Is the GOP’s Flip-Flop on the Individual Mandate Any Different From Democrats’ Flip-Flop on Medicare Reform?

In The New Yorker, Ezra Klein traces the history of the individual mandate to purchase health insurance, which began as a proposal by the conservative Heritage Foundation, and wonders why Republicans flip-flopped on the issue. The answer he settles on? Motivated cognition, “which Dan Kahan, a professor of law and psychology at Yale, defines as ‘when a person is conforming their assessments of information to some interest or goal that is independent of accuracy’—an interest or goal such as remaining a well-regarded member of his political party, or winning the next election, or even just winning an argument.” Republicans shifted positions, in other words, because it was politically convenient.

It’s a nifty piece, nicely researched and enjoyable to read. But I have a few quibbles on his presentation of the history, and a bigger question: Couldn’t you accuse Democrats of more or less the same thing when it comes to Medicare reform?

Let’s start with the quibbles. Klein begins his piece with a brief backstory on the mandate: It first appeared as a proposal in a Heritage policy brief, then appeared in a 1993 bill cosponsored by 18 Republicans. All true, and genuinely damning to the GOP. But I think Klein goes slightly too far in writing that the mandate was “at the heart of Republican health-care reforms for two decades.” This overstates the strength and depth of the Republican party’s support for the policy. The 1993 bill was offered as an alternative to Bill Clinton’s health care reform push at a time when some mostly moderate Republicans felt they had no choice but to offer a different plan. It wasn’t even a purely Republican proposal: Democratic Senators John Kerry and David Boren also cosponsored the legislation. And it never gained widespread GOP support; it was never voted on or even formally debated.

The mandate was not then and did not go on to become a core policy for Republican legislators in Congress; it wasn’t something any GOP elected official really wanted, that any of them would have traded anything or risked anything for. It was one part of one plan — a plan offered in a moment when a handful of Republican legislators felt like they had to offer something, anything — that never made it to a vote.

Were Republican elected officials deeply opposed to the mandate in the years between the mandate plan and President Obama’s election? Probably not. But they certainly weren’t making any push for it either. A number of the legislators who sponsored the original bill left office, and incoming legislators likely gave it little thought. At the national level, the Republican party wasn’t particularly interested in the mandate one way or another because it wasn’t particularly interested in health policy at all.

You can make a better case that the mandate remained quite popular amongst within the broader conservative policy community. Heritage continued to support the policy, as did Newt Gingrich’s health policy shop. And they did eventually convince one Republican politician that the mandate was not only a useful alternative to counter the argument that the GOP has no health care plans, but an idea worth pursuing. That politician was the governor of Massachusetts, Mitt Romney, whose team insisted on a strong and clear mandate when drawing up plans for RomneyCare. Despite the GOP’s current loathing of the policy, Romney still defends the mandate he signed in Massachusetts. But there are few if any other prominent Republicans who ever have risked anything to support the mandate, or made any noticeable effort to get one passed.

It was a policy that some conservative policy wonks were interested in, but never one that generated long-term devotion from the vast majority of party officials or legislators — which makes it a stretch to describe it as the “heart” of GOP health policy.

Democrats and liberal policy wonks took a similar turn with Medicare premium support, now championed in broad form by both GOP presidential nominee Mitt Romney and the party’s leading policy entrepreneur, House Budget Committee Chairman Paul Ryan. The story is remarkably similar: The idea started out as a policy promoted by prominent liberal wonks, briefly gathered support from a handful of top-level policymakers near the end of the Clinton presidency, and is now deeply opposed by the majority of Democrats, who often refer to the idea as a plan to “end Medicare as we know it” — or occasionally just a way to “end Medicare,” period.

