While neither condemning or endorsing the present Senate HIR bill, the startling thing is that it is almost identical to the plan proposed by Republicans in 1993 to counter the Clinton proposal. Boston NPR and the Kaiser Family Foundation have now come up with excellent stories that show the amazing similarity.


Clinton's proposal relied heavily on employer mandates and most assumed it would provide for a single payer plan. The Democratic position since opposing Nixon's universal-coverage-with-a-public-option, has been that single payer is the only responsible way to go. In compromising what was to have been the Baucaus/Grassley Bill, Democrats for the first time have backed away from a firm demand for single payer and embraced the the concept of totally private insurance with an individual mandate.  

The damning evidence for Republicans is that 4 currently sitting Repug Senators were co-sponsors of the '93 GOP individual mandate bill, including Orin Hatch, Charles Grassley, Richard Lugar and Robert Bennett. Hatch especially is vocal today that an individual mandate destroys liberty.

GOP : Individual Mandate to Stop Free-Riders & Maintain Private Insurance

Mark Pauly, a frequent adviser to Bush I originally came up with the idea of an individual mandate to counter Democratic proposals. Basically it stressed the unfairness of allowing "Free-Riders" who didn't have insurance and relied on fellow citizens good will in medical emergencies. Although it never came into being nationally it was the basic idea for RomneyCare in MA.  

Pauly, a conservative health economist at the University of Pennsylvania's Wharton School, says it wasn't just his idea. Back in the late 1980s — when Democrats were pushing not just a requirement for employers to provide insurance, but also the possibility of a government-sponsored single-payer system — "a group of economists and health policy people, market-oriented, sat down and said, 'Let's see if we can come up with a health reform proposal that would preserve a role for markets but would also achieve universal coverage.' "

The idea of the individual mandate was about the only logical way to get there, Pauly says. That's because even with the most generous subsidies or enticements, "there would always be some Evel Knievels of health insurance, who would decline coverage even if the subsidies were very generous, and even if they could afford it, quote unquote, so if you really wanted to close the gap, that's the step you'd have to take."

One reason the individual mandate appealed to conservatives is because it called for individual responsibility to address what economists call the "free-rider effect." That's the fact that if a person is in an accident or comes down with a dread disease, that person is going to get medical care, and someone is going to pay for it.


The '93 Republican HCR plan became known as the "Chaffee Bill" and besides having 21 Republicans co-sponsors, also had 2 Democratic co-sponsors.

the key provisions in the Chafee bill may seem familiar, as they bear a strong resemblance to those in the current Democratic Senate bill, and now in President Barack Obama's proposal. A mandate that individuals buy insurance, subsidies for the poor to buy insurance and the requirement that insurers offer a standard benefits package and refrain from discriminating based on pre-existing conditions were all in the 1993 GOP bill.


Here is a summary of the 1993 Republican HCR bill:

And here is a chart comparing today's Senate Bill, the 1993 GOP bill, and today's GOP bill (The Boehner Bill):


One of the co-sponsors of the '93 Republican HCR bill was Dave Durenburger who summarizes what he sees as the state of the current bill as this:

It puts in more money, it improves on this and improves on that, but I’ve got to tell you there’s probably about a dozen people who understand that out of 306 million Americans.

I will be eagerly looking for the points of agreement. But I can tell you in advance: the major agreement would be on getting national rules by which major insurance companies will be forced to compete at the local level. Already that’s been characterized as "buying over state lines" by Republicans, and now being characterized as some kind of a "national health insurance rate authority" by the Democrats.


So what has changed since '93? Why is what was conservative in '93 liberal now? It's a re-definition of what it is to be a Republican but also what it is to be a Democrat as both parties have swung wildly to the right.

Originally posted to tassojunior on Tue Mar 09, 2010 at 02:21 PM PST.

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