Obamacare Architect: Time for Single Payer

[Weatherman2020]

Bet you never saw that one coming.

It’s time for America to consider seriously a single-payer, government-run health system, says Max Baucus, Montana’s longest serving U.S. senator, former ambassador to China and one of the chief architects of Obamacare.

“My personal view is we’ve got to start looking at single-payer,” Baucus said Thursday night at Montana State University. “I think we should have hearings…. We’re getting there. It’s going to happen.”

It was a startling turnaround for Baucus, who eight years ago was chairman of the powerful Senate Finance Committee and a key Democratic leader in the political battles that ultimately passed the Affordable Care Act.

Back then, Baucus said, he felt adamantly that Congress wouldn’t pass a government-run system like Canada’s. So it was the one alternative he refused to put “on the table” for consideration.

But you can see the difference, Baucus said, when you visit hospitals on either side of the border. In Montana, half a rural hospital will be dedicated to processing medical insurance claims. In Canada, he said, just one small room is needed to verify that patients are residents.[…]

Baucus decried several changes in Congress over the last 40 years. No longer do senators get together for bourbon, or lunch in a private dining hall. Instead every lunch is dedicated to party strategizing about how to defeat the terrible people down the hall, he said. No longer can you win an election with less than $1 million, he said. Now it can cost $24 million.

Baucus also lamented the end of earmarks, which the press criticized as political “pork” for the folks back home and as “bridges to nowhere.” He spoke proudly of getting farm bills, rural hospital money, conserving open space and landing highway money for Montana that built Bozeman’s North 19th Avenue freeway interchange and interchanges in Belgrade and Billings. Ninety percent of earmarks were good, he said, and they were “the glue” that held politics together. “We got bamboozled by the press,” he said.

Keep reading…

 

[Fenton Lum]

Obama-Romneycare was hatched at the Heritage Foundation hon, just sos' ya know.
The Tortuous History of Conservatives and the Individual Mandate



The individual mandate as an alternative to the employer mandate

There are five obvious, and large, problems with an employer mandate. The first is that an employer mandate massively drives up the cost of hiring new employees, discouraging new hiring and increasing unemployment. The second is that forcing employers to pay for health costs increases the costs of running a business, and these increased costs are passed onto consumers in the form of higher prices for goods and services.

The third problem is that an employer mandate does nothing to address the health needs of the unemployed. The fourth is that the employer-based system insulates consumers from the value of the health care they are paying for, giving them no incentive to economize, thereby driving up the cost of health insurance. The fifth is that the employer-based system leads to “job lock,” whereby people are afraid to leave their jobs if they fall ill on the job, because switching plans could mean higher premiums or denial of coverage.

Hence, some conservatives, seeking a more market-oriented path to universal coverage, began endorsing an individual mandate over an employer mandate. An individual mandate would address the “free rider” problem caused by EMTALA, by requiring people to buy their own insurance. In addition, moving to a more individual-based system from the employer-based one would significantly increase the efficiency of the health-insurance market.

With these considerations in mind, in 1989, Stuart Butler of the Heritage Foundation proposed a plan he called “Assuring Affordable Health Care for All Americans.” Stuart’s plan included a provision to “mandate all households to obtain adequate insurance,” which he framed explicitly as a way to address the “free rider” problem and employer mandates (emphasis added):

Many states now require passengers in automobiles to wear seatbelts for their own protection. Many others require anybody driving a car to have liability insurance. But neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement.

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.

Republican support for the individual mandate

As far as I have been able to find, Stuart’s 1989 brief is the first published proposal of an individual mandate in the context of private-sector-managed health systems. In 1991, Mark Pauly and others developed a proposal for George H.W. Bush that also included an individual mandate. While others credit Stanford economist Alain Enthoven with the idea, Enthoven’s earliest published reference to an individual mandate was an indirect one in the 1992 Jackson Hole paper.