Premium support, which would pay a flat rate toward the purchase of a private insurance plan for each Medicare beneficiary, was first developed by Alain Enthoven, a Democratic adviser who had previously served as a health policy consultant to President Jimmy Carter,  in “The History of Principles of Managed Competition” in 1993. In 1995, Henry Aaron, a scholar at Brookings who served as a senior official in President Carter’s Department of Health, Education, and Welfare, gave the policy its name — premium support — and suggested that it represented a Medicare reform compromise, a “middle ground” that could retain Medicare’s strengths but address budgetary challenges. In 1999, the National Bipartisan Commission on the Future of Medicare, which was chaired by Democratic Senator John Breaux and included Democratic Sen. Bob Kerrey, met to develop a proposal to reform the seniors’ health entitlement. The first item in the final proposal put forth by Breaux and supported by Kerrey was “the design of a premium support system.”

And just as Democrats saw hope for bipartisan agreement in the GOP’s previous support for the mandate, Republicans like Paul Ryan saw hope for bipartisan Medicare reform in previous Democratic acceptance of premium support.

Was premium support the “heart” of the Democrats’ Medicare reform plan for years? Not exactly. But it was developed by liberal wonks who served in Democratic administrations and supported in a national commission run by a Democrat. At least one Democratic Senator — Oregon’s Ron Wyden — still supports the plan, as does former Clinton budget adviser Alice Rivlin.

Yet for the most part the party’s legislative leadership and rank and file have become deeply opposed to the idea in recent years, with liberal activists famously running an ad comparing Paul Ryan’s Medicare overhaul to pushing a wheelchair-bound grandmother off a cliff, and the "ending Medicare" talk common amongst prominent Democrats. Even Henry Aaron now argues against implementing premium support any time soon.

Would opposition have been so vehement, so ugly, so powerful back when the policy was understood as a creation of Democrats? Did Democrats develop and strengthen their opposition in response to Paul Ryan’s plan? Were they “conforming their assessments of information to some interest or goal that is independent of accuracy” — perhaps with the goal of villifying Ryan’s plan in order to help them win the next election? No doubt some changed their minds after thoughtful consideration, and others strengthened opposition where little feeling or opinion of any kind had existed. But it also seems likely that Democrats adjusted and developed their stances because it was politically convenient, just as Republicans did.



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  • Whiterun Guard||

    I'd be all for the Man-date and any health care plan that lets me push a wheelchair bound grandmother off of a cliff.

  • o3||

    one dumps grandma outta the chair und over the cliff so one may resell the wheelchair.

  • sloopyinca||

    And after they resell the wheelchair, they can enroll in a basic English grammar class so their ramblings can become at least moderately coherent.

  • o3||

    nah, im using the wheelchair money to pay my health premiums. comprehende amigo?

  • sloopyinca||

    You ought to use the wheelchair money to buy a better helmet for that water-baby head of yours. Or are you, too, just having a "seizure"?

  • o3||

    so nolo comprehende eh?

  • ||

    Don't respond to the retard, Ken. Just don't.

  • Ken Shultz||

    But he's a fucking retard!

  • o3||

    whiterun intended humor on the first post. god what killjoys

  • Whiterun Guard||

    And then they get the hose again.

  • sloopyinca||

    Oh, shit. This reminds me of a recent trip to the grocery store. (Banjos can confirm)

    We were at a store where you self-bag. Being a good libertarian, I made sure my kids did the bagging as I lorded over the cashier. My daughter was dicking around and wasn't putting the groceries and other items in the bags very quickly because 14 year old girls are lazy and do nothing but text their friends (OMG, LOL!). I told her to hurry up and put the things in the basket. She kept working slowly, and I said "It puts the lotion in the basket." When she didn't comply, I said louder "It puts the lotion in the basket," to which a person behind me laughed and said, "Man, I loved Joe Dirt.

    I have rarely wanted to inflict punishment on somebody as badly as I wanted to at that moment. Fortunately, my son corrected the person when he said, "Joe Dirt stole it from Silence Of The Lambs," and prevented an unnecessary, but totally justified, murder.

  • ||

    Man, I loved Joe Dirt.

    Why didn't you kill him, again?

  • sloopyinca||

    Because of the goddamn Non-Aggression Principle. Stupid morals kept me from doing the world a favor.

  • SIV||

    All true, and genuinely damning to the GOP.

