Thursday, July 31, 2014
Inquirer Daily News

Who created Obamacare? Free market conservatives!

The individual mandate is the flash point of health reform. So who created it? It was the brainchild of one of the most conservative think tanks in the country. They saw it as part of the salvation of free market health care.

Who created Obamacare? Free market conservatives!

You must purchase health insurance. The government says so. That is the flashpoint of health reform – the individual mandate forcing everyone to buy coverage whether they want to or not.

Who concocted this idea? Was it wide-eyed liberals trying to replace the free market with a government-run system? Hardly.

The individual mandate was the brainchild of the Heritage Foundation, one of the most conservative think tanks in the country. They saw it as part of the salvation of free market health care.

You’d hardly know it today from the Foundation’s website. A recent visit to the homepage found news on the fight against Obamacare, with links to a page condemning health reform for its “mandates and federal control.” But do some searching on the site, and you’ll discover where the mandate idea actually came from.

Or, you can follow this direct link to Heritage’s 1990 policy report, which explains why an individual mandate should be part of a free market approach to health reform. (The report can also be accessed here in html format.)

Here is some of what it says. “Under the Heritage proposal, it would be illegal not to buy basic catastrophic insurance…” When you file your tax return, “If the proof of insurance forms were not attached, or did not indicate that the family was insured throughout the year, a financial penalty would be imposed.” (See page 13 of the report.)

The mandate served the same purpose in Heritagecare in 1990 as it does in Obamacare today. Private insurance markets don’t work if the risk pool is too small. When too many healthy people opt out of coverage, insurance becomes unaffordable for everyone else because it is impossible to spread the cost. Then, the only alternative is a government plan.

The mandate-based approach was so appealing to free market supporters in the 1990s that the Republicans proposed it as a law in 1993. Bob Dole, the Senate minority leader at the time, served as co-sponsor.

This says a lot about health reform debates today. Contrary to almost everything you hear, they do not primarily revolve around ideology. To claim otherwise is to succumb to severe amnesia. Differences are almost entirely driven by partisan politics.

It would be nice to return to more reasoned public discussions about how best to improve our health care system. Conservative and liberal ideas actually align more closely than you might think. Proposals in Congress for all-or-nothing repeal and threats to de-fund reform do nothing to advance this goal, to say the least.

It would also be nice, in the interests of promoting truthful discourse, if those who invented the basis of Obama’s plan would put partisanship aside and acknowledge who they are.

 

To check out more Check Up items go to www.philly.com/checkup

About this blog

Check Up covers major health events in our region and offers everything from personal health advice to an expert look at health reform. Read about some of our bloggers here.

For Inquirer.com. Portions of this blog may also be found in the Inquirer's Sunday Health Section

Robert Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Latest Health Videos
Also on Philly.com:
Stay Connected