In 1992 and 1993, some Republicans in Congress, seeking an alternative to Hillarycare, used these ideas as a foundation for their own health-reform proposals. One such bill, the Health Equity and Access Reform Today Act of 1993, or HEART, was introduced in the Senate by John Chafee (R., R.I.) and co-sponsored by 19 other Senate Republicans, including Christopher Bond, Bob Dole, Chuck Grassley, Orrin Hatch, Richard Lugar, Alan Simpson, and Arlen Specter. Given that there were 43 Republicans in the Senate of the 103rd Congress, these 20 comprised nearly half of the Republican Senate Caucus at that time. The HEART Act proposed health insurance vouchers for low-income individuals, along with an individual mandate.

Newt Gingrich, who was House Minority Leader in 1993, was also in favor of an individual mandate in those days. Gingrich continued to support a federal individual mandate as recently as May of last year.

It would seem that 1990s conservatives weren’t concerned with the constitutional implications of allowing Congress to force people to buy a private product. “I don’t remember that being raised at all,” Mark Pauly told Ezra Klein last year. “The way it was viewed by the Congressional Budget Office in 1994 was, effectively, as a tax…So I’ve been surprised by that argument.”

 

[dblack]

Single Payer for Everyone for Everything!

 

[BlackFlag]

Since both repeal and replace are now off the table, maybe it IS time for single payer

 

[dblack]

Since both repeal and replace are now off the table, maybe it IS time for single payer

For everyone! For everything!

 

[basquebromance]

The "right to healthcare" is enshrined in the South African Constitution. The nation ranks 182/191 in health level.

 

[Kimura]

Single Payer for Everyone for Everything!

It's the only way to bend the cost curve. As long as for-profit insurers are in the mix, and other rent extractors are in the feeding chain, the US will never lower costs and/or achieve universal coverage.

 

[Kimura]

The "right to healthcare" is enshrined in the South African Constitution. The nation ranks 182/191 in health level.

I currently live in Italy. We have a better health care system than the United States. In point of fact, most OECD countries outperform the US in overall health care outcomes.

 

[Kimura]

Obama-Romneycare was hatched at the Heritage Foundation hon, just sos' ya know.
The Tortuous History of Conservatives and the Individual Mandate



The individual mandate as an alternative to the employer mandate

There are five obvious, and large, problems with an employer mandate. The first is that an employer mandate massively drives up the cost of hiring new employees, discouraging new hiring and increasing unemployment. The second is that forcing employers to pay for health costs increases the costs of running a business, and these increased costs are passed onto consumers in the form of higher prices for goods and services.

The third problem is that an employer mandate does nothing to address the health needs of the unemployed. The fourth is that the employer-based system insulates consumers from the value of the health care they are paying for, giving them no incentive to economize, thereby driving up the cost of health insurance. The fifth is that the employer-based system leads to “job lock,” whereby people are afraid to leave their jobs if they fall ill on the job, because switching plans could mean higher premiums or denial of coverage.

Hence, some conservatives, seeking a more market-oriented path to universal coverage, began endorsing an individual mandate over an employer mandate. An individual mandate would address the “free rider” problem caused by EMTALA, by requiring people to buy their own insurance. In addition, moving to a more individual-based system from the employer-based one would significantly increase the efficiency of the health-insurance market.

With these considerations in mind, in 1989, Stuart Butler of the Heritage Foundation proposed a plan he called “Assuring Affordable Health Care for All Americans.” Stuart’s plan included a provision to “mandate all households to obtain adequate insurance,” which he framed explicitly as a way to address the “free rider” problem and employer mandates (emphasis added):

Many states now require passengers in automobiles to wear seatbelts for their own protection. Many others require anybody driving a car to have liability insurance. But neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement.

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.

Republican support for the individual mandate

As far as I have been able to find, Stuart’s 1989 brief is the first published proposal of an individual mandate in the context of private-sector-managed health systems. In 1991, Mark Pauly and others developed a proposal for George H.W. Bush that also included an individual mandate. While others credit Stanford economist Alain Enthoven with the idea, Enthoven’s earliest published reference to an individual mandate was an indirect one in the 1992 Jackson Hole paper.

