Currently, due to objections from both moderates and conservatives, Republican efforts in the Senate to replace Obamacare are at an impasse. According to Kimberley A. Strassel, the sticking point is really the conservatives -- four of them -- who reject the inclusion of continued protections for those with pre-existing conditions.

What, exactly, is the conservatives’ objection? Presumably, it is partly because such protection to such-higher risk persons increase the price of medical insurance premiums that normal-risk persons would have to pay.That’s part of the reason, but, for conservatives, not the primary reason. The primary reason is, that in order to require such continued inclusion, the government must infringe on the rights of private parties to make contracts on their own terms, without government dictating those terms to them. To say that government can do so is a position that fundamentally alters the relationship between it and its citizens. Rather than being an impartial and disinterested arbiter/umpire, government acts on behalf of some citizens at the expense of others. To conservatives, to thinking democrats of any party, this is a very serious concern.

But, on the other hand, it’s hardly a new concern. If, in requiring continued protections, government sheds its impartiality to act as advocate for some particular group over the lawful interest of others, it would not be for the first time, or the one-hundredth and first time. And, in light of this reality, Strassel, a conservative herself, contends that the four conservatives must simply accept political reality. But, like many, Strassel seems to assume that the choices presented by that reality are binary – that is, that those with pre-existing conditions will either continue to receive protections, or they will not.

But there is a third option -- that they continue to receive protection, but that they receive it under different terms -- that they receive taxpayer subsidies for premiums not as unconditional subsidies, but as conditional ones -- that condition going to the ability to pay. Not “the ability to pay,” however, in the same sense that that phrase is used with respect to outstanding taxes or other obligations, but rather in a way created specifically for such “medical insurance loans.”

Such loans could, for example, (as I have also argued in an earlier article) be asserted as "last-priority" loans -- subordinate to all other debts, including debts incurred after the incursion of the medical debt. (Consequently, it should have no effect on a medical debtor's credit rating.) Moreover, we could further stipulate that, even if there were no superior debts, and there were sufficient assets, even then, the government still could not take collection action. The only collection action it could take would be against the estate of the debtor. (Toward this purpose, there would be no statute of limitations, and, if there is no interest, there would be adjustment for inflation.)

Alternatively, to create an incentive for quicker repayment, government could also offer a discount for earlier payment. (For example: 25% off if paid within the first year, reduced by one percent annually thereafter.)

But, if we place such an obligation on the medically higher-risk, how could we not demand the same of normal-risk individuals? Certainly, under equal protection, if nothing else, we couldn’t. Under this approach, they could not receive outright subsidies either. They also would receive “last-priority” loans instead.

So what is accomplished? All parties would have a personal obligation for payment of the medical expenses covered by taxpayers, they would, in order to minimize that obligation, retain the right to free contract with insurers for terms they, not the government, desire. They would not be placed in a one-size-fits-all insurance plan, but could choose a plan more closely suited to their needs. For the normal-risk person, this would be a cheaper plan. For those with higher-risk, the plan would be more expensive. But, through last-priority loans, everyone will be able to purchase the plans they need.

Because some of the loans will be paid back, the government health care dollar will go further. Or, to put it another way, the burden on taxpayers will be alleviated. But it would do more than that. It would preserve the freedom of contract and the idea of personal responsibility for the expenses that one incurs.

And actually, it would do more than that. With ObamaCare, (if not earlier,) access to medical care, regardless of ability to pay, has been established as a “right.” But since medical care does come at a cost, what this right translates to also is a “right” for the money -- the property -- of other people. This is a pernicious notion that can only bring strife between economic classes.

The proposed policy would clarify the concept of a “right” for medical treatment. While it would continue to guarantee the right to medical treatment itself, it would not guarantee the right of taxpayer money to pay for it. If such money must, if possible, be repaid, then the possession of such money is no right.

That notwithstanding, however, some may believe that, simply on the face of it, such a policy -- where millions of people who are expecting to receive outright subsidies would get (however lenient the terms) only loans -- would be a very tough political sell. But tough compared to what? Discontinuing protections for those millions with preexisting conditions? For those millions, a loan -- particularly a last-priority loan -- would be far, far more appealing.

And particularly when those receiving such loans – normal risk and higher-risk alike – fully understand its terms – terms and rationales that could be included in the annual statement to them.

Through such a policy, we would strike a balance between limited government and the welfare state. By bringing in additional revenue without raising taxes, this policy should appeal to both Democrats and Republicans. And by preserving freedom of contract, it should appeal to conservatives of both parties, and satisfy the objection of conservative Republicans.

Bert Peterson proposes a process and legislation for political education at 4thofjuly.info.