Hi all. I must apologize for my absence over the last few months. I have just completed the process of moving and the contents of my life have been packed in a variety of boxes, storage bins, etc. Needless to say, nothing can stop the writing process more than having your house (your life) in a state of complete disarray.
Over the last few months, I have had a lot of great ideas for various blog posts and have written them down in my journal, but for my first post since being back, I chose to focus on the individual mandate (surprise). I know it has been reported on many times since the Supreme Court decision, but in light of that decision, the fact that the congressional Republicans are today voting…yet again…to repeal the Affordable Care Act for the 33rd time, and the reaction from the right, their indignation and utter disbelief that one of “their” own actually voted against them, I wanted to go back and actually write about the origins of the individual mandate.
As some of you may already know, it was first proposed by the conservative think tank The Heritage Foundation. In 1989 Stuart Butler proposed a plan called Assuring Affordable Healthcare For All Americans. This plan included a provision to “mandate all households to obtain adequate insurance.” The reason for this mandate he explained is to address the “free rider,” a person who chooses not to have insurance.
This mandate is based on two important principles. First, that health care protection is a responsibility of individuals, not businesses. Thus to the extent that anybody should be required to provide coverage to a family, the household mandate assumes that it is the family that carries the first responsibility. Second, it assumes that there is an implicit contract between households and society, based on the notion that health insurance is not like other forms of insurance protection.
If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate but society feels no obligation to repair his car. But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance. If we find that he has spent his money on other things rather than insurance, we may be angry but we will not deny him services even if that means more prudent citizens end up paying the tab.
A mandate on individuals recognizes this implicit contract. Society does feel a moral obligation to insure that its citizens do not suffer from the unavailability of health care. But on the other hand, each household has the obligation, to the extent it is able, to avoid placing demands on society by protecting itself…
A mandate on households certainly would force those with adequate means to obtain insurance protection, which would end the problem of middle-class free riders on society’s sense of obligation.
In 1991 Mark V. Pauly developed a proposal for the George H. W. Bush presidency entitled A Plan For Responsible National Health Insurance, which also includes a mandate. In the section titled Proposed Plan For National Healthcare he addresses the reason for mandating everyone to have at least a basic level of health insurance.
All citizens should be required to obtain a basic level of health insurance. Not having health insurance imposes a risk of delaying medical care; it also may impose costs on others, because we as a society provide care to the uninsured. The risk of shifting costs to others has led many states to mandate that all drivers have liability insurance. The same logic applies to health insurance. Currently, those who obtain insurance, usually by taking a job that comes with health insurance benefits in lieu of cash wages, subsidize those who remain uninsured, whether or not by choice. Permitting individuals to remain uninsured results in inefficient use of medical care, inequity in the incidence of costs of uncompensated care, and tax-related distortions.
On page 8 when listing the plan’s “characteristics,” the first issue they deal with is entitled Mandatory Basic Coverage.
Mandatory basic coverage. In our scheme, every person would be required to obtain basic coverage, through either an individual or a family insurance plan. All basic plans would be required to cover specified health services; plans could, however, offer more generous benefits or supplemental polices.
Then, after President Clinton took office, Hillary Clinton spearheaded a group to work on a proposal to overhaul healthcare. Needless to say Republicans were not supportive of the proposal they put forward, so in 1992 and 1993 they came up with an alternative to “Hillarycare.”
The alternative was based on the proposal put forward by Mark Pauly. Senator John Chafee of Rhode Island along with 19 other Senate Republicans (who were cosponsors) including Christopher Bond, Bob Dole, Chuck Grassley, Orrin Hatch, Richard Lugar, Alan Simpson, and Arlen Specter. proposed a bill, the Health Equity and Access Reform Today Act of 1993 (HEART Act), and it proposed health insurance vouchers for low-income individuals, along with an individual mandate.
As we all know, nothing every actually passed, and this is why we find ourselves in the situation we are in today. So for all the faux outrage by the Republicans, both elected officials and pundits, all we have to do is to look back to the past and discover the reason of their angry, it’s President Obama. The fact is ever since he took office Republicans have had one goal, make Obama a one term president.
Republicans are using this issue to gin up their base and they don’t mind just how hypocritical they appear in doing it. It really does show their lack of ethics and basic morality and the lack of even the smallest amount of respect they should have for their own constituents.