On Wednesday, CBS reported a programmer saying the new Healthcare.gov exchange looks as if "nobody tested it," acknowledging the lack of functionality that has gone well beyond glitches and throwing another monkey wrench into the Obama administration's plans for health care reform. Pouring gasoline on the fire would be an understatement and adds to the frustration that most Americans are feeling about anything about everything concerning this law and the ancillary battles that have ensued.
Sadly, what Americans don’t know about the history of the individual mandate is a lot. Facts can be funny things and these days, few on the left or right want to acknowledge them when they don’t reinforce confirmation bias.
The health care debate is as good an example as any.
The left isn’t thrilled with Obamacare but they will defend it as a “step in the right direction,” presumably toward universal health care or a single-payer system. Unfortunately it doesn’t really resemble either.
The right can’t satisfy themselves by pointing out what is actually wrong with Obamacare, somehow feeling the need to make things up and engage in hyperbole. When you have the truth on your side, why exaggerate? Because the faithful approve?
History of the Mandate
Many people are aware of the roots of the individual mandate in this country tracing back to the work of Stuart Butler of the Heritage Foundation, who published “Assuring Affordable Health Care for All Americans” in 1989.
"President Nixon was concerned that he would once again have to face a [Ted] Kennedy ...with a proposal to extend health care to all Americans. Feeling the need to offer an alternative, Nixon asked Congress to require for the first time that all companies provide a health plan for their employees, with federal subsidies for low-income workers.
At first, Kennedy rejected Nixon's proposal as nothing more than a bonanza for the insurance industry that would create a two-class system of health care in America. But after Nixon won reelection, Kennedy began a series of secret negotiations with the White House that almost led to a public agreement.
In the end, Nixon backed out after receiving pressure from small-business owners and the American Medical Association. And Kennedy himself decided to back off after receiving heavy pressure from labor leaders, who urged him to hold out for a single-payer system once Democrats recaptured the White House in the wake of the Watergate scandal."
Health care reform torpedoed by special interests? Fancy that—and absent the cries of "socialism!"
Eighteen years later, Butler advocated the "new" idea of a mandate. Notable “conservative” contents in his proposal included as the first objective that “all citizens should be guaranteed universal access to affordable health care.” Early in the remedies is the requirement to “mandate all households to obtain adequate insurance.”
It appears the communists had infiltrated the Heritage Foundation.
Regardless, the seeds had been sown, and then a curious succession of support and opposition ensued. Conservatives supported it then opposed it, liberals opposed it then supported it, and finally we have the result: the Patient Protection and Affordable Protection Act.
Important benchmarks in the evolution of this law show a curious consistency of inconsistency.
1972: President Richard Nixon (R) asks Congress to implement employer mandate while negotiating with single-payer advocate Senator Ted Kennedy (D-Mass). Nixon resigns and Kennedy pulls support after Watergate.
1989: Stuart M. Butler, PHD, of the Heritage Foundation, publishes “Assuring Affordable Health Care for All Americans” also known as "A National Health System for America."
1991: Milton Friedman, in a Wall Street Journal article, advocates replacing Medicare and Medicaid "with a requirement that every U.S. family unit have a major medical insurance policy."
1993: Individual health insurance mandates appear in two bills introduced by Republican lawmakers. Support includes Senators Orrin Hatch (R-Utah) and Charles Grassley (R-Iowa) who today oppose the mandate under current law.
1994: Switzerland passes the Swiss Federal Law on Compulsory Health Care. This law instituted mandatory healthcare insurance and an optional insurance scheme to compensate for the loss of daily earnings. The health insurance provides for payments in case of sickness, accidents (unless covered by a separate accident insurance policy) and maternity.
In a budget analysis, the Congressional Budget Office says that the Heritage Foundation "substantially revised" its proposal.
1996: The Swiss Federal Law on Compulsory Health Care goes into effect
2006: Massachusetts Governor Mitt Romney signs off on a state law requiring residents to purchase individual health insurance
2007: A bi-partisan Senate bill, the Healthy Americans Act (HAA) authored by Senators Bob Bennett, R-Utah, and Ron Wyden, D-Oregon, contains a mandate. A 2008 preliminary analysis by the Congressional Budget Office concluded it would be "essentially" self-financing in the first year that it was fully implemented. The bill does not advance and is resubmitted in 2009 with the same result.
2008: Senator and presidential candidate Barack Obama expresses opposition to a mandate requiring all Americans to buy health care insurance.
2009: Republican senators declared provisions including individual mandates “unconstitutional.”
