Four Ironies of the Individual Mandate

As anticipation rises about how the Supreme Court will rule on the individual mandate, a key element of Obama's healthcare reform, it is worth reflecting on how ironic it is that the individual mandate has emerged as such a polarizing issue. At least four ironies come to mind.

First, the individual mandate began as a conservative idea. Specifically, it was originally popularized by the Heritage Foundation in a 1989 policy brief by Stuart Butler. As explained in a 1990 policy brief (see p. 7), Heritage called for a new "social contract" on healthcare, in which government would ensure access to healthcare through tax credits, and in turn "government would require, by law, every head of household to acquire at least a basic health plan for his her family." This was not just a passing idea at Heritage. The case for an individual mandate was made repeatedly by Heritage staff, including in a 1992 brief and a 1994 brief in which Robert Moffitt made a philosophical case for the mandate:

An individual mandate for insurance, then, is not simply to assure other people protection from the ravages of a serious illness, however socially desirable that may be; it is also to protect ourselves. Such self protection is justified within the context of individual freedom; the precedent for this view can be traced to none other than John Stuart Mill.

Second, the individual mandate was first mainstreamed into policy debates by Republican members of Congress. Specifically, it first appeared in legislation introduced as an alternative to the Clinton healthcare plan. A bill introduced by Senator John Chafee in 1993, with 18 Republican and 2 Democrat co-sponsors would have required "each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005."

A third irony here is that the individual mandate was first successfully turned into law by Governor Mitt Romney, in his healthcare reform in Massachusetts. And guess what: that law is working pretty good:

The Massachusetts health reform initiative enacted into law in 2006 continued to fare well in 2010, with uninsurance rates remaining quite low and employer-sponsored insurance still strong. Access to health care also remained strong, and first-time reductions in emergency department visits and hospital inpatient stays suggested improvements in the effectiveness of health care delivery in the state. There were also improvements in self-reported health status. The affordability of health care, however, remains an issue for many people, as the state, like the nation, continues to struggle with the problem of rising health care costs.

A fourth irony is that Barack Obama, who has been pilloried for his socialistic support of the individual mandate and is likely to face former mandate champion Romney this fall, was against the individual mandate when he ran for president. Obama was quite articulate on the problems with the individual mandate, as you can see from the YouTube clip below.

Can politics get any weirder than this? President Obama finds himself defending a policy idea he once opposed from conservative critics who invented the idea, a Republican party that mainstreamed it, and an electoral opponent who first enacted it into law.

Meanwhile, Stuart Butler -- the mandate's most vigorous early proponent -- has come out to say that he and Heritage aren't to blame for the individual mandate.

All this should stand as a textbook case of how giving ideological ground to the right doesn't necessarily get Democrats any mileage. Such is the extremism of modern day conservatism that ideas that even Heritage embraced are now considered too liberal, and such is the opportunism of this movement that it will shamelessly attack its own ideas if it thinks that this will lead to political gains.