A brief timeline of Republicans and the individual mandate:
1960s: President Kennedy subtly hints at universal healthcare for America. Republicans don’t know how to react.
1970s: Republican President Nixon offers market based solution and employer mandate.
1980s: Republican think tank comes up with individual mandate.
1990s: Democrats offer ‘HillaryCare’ a step on the path to universal healthcare.
1990s: Republicans respond by sponsoring market-based Acts with individual mandate attached.
1990s: Republicans propose individual mandate, to prevent government-run healthcare.
2000s: Republicans create individual mandate system in Massachusetts.
2010s: Democrats throw out universal healthcare goal, adopt Republican individual mandate idea.
2010s: Republicans forget that it was their idea for decades, and decide it’s actually Marxist.
Through all the misinformation and misleading arguments against the Affordable Care Act, one of the most prominent is the conservative assurance that the individual mandate represents ‘government compulsion’ and so is the death of liberty. With this in mind, it would then seem natural to believe that the Affordable Care Act was conceived in a room of shadowy Marxists, waving an American flag upon which the 50 stars of Old Glory replaced by a hammer and sickle, thinking up devious ways to enslave the American people to the will of the big bad government. And conservatives – in the most over-dramatic fashion possible, are sure of that synopsis:
Born close to the border between England and Wales, Stuart Butler emigrated to the US in 1975 and has slowly worked his way up the ranks of the conservative Think Tank ‘The Heritage Foundation’, and is currently the foundation’s Director of the Center for Policy Innovation. In 1981, Butler gave a speech on healthcare in the United States, in it he says:
“We would include a mandate in our proposal–not a mandate on employers, but a mandate on heads of households–to obtain at least a basic package of health insurance for themselves and their families. That would have to include, by federal law, a catastrophic provision in the form of a stop loss for a family’s total health outlays. It would have to include all members of the family, and it might also include certain very specific services, such as preventive care, well baby visits, and other items.”
– Here we have for the first time, an influential right winged think tank proposing ‘government compulsion’ within the healthcare market. This idea was pushed an alternative to universal healthcare, which of course was then described as ‘government compulsion’ whilst the individual mandate promoted as a reasonable market-driven solution. Republicans today complaining that the President is not compromising appear to not understand that Obamacare absolutely is the compromise.
Conservatives including the Heritage Foundation today claim they changed their position in the early 90s and were now against the mandate. This isn’t exactly the case. They were against inclusion of the mandate in a Democratic authored Bill, not because they suddenly disagreed with the principle of an individual mandate, but because of the projected cost of the Democrat plan. We know that Butler was not against the idea of an individual mandate in principle, because in 2003 he told Congress:
“The obligations on individuals does not have to be a “hard” mandate, in the sense that failure to obtain coverage would be illegal. It could be a “soft” mandate, meaning that failure to obtain coverage could result in the loss of tax benefits and other government entitlements.”
– Are Republicans in 2013 willing to suggest that the Director of the Center for Policy Innovation at a leading conservative think tank, is advocating ‘Marxist’ forced government interference, with his 25 year support for an individual mandate?
In 1991, Mark Pauly – the lead author of a Health Affairs paper – wrote a paper for President Bush insisting that an individual mandate to purchase private health insurance was an effective way to keep government from nationalising healthcare. The individual mandate, in other words, was an anti-socialist principle in 1991. Pauly says:
“I was involved in developing a plan for the George H.W. Bush administration. I wasn’t a member of the administration, but part of a team of academics who believe the administration needed good proposals to look at. We did it because we were concerned about the specter of single payer insurance, which isn’t market-oriented, and we didn’t think was a good idea. One feature was the individual mandate.”
– So, all through the ’80s, ’90s, and early 00’s, Republicans and conservatives were touting an individual mandate for purchasing private health insurance, as a conservative principle designed to derail nationalised healthcare.
In 2011 Tea Party favourite Orrin Hatch (R-Utah) referred to an individual mandate as:
“…the unconstitutional employee mandate.”