In 1992 and 1993, some Republicans in Congress, seeking an alternative to Hillarycare, used these ideas as a foundation for their own health-reform proposals. One such bill, the Health Equity and Access Reform Today Act of 1993, or HEART, was introduced in the Senate by John Chafee (R., R.I.) and co-sponsored by 19 other Senate Republicans, including Christopher Bond, Bob Dole, Chuck Grassley, Orrin Hatch, Richard Lugar, Alan Simpson, and Arlen Specter. Given that there were 43 Republicans in the Senate of the 103rd Congress, these 20 comprised nearly half of the Republican Senate Caucus at that time. The HEART Act proposed health insurance vouchers for low-income individuals, along with an individual mandate.

Newt Gingrich, who was House Minority Leader in 1993, was also in favor of an individual mandate in those days. Gingrich continued to support a federal individual mandate as recently as May of last year.

It would seem that 1990s conservatives weren’t concerned with the constitutional implications of allowing Congress to force people to buy a private product. “I don’t remember that being raised at all,” Mark Pauly told Ezra Klein last year. “The way it was viewed by the Congressional Budget Office in 1994 was, effectively, as a tax…So I’ve been surprised by that argument.”

The ACA would work if health insures were not for profit. This is how they do it in France, Germany and Switerzland IIRC.

 

[CrusaderFrank]

Bet you never saw that one coming.

It’s time for America to consider seriously a single-payer, government-run health system, says Max Baucus, Montana’s longest serving U.S. senator, former ambassador to China and one of the chief architects of Obamacare.

“My personal view is we’ve got to start looking at single-payer,” Baucus said Thursday night at Montana State University. “I think we should have hearings…. We’re getting there. It’s going to happen.”

It was a startling turnaround for Baucus, who eight years ago was chairman of the powerful Senate Finance Committee and a key Democratic leader in the political battles that ultimately passed the Affordable Care Act.

Back then, Baucus said, he felt adamantly that Congress wouldn’t pass a government-run system like Canada’s. So it was the one alternative he refused to put “on the table” for consideration.

But you can see the difference, Baucus said, when you visit hospitals on either side of the border. In Montana, half a rural hospital will be dedicated to processing medical insurance claims. In Canada, he said, just one small room is needed to verify that patients are residents.[…]

Baucus decried several changes in Congress over the last 40 years. No longer do senators get together for bourbon, or lunch in a private dining hall. Instead every lunch is dedicated to party strategizing about how to defeat the terrible people down the hall, he said. No longer can you win an election with less than $1 million, he said. Now it can cost $24 million.

Baucus also lamented the end of earmarks, which the press criticized as political “pork” for the folks back home and as “bridges to nowhere.” He spoke proudly of getting farm bills, rural hospital money, conserving open space and landing highway money for Montana that built Bozeman’s North 19th Avenue freeway interchange and interchanges in Belgrade and Billings. Ninety percent of earmarks were good, he said, and they were “the glue” that held politics together. “We got bamboozled by the press,” he said.

Keep reading…

The best remedy for single payer? Helicopter rides

 

[dblack]

Single Payer for Everyone for Everything!

It's the only way to bend the cost curve. As long as for-profit insurers are in the mix, and other rent extractors are in the feeding chain, the US will never lower costs and/or achieve universal coverage.

We should just have government provide us with all our necessities.

 

[Kimura]

Single Payer for Everyone for Everything!

It's the only way to bend the cost curve. As long as for-profit insurers are in the mix, and other rent extractors are in the feeding chain, the US will never lower costs and/or achieve universal coverage.

We should just have government provide us with all our necessities.

Not really. Health care is ultimately a public good. The reason health care doesn't work in the classic supply and demand fashion is multifaceted. First of all, and most importantly, it's a credence good. It also suffers from information asymmetries between sellers (physicians) and purchasers (patients) of health care.

