tax) to cover costs. That way, if you’re smoking Marlboro and eating Ho-ho’s three square meals a day, that tax burden will either a) incent you to eat bad foods less often, or b) pay for your healthcare when you’re laid up in the hospital bed with a gangrenous leg.

I distilled this plan from reading various health care experts and political wonks for several years, but since it’s middle-of-the-road, pragmatic, and violates both the Tea Party and the hippy left’s ideologies, is guaranteed to make everyone mad and will never happen in a million years.

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