2010: A Democratic-controlled Congress passes the Patient Protection and Affordable Care Act that puts into place an individual mandate along with the manifold other provisions. President Obama signs it into law.
Stuart himself has explained his change of heart and as far as his reasoning goes, you can take it or leave it:
1) Behavior economics now indicates many people will enroll on their own so we don’t need a mandate
2) Risk adjustment tools have made voluntary insurance more stable
3) Today, mandates are more about what’s good for government than the people
Who wants to buy some oceanfront property in Arizona?
More palatable is the very valid argument that those on the right who hadn’t already declared an individual mandate unconstitutional changed their minds because Obamacare does not resemble Butler’s original idea or the Swiss model. Butler adds to those points:
“Moreover, I agree with my legal colleagues at Heritage that today's version of a mandate exceeds the constitutional powers granted to the federal government. Forcing those Americans not in the insurance market to purchase comprehensive insurance for themselves goes beyond even the most expansive precedents of the courts.“
Or it could be because Obama is a Marxist Kenyan Muslim. You be the judge.
There is little doubt the mandate could have been implemented in a much better, simpler way. Democrats might well ask themselves exactly what motivated their leaders to change the Swiss model into the abomination we have.
So the common talking point is that some on the right were for it before they were against it. They fail to mention that some on the left were against it before they were for it. Either way, it misses the subtleties of the argument, which look something more like this:
The left wants universal health care and a single-payer system. So Democrats take an idea from a conservative think tank that resembles what some, including Forbes columnist Avik Roy consider to the best healthcare system in the world and add a few hundred pages of other garbage to create the PPACA. Somehow the left thinks this is a step in the right direction.
Meanwhile, Butler had written about an idea that resembles a very good system. There is some support and some opposition. Barack Obama, previously opposed to a mandate, reverses course and champions the PPACA, which is much more than an individual mandate. After that, Republicans show universal opposition but can’t do anything while the Democrats control the presidency and both houses of Congress. After recapturing the House, they vote to repeal Obamacare nearly 50 times and used defunding and shutdown tactics in an attempt to derail it but fail to offer any alternatives along the lines of, you know…what Butler offered to begin with.
< Sigh >
The problem with the GOP side in this argument, as has become routine on both sides of the aisle, is to stick with “the sky is falling” approach instead of looking at specifics. In addition, while Democrats have managed to engage in unprecedented rhetoric about Republican tactics, the GOP has still somehow managed to remain the lowest uncommon denominator with an approach that is inexplicable and grossly unpopular. which is pretty sad considering they could have easily said “this is not the mandate we envisioned” but instead they launched into the usually valid but sadly routine mantra of “big government.”
Now we can forget the fact that there are many countries, including the aforementioned Switzerland, that provide better health care than ours, at a lower cost to both citizens and the government.
But wait! They’re socialists! Government-run health care will take away our freedom!
Oh you mean along the lines of the Veteran’s Administration, which actually employs the doctors and owns the facilities that provide the care? Kinda like that?
Or Medicare and Medicaid? Although that’s really only socialized health insurance…but why quibble over semantics? After all, it sounds so much more dramatic to call it a “complete government takeover of healthcare,” even though that was Politifact’s 2010 “Lie of the Year.”
And then of course, the subject no one broaches unless they’re complaining about Monsanto, the silent partner in our medical mess: the FDA.
Now where is the “big government” again? Apparently it’s here, not in Europe.
Now we know only the unrestricted free market of the United States can innovate anything but about one-third of the new drugs brought onto the world market each year are in the European Union. Wikipedia reports:
"At the heart of this is the European Medicines Agency, roughly parallel to the U.S. Food and Drug Administration (FDA), but without FDA-style centralisation, [the EMA] was set up in 1995 with funding from the European Union and the pharmaceutical industry, as well as indirect subsidy from member states, in an attempt to harmonise (but not replace) the work of existing national medicine regulatory bodies.
The hope was that this plan would not only reduce the €350 million annual cost drug companies incurred by having to win separate approvals from each member state but also that it would eliminate the protectionist tendencies of states unwilling to approve new drugs that might compete with those already produced by domestic drug companies.”
In other words, this is another episode of Regulation: You’re Doing it Wrong. Once again, we can see that the issue is not necessarily about big government but bad government. The EMA manages to coordinate public and private efforts between several independent countries better than the FDA can manage them in ONE.
Many of us realize there are three sides to every story. It's okay to change your mind but revisionist history, not so much. When more Americans acknowledge this and begin showing interest in something beyond their preconceived notions, chances are the country will benefit greatly.