Mandates Are Once Again An Issue

Whether or not to have an individual mandate to purchase health insurance was a controversial issue during the 2008 battle for the Democratic nomination but is now only beginning to be raised during this year’s health care debate. Soon after Obama became president many in the insurance industry began to make statements that they would accept health care reform with the elimination of pre-existing conditions if there was an individual mandate and universal coverage. This was initially seen as both a worthwhile sign of cooperation and a pragmatic move on the part of the insurance industry to increase the size of their market. In realty this was a way for insurance companies to limit the down side if health care reform passed while continuing to fight it.

The political effect of this was to suspend any meaningful political opposition to mandates. The Republican Party, being in the pocket of the insurance industry, would only oppose their wishes as a last resort. Having both major elements of the Democratic Party as well as the Republicans backing mandates, Obama surrendered to pragmatism in the hopes of passing health care reform and gave up his opposition.

There is suddenly opposition to mandates coming from both the left and the right. As the public option got into trouble, many liberals had second thoughts about forcing people to buy health insurance from insurance companies they have legitimate reasons to distrust. Suddenly Republicans are showing signs of changing their view on the subject. In reporting recent objections to mandates being expressed by some Republicans, Sam Stein notes how they backed mandates until recently:

Indeed, for months it was presumed that a relatively ironclad deal was in place: in exchange for the government mandating coverage, private insurance companies would agree to cover individuals with pre-existing conditions. The arrangement was all but blessed by prominent figures from within the GOP ranks. In mid-August, the ranking member of the finance committee, Sen. Chuck Grassley (R-Iowa), announced that the way to get universal coverage is “through an individual mandate.”

“That’s individual responsibility,” the senator told Nightly Business Report. “And even Republicans believe in individual responsibility.”

Months earlier, Grassley told Fox News that there wasn’t “anything wrong” with mandates even if some may view them “as an infringement upon individual freedom.”

“But when it comes to states requiring it for automobile insurance the principle then ought to lie the same way for health insurance,” Grassley added. “Because everybody has some health insurance cost and if you aren’t insured there aren’t free lunches.”

Grassley wasn’t alone. His fellow Republican Senator John Thune (R-S.D.) recently told reporters that while he was conflicted on a mandate, it was “something I guess that I would take a look at. There — there are good arguments on behalf of getting everybody in the — in the pool,” he said. Former Massachusetts Governor Mitt Romney made an individual mandate a staple of the health care overhaul he pursued for his state. “For the uninsured who can afford insurance but expect to be given free care at the hospital, require them to either pay for their own care or buy insurance,” he wrote in Newsweek.

Former Senate Majority Leader Bill Frist, himself a doctor, told Fox Business Network that consumers should “be responsible to paying for” their insurance. If they can’t afford it, he added, “there are going to be taxes, excise taxes, user taxes on companies like Aetna, on individuals.”

Meanwhile, six current Republican Senators – Lamar Alexander (Tenn.), Bob Bennett (Utah), Mike Crapo (Idaho), Lindsey Graham (S.C.) and Judd Gregg (R-N.H.) – all have sponsored legislation (Sen. Ron Wyden’s 2009 “Healthy Americans Act”) that includes an individual mandate.

Steve Benen notes the change in view among Republicans and concludes:

Congressional Republicans could probably save themselves a lot of trouble by simply saying, “Whatever Democrats are for, we’re against,” in response to every question.

The answer is slightly more complicated than this. The top priority for Republicans is to block health care reform not because of ideology or objection to any specifics but because they do not want to see the Democrats have a legislative victory of this magnitude. They see opposing health care reform as improving their chances for picking up House seats in 2010. They are even willing to risk crossing the health insurance industry on mandates if they find it necessary to raise a new objection, probably figuring that the insurance industry will continue to contribute to Republicans, especially if they are successful in blocking health care reform.

James Joyner has linked to one of many posts I have written in opposition to mandates. I agree with him that, despite the questions of hypocrisy raised above, this is controversial and is a legitimate objection to Obama’s current policies.  I disagree with him in citing this one reasonable objection to the current health care reforms as evidence that the general opposition to health care reform has been reasonable. Not only have most (but not all) conservatives been silent about this objection until now, but the vast majority of objections have been absurd. Having some valid objections such as opposition to mandates does not make false claims of “death panel,” “a government take over of health care” and other Republican distortions of what is being proposed any more justifiable.

(As an aside, Big Tent Democrat also linked to my post via Joyner. The manner in which I sometimes distinguish between progressivism and liberalism as well as any views on taxation would be a needless distraction from the main points of this post. Therefore for the moment I’ll just note that for Big Tent Democrat–especially considering his track record–to call views of mine he has no knowledge of “rather absurd” is like Sarah Palin calling views she has no knowledge of too intellectual. I do share some of his concerns about the Baucus plan.)

I fear that the new found objection to mandates is too little too late. I can imagine a scenario in which Republicans objected to this at the start, leading Obama to stick to his initial opposition to mandates in hopes of achieving a bipartisan compromise. In such a scenario Congressional Democrats might have continued to write legislation which included mandates, largely because, regardless of my philosophical objections, including mandates is much simpler. Perhaps health care reform might have been written differently based more upon voluntarily providing assistance to those who require assistance with coverage, as well as eliminating many of the unsavory practices of the health insurance industry.

At this point it is doubtful that they will start from scratch and go about writing health care reform in a different manner. Besides, even a voluntary approach would still result in GOP opposition, as they also attacked John Kerry’s voluntary 2004 plan as “a government take over of health care.” As Steve Benen noted, having the Democrats propose a plan is enough to have Republicans oppose it.

Update: Placing The Individual Mandate in Perspective

1 Comment

  1. 1
    Eclectic Radical says:

    Has Gregg dropped his ‘CPR’ and jumped onto the Wyden-Bennett bill, then? That’s interesting. Gregg’s ‘CPR’ was a fancily written proposal to gradually privatize Medicare by rationing care and raising rates for everyone who stayed on the program. Wyden’s bill, though a granola-bar-and-brand-flake-liberalism fantasy worthy of some of the more naive and less educated medical writers on the Huffington Post, was certainly the opposite of Gregg’s ideas about Medicare. Wyden wants to expand Medicare to pay for nutritionists and nicotine treatment and force private insurers to do the same.
    Gregg jumping onto a bill so diametrically opposed to his own can only be interpreted as a cynical move to support something that undermines reform bills more likely to succeed while fostering the illusion that bipartisanship is possible on the issue.

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