    Which Mr McArdle follows up with along explanation why it wasn't.

  • ||

    He didn't say it was very damning.

  • sarcasmic||

    When Republicans do it it's a flip-flop.

    Democrats evolve.

  • Bee Tagger||

    Is the GOP’s Flip-Flop on the Individual Mandate Any Different From Democrats’ Flip-Flop on Medicare Reform?

  • BoscoH||

    Basically, Democrats don't have a monopoly on dumb ideas. I think you can trace this proposal further back to the early 1990s auto insurance wars in California. Insurance industry wanted no-fault, Dems wanted tight price regulation, and the GOP stumbled into insurance mandates and penalties. We got a combination of what Dems and Reps wanted, and the insurance industry was ecstatic with the compromise as it locked in customers.

  • Killazontherun||

    We got a combination of what Dems and Reps wanted

    Voltaire had a phrase for that.

    The absolute worst of all possible worlds.

  • Ken Shultz||

    Republicans shifted positions, in other words, because it was politically convenient.

    I think a better explanation is that things aren't usually judged on their own merits; they're often judged in comparison to something else.

    If the individual mandate was better in comparison to HillaryCare, then I can see why Republicans pushed for the mandate back when something like HillaryCare was considered the alternative.

    But if no mandate is better than the mandate on the table now, then maybe the Republicans are just consistently going with the better alternative.

    Also, can't help but notice that decrying doing what the American people want as "political convenience" opens up charges of authoritarianism. Because the opposite of political convenience is ignoring what the American people want, isn't it?

    If what the American people wanted shifted as they became more familiar with what an individual mandate really looks like, and going with what the people want is to be derided as "political convenience"? Then somebody's advocating some form of authoritarianism somewhere.

  • LemonMender||

    +1 on your last paragraph, Ken.

  • LemonMender||

    If I made this argument with most of my liberal leaning friends, they would accuse me of "false equivalency." They never get beyond that accusation, and think merely to utter those words is to win the argument.

  • Tulpa the White||

    There's a lot of those magic words here on H and R, too. The current one is "moving the goalposts".

  • sarcasmic||

    If you didn't do it all the time, then people would stop pointing it out.

  • Citizen Nothing||

    My favorite magic words: Perpendicular to Traffic

  • Bill Brasky||

    HAHAHAHA FUCK

  • Tulpa the White||

    I move the goalposts as much as LemonMender falsely equivalences.

  • Tulpa the White||

    Motivated cognition, “which Dan Kahan, a professor of law and psychology at Yale, defines as ‘when a person is conforming their assessments of information to some interest or goal that is independent of accuracy’—an interest or goal such as remaining a well-regarded member of his political party, or winning the next election, or even just winning an argument.”

    Basically a fancy word for lying. Which Mr Klein should be familiar with already.

    Hey, bringing the troops home from Iraq and Afghanistan and closing Guantanamo used to be Democratic positions, much more recently than 1993 too.

  • T||

    No, not just lying, Tulpa: lying to yourself. Remember, the most successful bullshit artists believe, on some level, the crap they're peddling.

  • anon||

    Remember, the most successful bullshit artists believe, on some level, the crap they're peddling.

    Tony can become president like his idol Obama?

  • Tim||

    DISHWASHING LIQUID?
    You're soaking in it.

  • sloopyinca||

    There's a more meta question here: When has either party done only that which is Constitutionally mandated or permitted except when it was politically expedient?

    Both parties have stood for almost everything the other has at one time or another. If you boiled down the strict differences between the majority of the followers in the two major parties, it would be this:
    Team Red is for waterborading.
    Team Blue is against waterboarding.

    Team Blue likes murderdroning.
    Team Red is against murderdroning.

    Team Red is against abortion.
    Team Blue is for abortion.

    That's it. And two of those three policy positions are subject to change within 2 weeks of the November election depending on the outcome.

  • Tim||

    I was for it before I was against it.

  • sloopyinca||

    That should be the Obamneybot2012 Campaign slogan. At least it would be honest.

