The Campaign Spot

The GOP’s Mandate Temptation

Why have so many conservatives and Republicans endorsed, or praised, an individual mandate for health care in the past? Today Rush Limbaugh hit upon it:

RUSH: Now this mandate business. This has gotten out of hand, too, ‘cause it’s out there now that Newt supported the individual mandate as recently as 2009. It’s being reported that Newt supported Obamacare, the individual mandate and Obamacare in 2009. Some people are saying, “Well, he couldn’t have done that because Obamacare didn’t exist in 2009. It hadn’t been written yet.” That’s a bit of a stretch. The fact of the matter is that the Heritage Foundation at first (and Newt and Romney) are all on record, at some point in their careers, as supporting the individual mandate which is what the lawsuit against Obamacare is about. But of the three, only Romney has actually enacted it into law, supported it to the point that he’s put it into law.

Now, I know why. I know exactly — and for the life of me, I can’t figure out why one of these guys hasn’t tried this as an explanation. I know exactly why Heritage supported it. (I’m guessing, but I know. Don’t doubt me.) I know why Heritage, I know why Newt and any other Washington, DC-ite saw that individual mandate and glommed onto it. You want to know why? It’s very simple. They are conservatives, and the first thing they saw in an individual mandate for people to get their own insurance is individual responsibility, and what do we as conservatives believe? We believe in individual responsibility; we believe in self reliance.

So if somebody proposed, “Hey, you know what? We got too many free riders. Everybody ought to have their own health insurance.” So conceptually it sounded good. It sounded conservative. So you could say, “I support that because that makes me conservative.” Only later when it’s too late, you figure out it’s nothing about individual responsibility. It’s a violation of the Constitution, because the thing comes about by virtue of the government demanding that you buy it or you go to jail or pay a fine. Now, why somebody hasn’t said, “You know what? I goofed up.” Well, the Heritage Foundation has.

They have distanced themselves from their original support of the health care mandate a long time ago. I don’t know why one of these guys hasn’t said this.

Back on January 11, in a chat with the Guardian, I said:

Why do you think the GOP candidates haven’t used “Romneycare” as the cudgel to beat Romney? It seems that would be a better line of attack than Bain, but in all of the debates no one has strongly and effectively used this line of attack.

Jim Geraghty replies:

That is a great question.

One minor complication is that Gingrich, and a bunch of Republicans have at one point or another in the past decades expressed something supportive, or at least not hostile, to the concept of the individual mandate. There is something of a conservative argument that the individual mandate is fostering individual responsibility – ie, while we want to have a merciful and generous society, it’s not fair to take no steps to protect your own health and expect everyone else in society to foot the bill when you suddenly require expensive treatment. To provide free healthcare for those who refuse to purchase insurance amounts to a form of welfare.

But once the concept of the individual mandate was enacted, conservatives (and more than a few independents) saw it through the lens of expanding government power. If the federal government has the power and authority to make you buy health insurance from a private company, what don’t they have the power to do? Who works for whom in this circumstance?

Romney’s defense on the individual mandate is that he opposes the one in Obamacare as unconstitutional (a question the Supreme Court will take up later this year) but that the one enacted by the state government of Massachusetts does not violate the state constitution. Legally, he may be perfectly right, but it makes for an awful rallying cry for conservatives: “Let’s get rid of that terrible FEDERAL-LEVEL individual mandate . . . so that each state can enact it’s own STATE-LEVEL individual mandate!”

The gripe about the Obamacare mandate isn’t that the federal government is making people buy health insurance . . . it’s that anybody is making people buy health insurance.

The U.S. has a broad, general tradition that if someone needs emergency life-saving care, they’re given it, regardless of their ability to pay. Thus, many Americans receive often expensive care regardless of their ability to pay and “others” make up the difference — thus the “free rider” problem.

But as Phil Klein notes, the math on Romneycare isn’t working:

In fact, Massachusetts collects a small amount in penalties from the individual mandate, and what little money is raised pales in comparison to how much free care (typically called “uncompensated care”) is still being provided by hospitals and how much money the state is spending on health care subsidies under Romneycare.

In fiscal year 2010, according to the Massachusetts Division of Finance, the state government collected just $17.8 million in fines from people not complying with the mandate. But uncompensated care was a stubborn $475 million, according to the state’s Division of Health Care Finance and Policy. (The state could only pay $405 million, with shortfall cost falling on hospitals.)

Under Obamacare, by 2016, those without health insurance will have to pay $695 or 2.5 percent of household income, whichever is greater.

The “free rider” problem is a genuine problem. But giving government the authority to require citizens to purchase anything* is a greater one.

* Mandate defenders inevitably bring up the requirement to purchase car insurance, but that is requiring a purchase for a privilege (owning a car) not a right. The state requires quite a few things from citizens to drive a car — passing the driving test, corrective lenses if needed, carrying the license while driving, etc. None of those are required for the exercise of a right.


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