We can assume the private sector is more efficient than the public sector most of the time, but there are exceptions to the rule. Things like imperfect competition, informational asymmetries, etc. Our goals as a society don't revolve around profit-seeking opportunities for the private sector. This is where public purpose comes into the picture. It boils down to efficiency and effectiveness of government.

 

[dblack]

Single Payer for Everyone for Everything!

It's the only way to bend the cost curve. As long as for-profit insurers are in the mix, and other rent extractors are in the feeding chain, the US will never lower costs and/or achieve universal coverage.

We should just have government provide us with all our necessities.

Not really. Health care is ultimately a public good.

Well, no. Ultimately, health care is about the most personal, individual concern anyone has. That's the point behind my sarcastic comment. If you're willing to declare health care a "public good", and thus controlled by government, what else would you go after?

The reason health care doesn't work in the classic supply and demand fashion is multifaceted. First of all, and most importantly, it's a credence good. It also suffers from information asymmetries between sellers (physicians) and purchasers (patients) of health care.

We can assume the private sector is more efficient than the public sector most of the time, but there are exceptions to the rule. Things like imperfect competition, informational asymmetries, etc. Our goals as a society don't revolve around profit-seeking opportunities for the private sector. This is where public purpose comes into the picture. It boils down to efficiency and effectiveness of government.

Health care works fine in a free market. What doesn't work is "group" health insurance.

 

[Kimura]

Single Payer for Everyone for Everything!

It's the only way to bend the cost curve. As long as for-profit insurers are in the mix, and other rent extractors are in the feeding chain, the US will never lower costs and/or achieve universal coverage.

We should just have government provide us with all our necessities.

Not really. Health care is ultimately a public good.

Well, no. Ultimately, health care is about the most personal, individual concern anyone has. That's the point behind my sarcastic comment. If you're willing to declare health care a "public good", and thus controlled by government, what else would you go after?

I don't live in the US, that's a political decision, what you want to make public goods. If you lived in a functional nation, your leaders would want a healthy and educated citizenry, not people going bankrupt and literally dying from lack of insurance (roughly 45k per year in the US).

The reason health care doesn't work in the classic supply and demand fashion is multifaceted. First of all, and most importantly, it's a credence good. It also suffers from information asymmetries between sellers (physicians) and purchasers (patients) of health care.

We can assume the private sector is more efficient than the public sector most of the time, but there are exceptions to the rule. Things like imperfect competition, informational asymmetries, etc. Our goals as a society don't revolve around profit-seeking opportunities for the private sector. This is where public purpose comes into the picture. It boils down to efficiency and effectiveness of government.

Health care works fine in a free market. What doesn't work is "group" health insurance.[/QUOTE]

First of all, there no such thing as a "free market". There hasn't been a "free market" since humans were hunter-gatherers. Once we had the rise of city-states, we entered the realm of political economy. Obviously, in terms of health care, the "free market" doesn't work. It's an abysmal failure if universal coverage is one tof the goals.

Obamacare will fail with regards to the other developed nations and your country will continue to take a backseat to the developed world until people finally comprehend single payer is the most effective and efficient delivery mechanism for health care.

It should be abundantly clear the health care market doesn't operate properly as result of special interests controlling prices in the private sector, so there's not even a semblance of correct market pricing, The entire business model of health insurers is to deny coverage, cherry pick and deny coverage which leads us to where we are today in the US. All other developed and emerging nations realize this and have instituted some type of universal coverage which consists of public and private or a combination of both.

If you want to see what a comprehensive and efficient health care system looks like, buy a ticket, and get on a plane to Italy.

 

[Kimura]

Bet you never saw that one coming.

It’s time for America to consider seriously a single-payer, government-run health system, says Max Baucus, Montana’s longest serving U.S. senator, former ambassador to China and one of the chief architects of Obamacare.

“My personal view is we’ve got to start looking at single-payer,” Baucus said Thursday night at Montana State University. “I think we should have hearings…. We’re getting there. It’s going to happen.”

It was a startling turnaround for Baucus, who eight years ago was chairman of the powerful Senate Finance Committee and a key Democratic leader in the political battles that ultimately passed the Affordable Care Act.