  • T||

    Obama - I was for it before I was against it!

    Romeny - I was against it before I was for it!

  • BarryD||

    The Heritage Foundation =/= Conservatism

    Every libertarian can't be held liable for every word that comes from the Reason Foundation, either.

    18 Republican cosponsors =/= The GOP

    A party-line vote can be fairly said to represent the parties' positions. But a think tank and a handful of cosponsors? That wouldn't be legit on either side.

    Point fingers where fingers are due.

  • o3||

    its still the elephant-in-the-room even w lipstick

  • T||

    Every libertarian can't be held liable for every word that comes from the Reason Foundation, either.

    No, but my [diety of choice], we're stuck with fucking Ayn Rand until the end of time.

  • Citizen Nothing||

    I've never fucked Ayn Rand.

  • Joe R.||

    I certainly have no desire to do so until the end of time.

  • Citizen Nothing||

    Exactly. But once or twice, for the team -- maybe.

  • Citizen Nothing||

    Which, come to think of it, is probably what Nathaniel Branden once said.

  • anon||

    John'd probably fuck her.

    Come on, it had to be said.

  • Tim||

    Not really.

  • Brett L||

    If his wife was half as hot in real life as the chick who plays her in The Passion of Ayn Rand, there was nothing objective about his idiotic decision to screw Ayn Rand.

  • Fluffy||

    She was in fact pretty hot.

    Every day on Jezebel ugly women raise their fists to the heavens and damn society for "only valuing" women who are attractive, and not caring about their other qualities.

    It is really poetic justice against their pinko asses that pretty much the only chick to ever SUCCESSFULLY bitch her way into convincing a guy that an ugly brilliant chick was more fuckable than a hot (and still pretty damn smart anyway) chick was...Ayn Rand. The evilest, moustache-twirlingest right winger of them all.

  • benji||

    Maybe you should read the entire piece next time BarryD.

  • DantoRang||

    One thing is for sure, you jsut gotta love dem flip flops lol.

    Anon-Browser.tk

  • sloopyinca||

    I've had a pair of Rainbows for 4-1/2 years now. They take a while to break in, but once they do, nothing comes close to the comfort. I'll never buy another brand.

  • Mike M.||

    If this is really the best response that the collective hive mind of The Journolist can muster to the Individual Mandate getting struck down, a childish "he did it first" retort, they'll never be able to sway the public over to their side.

  • Anonymous Coward||

    If you can screw up the courage, turn on MSNBC some time. It's a veritable festival of tu quoque.

    OMG! Reagan/H.W. Bush/W. Bush did it! So you can't complain about it, EVER! Evolving is only for Dear Leader Barry!

  • T o n y||

    Good addition to the odd libertarian the-parties-are-equivalent argument.

    The strange development, though, is how the individual mandate became not just opposed by Republicans but deemed unconstitutional. That notion was dismissed as nonsense not long ago (it being based on the nonsense premise that there was a meaningful distinction between regulating activity and inactivity), but became a rightwing charge filtered through FOX News all the way up to Antonin Scalia's brain. The right doesn't just change its mind, it changes reality.

  • o3||

    its all about brocolli

  • sloopyinca||

    We'll find out if it's constitutional in a few short days/weeks.

    Oh, and "separate But Equal" was deemed constitutional for the longest time. Should we go back to how the Progressive-dominated Melville Fuller court ruled, Tony?

    And by the way, we're not by and large Republicans here, dumbass.

  • sarcasmic||

    We'll find out if a gaggle of lawyers in black robes say it's constitutional...
    ftfy

  • sloopyinca||

    Thanks, sarcasmic. I should have clarified.

  • T o n y||

    Didn't say you were. I was just commenting on the subject of the article.

    There is no legal or logical precedent for assuming that it would be unconstitutional for the government to force you to be insured. But it's also true that there's nothing stopping the Roberts court from ushering in a new era of a limited commerce clause. I'm sure that will work out just swell.

  • sloopyinca||

    Didn't say you were. I was just commenting on the subject of the article.

