Romney's health plan says all should pay for insurance

You have to buy car insurance if you own a car. You have to buy home insurance to get a mortgage. Why don't you have to buy health insurance?

Massachusetts Gov. Mitt Romney re-ignited that debate last month when he announced a plan to expand health coverage to all the state's residents, with a caveat that those who don't buy coverage could face a penalty.

"We can't have as a nation 40 million people — or, in my state, half a million — saying, 'I don't have insurance, and if I get sick, I want someone else to pay,' " says Romney, a Repub- lican who says he might run for president in 2008.

It's the question behind all health care debates: Who should pay?

Romney's plan says everyone should: The state would work harder to enroll all residents eligible for Medicaid; employers, most of whom already offer insurance, would be encouraged to continue doing so voluntarily; and individuals who don't have insurance would have to sign on to one of two new insurance pools, one of which would be subsidized for lower-income residents.

Failing to sign up could lead to a loss of a personal tax exemption or garnishment of wages.

Romney's plan comes as politicians, employers and benefit consulting firms focus on the latest trend in cost control: personal responsibility.

That trend is playing out in several ways: larger payments by workers toward their own health costs; efforts by employers to get workers to change unhealthy behaviors; and new health savings plans that allow people to set aside money, tax free, to cover health costs.

"It's a conservative idea," says Romney, "insisting that individuals have responsibility for their own health care. I think it appeals to people on both sides of the aisle: insurance for everyone without a tax increase."