– Leaving aside the fact that the Supreme Court upheld the mandate, back in 1993 Orrin Hatch (R-Utah) was a co-sponsor of a Healthcare Bill introduced by Republicans, that included an individual mandate. He fully supported it, along with current Senators Charles Grassley (R-Iowa), and Richard Lugar (R-Ind). Senator Grassley is currently on the Senate Judiciary Committee, and supported Ted Cruz’s miserable attempts to defund The Affordable Care Act and its individual mandate, twenty years after he proposed and supported a similar Act. Senator Lugar (co-sponsor of the 1993 Act that included the individual mandate) is responsible for pushing Indiana Attorney General Greg Zoeller to question the constitutionality of the individual mandate. Both Senators support an individual mandate when Republicans propose it so much so that they co-sponsor it…. they’re then anti-individual mandate when Democrats compromise and propose it.
Instead of registering outrage at the ‘Marxist’ government compulsion involved in mandating individuals to purchase private health insurance (the strangest understanding of the concept of Marxism I’ve yet come across), Mitt Romney when governor of Massachusetts embraced it whole-heartedly. In 2006 the state of Massachusetts passed ‘An Act Providing Access to Affordable, Quality, Accountable Health Care’. Dubbed ‘Romneycare’, chapter 58 requires that all citizens of Massachusetts purchase health insurance coverage. Before signing the Act into law, Governor Romney vetoes eight provisions in the Act. Predictably, he vetoed providing dental help to the most vulnerable on Medicaid, and particularly heartlessly, he vetoed providing State funded care for legal immigrants with disabilities. What Romney didn’t veto, was the individual mandate. He seems to have been perfectly fine with that section. But don’t accept my word for it, here is what Romney himself had to say in 2006:
“With regards to the individual mandate, the individual responsibility program that I proposed, I was very pleased that the compromise between the two houses includes the personal responsibility mandate. That is essential for bringing the health care costs down for everyone and getting everyone the health insurance they need.”
And as a conservative idea, it seems to have worked. Conservatives should be proud. It’s a good idea. The Urban Institute released a report in 2010, that noted 98.1% of residents were insured, compared with 83% nationwide. 99.8% of children were now covered. 99.6% of seniors now covered. In 2011, the National Bureau of Economic research released a report noting that:
“…health care reform in Massachusetts led to better overall self-assessed health and improvements in several determinants of overall health, including physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity.”
– It works. Democrats adopted a Republican idea that works.
But it isn’t just the individual mandate that began life as a conservative idea. Let’s not forget that the employer mandate was first accepted by a Republican President. In 1974 President Nixon stood in front of Congress and offered his idea for comprehensive healthcare reform. He stated:
“Every employer would be required to offer all full-time employees the Comprehensive Health Insurance Plan.”
– Every employer. The Democrat President in 2012 has watered down this conservative proposal, and mandated that in 2015, only employers with over 50 employees provide health insurance for their workers, with the first 30 employees exempt. This is a major difference from what conservatives were offering with employer mandated health reform. Would Republicans be willing to accept that President Nixon was more ‘Marxist’ and anti-business, than President Obama? I suspect not.
It’s worth noting that Kennedy and the 1960s Democrats first argued the case for universal healthcare in the US. The UK had created the NHS after World War II during the wonderful Prime Ministerial reign of Clement Atlee. The NHS is a national treasure today. President Kennedy stood in front of an audience at Madison Square Garden and argued the case for a National Health Service in the US. Since then, Republicans have focused on reacting to Democrats on health care. First, they reacted by offering a market based solution that included an individual mandate to counter universal health care. For this, they also at times argued for an employer mandate. And now, the react by opposing Democrats, and previous generations of Republicans, but offer nothing new. The Republicans represent opposition to the President whatever he says or does, badly masked as a practical alternative.
It seems that for the majority of the past half a century, pre-Tea Party Republicans understood that healthcare is not a commodity like any other. That it isn’t based on choice in the first place. It is a necessity, and represents a product that can be the difference between life and death, and so it must be treated differently, focusing on the human aspect rather than the profit aspect first and foremost. Republicans in the past have understood that. Whilst universal healthcare is the ideal, it is still far away from being released in the US, and so until then Obamacare is a good, practical alternative that was first conceived by thinking Republicans, and that works well. We mustn’t be under the impression that Republicans oppose Democrats on health reform for any practical reason – after all they’ve offered no alternative – other than their traditional aimless opposition to Democrats on health reform, even if it was their own idea in the first place.