    Haha. Yeah, you never compare us to Team Red, do you?

    There is no legal or logical precedent for assuming that it would be unconstitutional for the government to force you to be insured.

    Unless, of course, you ever read and understood the Constitutional limitations written into the document itself.

    But it's also true that there's nothing stopping the Roberts court from ushering in a new era of a limited commerce clause.

    One can only hope.

    I'm sure that will work out just swell.

    So am I. And so is every reputable economist of the Austrian school. And so is every nation that has tried it.

  • sarcasmic||

    If you agree with the Republicans about something, then you agree with them about everything.

    No one is capable of interpreting the Constitution except highly trained scholars, which you are not.

    Also, "reputable economist of the Austrian school" is an oxymoron, since being part of the Austrian school immediately makes on unreputable.

    /snark

  • T o n y||

    reputable economist of the Austrian school

    No such thing.

    And so is every nation that has tried it.

    What nation has as limited economic governance powers as you think we should have?

  • sloopyinca||

    Look at the former Eastern Bloc and Baltic countries that are shrinking the government control of the private sector. They are flourishing when compared to your social paradises like Greece, Spain, Ireland and Italy. If you can't see that, you're blind.

    In more direct answer to your question, none of them have. But the closer nations get, the more prosperous they are becoming relative to where they were before the government was limited.

  • Killazontherun||

    Haven't you heard? Chernobyl is the new Somalia.

    Up with the radioactive anarco-capitalist paradise!

  • ||

    Wolves eat dogs.

  • T o n y||

    My "social paradises" that austerity policies have demonstrably kept on the brink of crisis? I don't know what you're talking about with respect to Eastern European countries--they've mostly been in a slump for years. Is this a little like libertarian praise for China? Why don't you add some big government countries like Sweden to the mix?

  • sloopyinca||

    Greece and Austerity?
    Ireland and Austerity?
    Spain? Portugal? Italy?

    Are you out of your fucking mind?

    And as far as Eastern European and Baltic countries: look at where they are relative to 10 years ago when they had a more burdensome government. 20 years ago. 30 years ago. There's no way you're gonna make this your Waterloo, Tony. It's not gonna end well for you.

    You have been warned.

  • T o n y||

    But I'm not a dogmatist who thinks more government is always better. Obviously relative to where former Soviet bloc countries were under that regime they are better. But country for country, austerity policies haven't worked and countries with strong public sectors have weathered things better.

  • sarcasmic||

    But I'm not a dogmatist who thinks more government is always better.

    Haaaaaaaaaaaa ha ha ha ha ha!
    Hooooo ho ho ho ho!
    HAAAA aaah haaaaa!

    whew!

    Gotta catch my breath here!

    OMG that was funny!

  • sarcasmic||

    Greece and Austerity?
    Ireland and Austerity?
    Spain? Portugal? Italy?

    Are you out of your fucking mind?

    Cutting the rate of increase amounts to a decrease.

    increase = decrease

    It's all in perception.

    It's like when a unionized government worker demands a 15% pay increase, and their paycheck increases by only 10%, it actually decreased by 5%.

    A 10% raise is a 5% pay cut because they planned on a 15% raise.

    So when these countries cut the rate of increase, while there is no decrease it is actually a radical decrease, even though it is a net increase.

    See?

    East is west, left is right,
    Up is down, and black is white,
    Inside-out, wrong is right,
    It’s back to front and I’m all uptight.

  • Tommy_Grand||

    Anyone who ever said or argued that the individual mandate was constitutional was just wrong. Some of these folks were stupid, but some were smart people blinded by "motivated cognition." Once the USSC stikes the unconstitutional provision, or maybe the whole law, butthurt intellectuals will get busy constructing ego shields, most being variations on the theme: "the supreme court is wrong b/c it's too conservative."

    But, deep down, these folks don't give a rip about the mandate, or obamacare, or the commerce clause. What they hate is being WRONG. Publically. Before this law was challenged in federal district court, they heard Pelosi and Larry Tribe say it was a slam dunk and they bought that line. By nature, these supposed progressives and egalitarians are not independent minded or free thinking. Rather, they love and trust their chosen authority figure. They rarely if ever subject the disseminated party dogma to logical scrutiny.