Back then, Baucus said, he felt adamantly that Congress wouldn’t pass a government-run system like Canada’s. So it was the one alternative he refused to put “on the table” for consideration.

But you can see the difference, Baucus said, when you visit hospitals on either side of the border. In Montana, half a rural hospital will be dedicated to processing medical insurance claims. In Canada, he said, just one small room is needed to verify that patients are residents.[…]

Baucus decried several changes in Congress over the last 40 years. No longer do senators get together for bourbon, or lunch in a private dining hall. Instead every lunch is dedicated to party strategizing about how to defeat the terrible people down the hall, he said. No longer can you win an election with less than $1 million, he said. Now it can cost $24 million.

Baucus also lamented the end of earmarks, which the press criticized as political “pork” for the folks back home and as “bridges to nowhere.” He spoke proudly of getting farm bills, rural hospital money, conserving open space and landing highway money for Montana that built Bozeman’s North 19th Avenue freeway interchange and interchanges in Belgrade and Billings. Ninety percent of earmarks were good, he said, and they were “the glue” that held politics together. “We got bamboozled by the press,” he said.

Keep reading…

The best remedy for single payer? Helicopter rides

Well...yeah. You guys should helicopter ride the CEOs of health insurance firms. I mean, what do they do? Besides act as middlemen, extract
rents, and impose massive externalities on US society.

 

[dblack]

I don't live in the US, that's a political decision, what you want to make public goods. If you lived in a functional nation, your leaders would want a healthy and educated citizenry, not people going bankrupt and literally dying from lack of insurance (roughly 45k per year in the US).

There's some truth here. Our leaders do want a healthy, educated citizenry. They also want obedient citizens, who can't afford to piss off their government.

First of all, there no such thing as a "free market". There hasn't been a "free market" since ...

Oh god, not this shit again. You can't yell fire in a crowded theater so there NO SUCH THING as freedom of speech! Is this just an attempt at distraction? Kind of a "baffle them with bullshit" tact?

If you want to see what a comprehensive and efficient health care system looks like, buy a ticket, and get on a plane to Italy.

I don't actually want a government preoccupied with making society "comprehensive and efficient". I want a government that protects our freedom - first and foremost. Caretaker government is slavery.

 

[CrusaderFrank]

Bet you never saw that one coming.

It’s time for America to consider seriously a single-payer, government-run health system, says Max Baucus, Montana’s longest serving U.S. senator, former ambassador to China and one of the chief architects of Obamacare.

“My personal view is we’ve got to start looking at single-payer,” Baucus said Thursday night at Montana State University. “I think we should have hearings…. We’re getting there. It’s going to happen.”

It was a startling turnaround for Baucus, who eight years ago was chairman of the powerful Senate Finance Committee and a key Democratic leader in the political battles that ultimately passed the Affordable Care Act.

Back then, Baucus said, he felt adamantly that Congress wouldn’t pass a government-run system like Canada’s. So it was the one alternative he refused to put “on the table” for consideration.

But you can see the difference, Baucus said, when you visit hospitals on either side of the border. In Montana, half a rural hospital will be dedicated to processing medical insurance claims. In Canada, he said, just one small room is needed to verify that patients are residents.[…]

Baucus decried several changes in Congress over the last 40 years. No longer do senators get together for bourbon, or lunch in a private dining hall. Instead every lunch is dedicated to party strategizing about how to defeat the terrible people down the hall, he said. No longer can you win an election with less than $1 million, he said. Now it can cost $24 million.

Baucus also lamented the end of earmarks, which the press criticized as political “pork” for the folks back home and as “bridges to nowhere.” He spoke proudly of getting farm bills, rural hospital money, conserving open space and landing highway money for Montana that built Bozeman’s North 19th Avenue freeway interchange and interchanges in Belgrade and Billings. Ninety percent of earmarks were good, he said, and they were “the glue” that held politics together. “We got bamboozled by the press,” he said.

