Another Kind of Mandate

You have to feel for the genuine policy wonks at a place like the Heritage Foundation. On one hand, they want to conduct their research with integrity. On the other hand, they work at an organization where the line between being ideological and being partisan is always fuzzy. Take the individual health-insurance mandate, an idea that had its origins at Heritage, where it started as a way to address some of the pathologies of the health-insurance market without relying on government-provided insurance. For years, this was seen as a conservative approach, which is one of the reasons Mitt Romney embraced it in his Massachusetts health-insurance reform. We all know the rest of the story: a similar mandate became part of the Affordable Care Act, and Republicans immediately decided that the fact that Obama used it now meant the mandate was the very essence of statist oppression. So opposition to the mandate became a partisan requirement. But what if you're a conservative health-care wonk (there are a few of them) who for years supported the mandate as a conservative approach to the problem?

Stuart Butler, one of the original designers of the individual mandate at Heritage in the early 1990s, offers a justification in a USA Today op-ed so weak it's almost sad. He gives a couple of technical differences between the mandate they advocated and the ACA's, none of which change the fundamental fact that they were advocating for a federal mandate to carry insurance, the very thing he now believes is an affront to liberty. Then there's my favorite part:

Additionally, the meaning of the individual mandate we are said to have "invented" has changed over time. Today it means the government makes people buy comprehensive benefits for their own good, rather than our original emphasis on protecting society from the heavy medical costs of free riders.

When Butler says the "meaning" of the mandate has changed, all he means is that the justification for it has changed. Which is another way of saying that before, the mandate was advocated by Republicans, while today it is advocated by Democrats, so before it was good, and today it is bad. But the effect of the mandate is the same (and we should note that Democrats, including President Obama, have always cited the free-rider problem as one of the key reasons a mandate is necessary).

Interestingly, one word you won't find in Butler's op-ed is "Romney." He doesn't mention that Heritage supported Romney's individual mandate in 2006, which every Republican with the exception of Mitt himself now believes to be the worst thing the likely GOP nominee ever did (Romney's own position is more nuanced: He says his health-care reform was great, but if it were expanded nationwide, as the ACA essentially does, it would be a catastrophic spit from the very fires of hell).

That Butler's own change of heart happened to coincide perfectly with a Democratic president adopting the mandate is bit hard to explain. But he gives it a shot:

Changing one's mind about the best policy to pursue—but not one's principles—is part of being a researcher at a major think tank such as Heritage or the Brookings Institution. Serious professional analysts actually take part in a continuous bipartisan and collegial discussion about major policy questions. We read each other's research. We look at the facts. We talk through ideas with those who agree or disagree with us. And we change our policy views over time based on new facts, new research or good counter-arguments.

Thanks to this good process, I've altered my views on many things. The individual mandate in health care is one of them.

I might be wrong, but I'm guessing that Stuart Butler genuinely believes this is what happened. I'm sure he regards himself as a serious policy analyst, not a partisan hack. But when his entire tribe turned against the individual mandate—indeed, they didn't just turn against it but made opposition to it one of the foundations of their political identity—his perspective started to change. When a president he hated embraced his idea, it didn't look so good anymore. The arguments against it suddenly seemed more persuasive, the arguments in favor of it not so strong. In his own mind, this evolution probably seems to have taken place with the utmost intellectual integrity. But really, what choice did he have?

Comments

It's not just that "Democrats, including President Obama, have always cited the free-rider problem as one of the key reasons a mandate is necessary". So far as I know, that has always been the justification for the mandate. The only way to make the US health care system work is to make sure that everyone has a piece of it.

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