    If the SC lets the mandate stand, I will say "Fuck me. I thought it was unconstitutional. Oh well, I've been wrong before."

    And then, like the majority of adult Americans who don't live in DC sucking off the taxpayers' largess, I'll go out and accomplish something prodcutive and profitable.

  • R C Dean||

    There is no legal or logical precedent for assuming that it would be unconstitutional for the government to force you to be insured.

    Actually, there are probably a couple of dozen SCOTUS decisions, pre-Wickard, of course, that one could cite.

    But it's also true that there's nothing stopping the Roberts court from ushering in a new era of a limited commerce clause. I'm sure that will work out just swell.

    It worked pretty well for the first 130 years of the Republic.

  • T o n y||

    Yes what a utopian time that was.

  • Anonymous Coward||

    But it's also true that there's nothing stopping the Roberts court from ushering in a new era of a limited commerce clause. I'm sure that will work out just swell.

    Tony w/spaces, I must know: How does it feel to have brief flashes of powerful insight before sinking back into a mire willful ignorance and partisanship?

    Oh, and you're the worst sockpuppet ever.

  • SIV||

    Every libertarian can't be held liable for every word that comes from the Reason Foundation, either.

    Bob Poole makes us all central planning authoritarian crony capitalists

  • SIV||

    Kerry Howley made us all progressive feminists.

  • Whiterun Guard||

    And I, for one, welcome our new pants-suited overlords.

  • Joe R.||

    Kerry Howley

    When I say that in my head, it's to the tune of Ozzy's "Mr. Crowley".

  • ||

    Projection is the glue that holds the fragmented psyches of TEAM BLUE together. I'd love to pin the same ribbon on TEAM RED, but in this case, TEAM BLUE stands alone.

  • ||

    Mmm...I dunno. What about the fag-hating part of TEAM RED?

  • ||

    Only applies to a small subsection of them. TEAM BLUE projects as a whole.

  • o3||

    so u think the gay-bashing is small in the gop?

  • R C Dean||

    so u think most gop'ers are repressed gays?

  • ||

    I don't get what the big deal is. I don't think it's fair to assume that every think take policy proposal MUST BE vetted in regards to its Constitutionality. I bet Ron Bailey or Heritage never even thought of the Constitutional implications of the mandate until the Barnett's of the world made them.

    It would be nice if Constitutionality was at the forefront of policy proposals. But it's not realistic.

  • T||

    I don't think it's fair to assume that every think take policy proposal MUST BE vetted in regards to its Constitutionality.

    This says more about the failure of our current political and intellectual class than I think you meant to.

  • John||

    The Heritage Foundation gets paid to think shit up. Sometimes they have good ideas sometimes bad. But the mere fact that they thought up the mandate doesn't make the mandate desirable or prohibit the Heritage Foundation or anyone else from later concluding it is a dumb idea.

  • anon||

    Agreed. Just because one thinks something up doesn't mean it's a good idea.

  • sarcasmic||

    General Welfare... Regulate Commerce... Necessary and Proper

    Seems Constitutional to me!

  • John||

    Klein begins his piece with a brief backstory on the mandate: It first appeared as a proposal in a Heritage policy brief, then appeared in a 1993 bill cosponsored by 18 Republicans. All true, and genuinely damning to the GOP.

    No it is genuinely damaging to the Heritage Foundation and the 18 Republicans who sponsored it. How does something that happened 20 years ago damage people now who had nothing to do with it?

  • ||

    Seriously, sloopy. Think about the externalities before you reply to trolls.

  • sloopyinca||

    [hangs head in shame]

  • ||

    You gotta pay the Troll Toll,
    If You Wanna Get Into That Boy's Soul
    You gotta pay the Troll Toll,
    To get in!

  • scareduck||

    I still do not understand why Reason engages Ezra Klein's partisan shillery.

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