The concept of the healthcare mandates evolved from conservative Republican thinking. That fact is indisputable and generally understood. Self-reliance and personal responsibility were core Republican values. Requiring that all citizens take responsibility for their own healthcare through healthcare insurance flows from these core Republican values.
History of the Mandate
In 1974, President Richard Nixon proposed the Comprehensive Health Insurance Plan. The plan would mandate that “every employer” provide a “Comprehensive Health Insurance Plan” to all full-time employees.
The Emergency Medical Treatment & Active Labor Act (EMTALA) was passed in 1986 by a Democratic House and a Republican Senate and signed into law by Ronald Regan. It was
an unfunded mandate that required hospitals participating in Medicare (nearly all) to provide emergency care to anyone who needed it, including illegal immigrants, regardless of ability to pay for the service. It was the first step in universal healthcare.
In 1989, Stuart Butler of the conservative Heritage Foundation published a plan called, “Assuring Affordable Health Care for All Americans.” This plan mandated that all
households obtain adequate health insurance. Butler believed that healthcare protection is the responsibility of individuals, not businesses.
In 1991, the renowned conservative economist, Milton Friedman, advocated, in a Wall Street Journal article, “a requirement that every U. S. family unit have a major medical insurance policy.”
In 1991, economist Mark Pauly created a proposal, which included a mandate, for President George H. W. Bush. His proposal was turned into a Congressional bill two years later.
In 1992, the Jackson Hole Group (Paul Ellwood, Alain Enthoven & Lynn Etheredge) published the “Jackson Hole Initiatives for a 21st Century American Health Care System.” It included employer mandates and was an alternative to the Clinton healthcare
proposal, which the group strongly opposed.
In 1993, Republicans in Congress introduced the Health Equity & Access Reform Today Act (HEART Act). It proposed an individual mandate and health insurance vouchers for low-income people. The 19 Senate Republican co-sponsors included John Chafee, Bob Dole, Chuck Grassley, Orrin Hatch, Richard Lugar, Alan Simpson and Arlen Specter. House Minority Leader, Newt Gingrich supported the HEART Act. Republicans believed that the individual mandate was more market friendly than an employer mandate.
Mitt Romney’s healthcare plan for Massachusetts was developed with assistance of the conservative Heritage Foundation (Bob Moffit & Ed Haislmaier). It included both
an individual mandate and an employer mandate, although Romney opposed the
employer mandate. Romney told reporters, “It’s the ultimate conservative idea, which is that people have responsibility for their own care, and they don’t look to government if they can afford to take care of themselves.”
The first irony is that when the individual mandate, conceived by Republicans, was proposed by a Democratic President, Republicans reversed their position and opposed it. Suddenly, the mandate became a violation of individual liberty. In this case, Republicans abandoned their core values of self-reliance and personal responsibility.
Consequences from Lack of Health Insurance
A 2009 Harvard study linked deaths of Americans to the lack of health insurance. The New York Times (9/17/09) reported, “Researchers from Harvard Medical School say the lack of coverage can be tied to about 45,000 deaths a year in the United States.” The
study suggested two primary reasons for the deaths. The first was the difficulty in finding
healthcare services for the uninsured. The second was the fact that uninsured people rarely receive treatment for chronic conditions, such as high blood pressure and diabetes.
More people have died from lack of healthcare coverage in the US each year than have died in the Syrian civil war. Ironically, critics of Obamacare often argue that the US should do more to save Syrian lives, while allowing Americans to die in greater numbers.
A study released by the American Journal of Medicine reported that 62% of bankruptcies were tied to medical expenses. That amounts to approximately 900,000 bankruptcies per year due to medical bills. The study’s lead author, Steffie Woolhandler, MD at the Harvard Medical School, stated, “Unless you’re a Warren Buffett or Bill Gates, you’re one
illness away from financial ruin in this country. If an illness is long enough and expensive
enough, private insurance offers very little protection against medical bankruptcy, and that’s a major finding in our study.”
Insuring Pre-Existing Conditions
Some health insurance is available in some states for people with pre-existing conditions, but it is very expensive. This health insurance generally does not cover the pre-existing conditions, such as heart disease, diabetes, cancer, stroke, back problems, AIDS and many others. Implementing a mandate increases the size of the insurance pool and
includes younger people who have fewer claims. This helps offset the cost of insuring people with pre-existing conditions.
Congressman Paul Ryan has recommended replacing Medicare with a voucher that would allow senior citizens to purchase their own healthcare insurance. Most people over 65 years old either have a pre-existing condition or will have one before they die. Insurance will be unavailable to this group at any reasonable price.
The Probable Solution
In most of the developed world, healthcare is considered a right rather than a privilege. Eventually, a majority of Americans will also come to view healthcare as a right instead of
a privilege. Germany, as an example, has had universal healthcare since 1883. Germany
pays half as much for healthcare per capita as the U S and Germans have a longer life expectancy than Americans.
Essentially, there are two realistic approaches to provide universal healthcare for everyone: (1) tax everybody, healthy & sick, and use this money to provide healthcare,
e.g., Medicare & Medicaid, and (2) mandate that everyone to buy insurance.
Repealing the Affordable Care Act would deny health insurance coverage to 30 million Americans. The alternative for universal healthcare becomes, by default, the single-payer system, i.e., Medicare for all Americans.
While it would have to be paid for with taxes, some cost benefits occur. According to the
Congressional Budget Office, Medicare’s administrative costs are less than 2% of expenditures, while private insurance has administrative costs of 11% plus a profit of 7%. Private insurance companies have certain costs that Medicare does not incur. These include: marketing costs, sales expense, lobbying, executive bonuses, etc.
The most improbably irony is that the political conservatives may be the driving force in bringing about the healthcare solution that political liberals desire – Medicare for everyone.