Keep reading…

The best remedy for single payer? Helicopter rides

Well...yeah. You guys should helicopter ride the CEOs of health insurance firms. I mean, what do they do? Besides act as middlemen, extract
rents, and impose massive externalities on US society.

You're an economic illiterate. No point in addressing the pointless

 

[CrusaderFrank]

Single Payer for Everyone for Everything!

It's the only way to bend the cost curve. As long as for-profit insurers are in the mix, and other rent extractors are in the feeding chain, the US will never lower costs and/or achieve universal coverage.

We should just have government provide us with all our necessities.

Clothing is a necessity, have you every watched "Naked and Afraid"? Why doesn't the government provide each with the same spiffy uniform?

 

[MadChemist]

Obama-Romneycare was hatched at the Heritage Foundation hon, just sos' ya know.
The Tortuous History of Conservatives and the Individual Mandate



The individual mandate as an alternative to the employer mandate

There are five obvious, and large, problems with an employer mandate. The first is that an employer mandate massively drives up the cost of hiring new employees, discouraging new hiring and increasing unemployment. The second is that forcing employers to pay for health costs increases the costs of running a business, and these increased costs are passed onto consumers in the form of higher prices for goods and services.

The third problem is that an employer mandate does nothing to address the health needs of the unemployed. The fourth is that the employer-based system insulates consumers from the value of the health care they are paying for, giving them no incentive to economize, thereby driving up the cost of health insurance. The fifth is that the employer-based system leads to “job lock,” whereby people are afraid to leave their jobs if they fall ill on the job, because switching plans could mean higher premiums or denial of coverage.

Hence, some conservatives, seeking a more market-oriented path to universal coverage, began endorsing an individual mandate over an employer mandate. An individual mandate would address the “free rider” problem caused by EMTALA, by requiring people to buy their own insurance. In addition, moving to a more individual-based system from the employer-based one would significantly increase the efficiency of the health-insurance market.

With these considerations in mind, in 1989, Stuart Butler of the Heritage Foundation proposed a plan he called “Assuring Affordable Health Care for All Americans.” Stuart’s plan included a provision to “mandate all households to obtain adequate insurance,” which he framed explicitly as a way to address the “free rider” problem and employer mandates (emphasis added):

Many states now require passengers in automobiles to wear seatbelts for their own protection. Many others require anybody driving a car to have liability insurance. But neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement.

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.

Republican support for the individual mandate

As far as I have been able to find, Stuart’s 1989 brief is the first published proposal of an individual mandate in the context of private-sector-managed health systems. In 1991, Mark Pauly and others developed a proposal for George H.W. Bush that also included an individual mandate. While others credit Stanford economist Alain Enthoven with the idea, Enthoven’s earliest published reference to an individual mandate was an indirect one in the 1992 Jackson Hole paper.

In 1992 and 1993, some Republicans in Congress, seeking an alternative to Hillarycare, used these ideas as a foundation for their own health-reform proposals. One such bill, the Health Equity and Access Reform Today Act of 1993, or HEART, was introduced in the Senate by John Chafee (R., R.I.) and co-sponsored by 19 other Senate Republicans, including Christopher Bond, Bob Dole, Chuck Grassley, Orrin Hatch, Richard Lugar, Alan Simpson, and Arlen Specter. Given that there were 43 Republicans in the Senate of the 103rd Congress, these 20 comprised nearly half of the Republican Senate Caucus at that time. The HEART Act proposed health insurance vouchers for low-income individuals, along with an individual mandate.

Newt Gingrich, who was House Minority Leader in 1993, was also in favor of an individual mandate in those days. Gingrich continued to support a federal individual mandate as recently as May of last year.

It would seem that 1990s conservatives weren’t concerned with the constitutional implications of allowing Congress to force people to buy a private product. “I don’t remember that being raised at all,” Mark Pauly told Ezra Klein last year. “The way it was viewed by the Congressional Budget Office in 1994 was, effectively, as a tax…So I’ve been surprised by that argument.”

So what ?

Who cares ?