It is an important but often overlooked fact that the individual mandate to purchase health insurance, the least popular and most constitutionally dubious provision in the health care overhaul signed last year by President Obama, originated at The Heritage Foundation, a prominent conservative think tank with strong ties to congressional Republicans. In between its inception at Heritage and its passage as one of the key elements of ObamaCare, it got a trial run in Massachusetts in the state-based health care overhaul passed by current GOP presidential wannabe Mitt Romney, who on Tuesday admitted having gotten the idea for the mandate in part from Heritage.
At The Wall Street Journal, James Taranto, who worked at Heritage when the mandate first made waves, provides a brief history of the provision's development:
Heritage did put forward the idea of an individual mandate, though it predated HillaryCare by several years. We know this because we were there: In 1988-90, we were employed at Heritage as a public relations associate (a junior writer and editor), and we wrote at least one press release for a publication touting Heritage's plan for comprehensive legislation to provide universal "quality, affordable health care."
As a junior publicist, we weren't being paid for our personal opinions. But we are now, so you will be the first to know that when we worked at Heritage, we hated the Heritage plan, especially the individual mandate. "Universal health care" was neither already established nor inevitable, and we thought the foundation had made a serious philosophical and strategic error in accepting rather than disputing the left-liberal notion that the provision of "quality, affordable health care" to everyone was a proper role of government. As to the mandate, we remember reading about it and thinking: "I thought we were supposed to be for freedom."
Was Heritage's proposal different from the one that's now law? Yes, in some ways. But not enough to escape the core charge that the fundamental policy idea that would become ObamaCare's individual mandate grew out of what Heritage proposed. Taranto again:
The Heritage mandate, at least in theory, would have been less burdensome than the ObamaCare one. You'd have to be covered against catastrophically costly conditions but could choose to buy additional insurance or pay out of pocket for everyday medical needs. On the other hand, Butler's vague language–"it might also include certain very specific services . . . and other items"–would seem to leave the door wide open for limitless expansion.
Whatever the particular differences, the Heritage mandate was indistinguishable in principle from the ObamaCare one.
This tells you something about why Republican party leaders have had such a hard time addressing health policy issues over the last few years. Rather than make a prolonged case for health policy that does not involve endless expansion of entitlements and insurance subsidies, the GOP has instead focused primarily on reacting to Democratic proposals. The individual mandate was an attempt to beat Democrats at the universal coverage game and preempt the what would become HillaryCare. Medicare's prescription drug benefit was passed by a Republican president and a Republican Congress under the pretense that if they didn't do it, Democrats would, and it would be worse. In the debate over ObamaCare, Republicans spent more energy arguing against the law's Medicare payment cuts than any other part of the law. Riding a wave of anger over ObamaCare's passage to electoral victory in 2010, party leadership continued to refuse to talk about broader entitlement reform. And now they're on track to nominate a presidential candidate who, in his only gig as an elected official, signed a state-based law that would provide the model and foundation for ObamaCare—their top legislative target.
Previously in the-GOP-doesn't-do-health-policy: Republicans Didn't Make the Case for Medicare Reform.