The ACP Advocate Blog
by Bob Doherty
Thursday, December 16, 2010
If you appreciate irony, it doesn’t get much sweeter than this:
A GOP-appointed judge rules that a GOP idea, recently embraced by a Democratic president who a few years ago campaigned against it, is unconstitutional, possibly paving the way for a government-run program.
Strange, but true. A Republican-appointed judge in Virginia has ruled that the ACA’s individual mandate is unconstitutional (although two other federal judges appointed by Democrats have upheld it, and the Supreme Court will ultimately decide). The irony is that the roots of the individual mandate can be found in conservative proposals from the early 1990s.
In 1990, the conservative Heritage Foundation developed a plan for universal coverage that described the individual mandate as a “social contract” between the government and individuals:
“Under this social contract, the federal government would agree to make it financially possible, through refund able tax benefits or in some cases by providing access to public-sector health programs, for every American family to purchase at least a basic package of, including catastrophic insurance. In return, government would require, by law every head of household to acquire at least a basic health plan for his or her family.”
The individual mandate was then incorporated into bills proposed by GOP stalwarts Orrin Hatch (R-UT) and Chuck Grassley (R-IO) as an alternative to “Hillary Care.” It later became a lynchpin of the Massachusetts health reform plan championed by then governor (and likely 2012 presidential candidate) Mitt Romney (R-MA).
That was then, this is now.
The Heritage Foundation now argues that the individual mandate is “unprecedented” and “unconstitutional”- conveniently ignoring its own past ownership of the idea. A few days ago, Senator Hatch hailed the Virginia judge’s decision to overturn the individual mandate as “a great day for liberty. Congress must obey the Constitution rather than make it up as we go along. Liberty limits on government, and today those limits have been upheld.”
The irony isn’t limited to Republicans. During the Democratic primary, candidate Barack Obama not only opposed an individual mandate, he used it in attack ads against Hillary Clinton:
"What's [Clinton] not telling you about her health care plan?" an announcer asks. "It forces everyone to buy insurance, even if you can't afford it."
That was then, this is now.
Following the Virginia ruling, the White House had this to say:
“Opponents of reform claim that the individual responsibility requirement – the requirement that all Americans carry a minimum level insurance by 2014 – exceeds Congress’ power to regulate interstate commerce because it penalizes economic ‘inactivity.’ Make no mistake -- individuals who choose to go without health insurance are actively engaged in economic decision making – the decision to pay for health care out-of-pocket or to seek uncompensated care. Every year millions of those who have chosen to go without health insurance actively seek medical care, which is evident in the billions of dollars spent on uncompensated care every year.”
(I wonder what Obama’s Secretary of State would have to say about this now, but of course, she can’t.)
The above is fact – you can look it up. More speculative is the part about the Virginia ruling possibly leading to a single payer plan. But the Washington Post’s Ezra Klein plausibly writes:
“The individual mandate was created by conservatives who realized that it was the only way to get universal coverage into the private market. Otherwise, insurers turn away the sick, public anger rises, and, eventually, you get some kind of government-run, single-payer system, much as they did in Europe, and much as we have with Medicare.”
If Ezra Klein is correct, could anything be more ironic?
Today’s question: What do you think about the irony involved in today’s debate on the individual mandate?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
- Your comments, my responses
- Looking out for internists . . . and their patient...
- What happens if universal coverage is allowed to s...
- “Death Panels” redux
- “Cowardice”—or bravery--on health care costs?
- “Just fix it!”
- Insurance companies to spend more $ on patients? ...
- Is "compete and succeed" better than "repeal and r...
- Is there an alternative to re-fighting health care...
- To repeal or not to repeal, that is the question
The Wall Street Journal's blog on health and the business of health.
Health Affairs Magazine Blog
The Policy Journal of the Health Sphere.
The Health Care Blog
Everything you always wanted to know about the Health Care system. But were afraid to ask.
Vignettes and commentaries on the medical profession.
The New Health Dialogue Blog
From the New America Foundation.
DB's Medical Rants
Contemplating medicine and the health care system
Notes From The Road
Bloggers post from medical meetings, press conferences, and policy gatherings from the U.S. and around the world, providing readers with a tasty analysis of the buzz, the people, and the stories that don't get told.
A blog dedicated to medical education, news, and policy as well as career advising.
Disease Management Care Blog
An ongoing resource for information, insights, peer-review literature and musings from the world of disease management, the medical home, the chronic care model, the patient centered medical home, informatics, pay for performance, primary care, chronic illness and health insurance.
Medical Professionalism Blog
The Medical Professionalism Blog was created by the ABIM Foundation to stimulate conversation and highlight best practices related to professionalism in medicine.