* Eighty percent of Republicans favor “creating an insurance pool where small businesses and uninsured have access to insurance exchanges to take advantage of large group pricing benefits.” That’s backed by 75 percent of independents. [...]
* Fifty two percent of Republicans favor “allowing children to stay on parents insurance until age 26.” That’s backed by 69 percent of independents.
* Seventy eight percent of Republicans support “banning insurance companies from denying coverage for pre-existing conditions; 86 percent of Republicans favor “banning insurance companies from cancelling policies because a person becomes ill.” Those are backed by 82 percent of independents and 87 percent of independents.
* One provision that isn’t backed by a majority of Republicans: The one “expanding Medicaid to families with incomes less than $30,000 per year.”
In light of this finding, some important observations need to be made. First, Democrats and President Obama need to do a better job of messaging. Secondly, despite the partisan rancor and win-at-all-costs attitude of Republican party leaders, rank and file Republicans have a lot in common with Independents and Democrats on this issue, and probably a host of others. Third, this shows a lot of potential for improvement in the tone of our national political dialogue if Republican leaders can be shown to be out of step with rank and file Republicans. With that thought in mind, let’s move to answer number two.
Answer number 2: Republican party leaders have become immoderate.
There are still plenty of moderate Republicans, but current party leaders are more immoderate than moderate. Attitudes toward the Affordable Care Act are just one case in point. Even Jeb Bush (link) has noticed how immoderate party leaders have become on a whole range of issues. As mentioned above, this at least gives potential for improving the tone of national dialogue if we bypass Republican leaders and appeal directly to rank and file Republicans and Independents.
But let’s focus just on the health care debate. First, there is the historical context. (link, link) President Nixon, yes that President Nixon, proposed an employer mandate for health care as a response to the idea of single payer health care reform. During President Reagan’s second term, legislation was passed that forced hospital emergency rooms to accept everyone, regardless of whether they could pay. It was after that legislation was passed that Republicans began to earnestly discuss a way to keep free riders from taking unfair advantage of the law. The first available example of this, dated October 2, 1989, comes from the Heritage Foundation’s Stuart Butler. (pdflink) Some within the Republican party, most notably Peter Ferrara, have sought to blame the Heritage Foundation for inventing and advocating for the individual mandate. (link, link) Butler however says lots of others were discussing the individual mandate at the time (link):
My view was shared at the time by many conservative
experts, including American Enterprise Institute (AEI)
scholars, as well as most non-conservative analysts.
Even libertarian-conservative icon Milton Friedman, in a
1991 Wall Street Journal article, advocated replacing
Medicare and Medicaid "with a requirement that every
U.S. family unit have a major medical insurance policy."
In 1991, President George H. W. Bush commissioned a study, headed by Mark Pauly. (pdflink
) In a 2011 interview with Ezra Klein, Pauly discussed the experience, explaining that Republicans were looking for a market-based option to single-payer (link
I was involved in developing a plan for the George H.W. Bush administration. I wasn't a member of the administration, but part of a team of academics who believe the administration needed good proposals to look at. We did it because we were concerned about the specter of single payer insurance, which isn't market-oriented, and we didn't think was a good idea. One feature was the individual mandate. The purpose of it was to round up the stragglers who wouldn’t be brought in by subsidies. We weren’t focused on bringing in high risks, which is what they're focused on now. We published the plan in Health Affairs in 1991. The Heritage Foundation was working on something similar at the time.
Shortly thereafter, President Clinton sort of co-opted the Nixon position by proposing an employer mandate. Republicans, who had already been discussing the issue during George H. W. Bush’s presidency, responded to President Clinton by focusing on their own mandate. As noted by Len Nichols of the New America Foundation in a February 2010 NPR broadcast (link
(T)he individual mandate was originally a Republican idea. "It was invented by Mark Pauly to give to George Bush Sr. back in the day, as a competition to the employer mandate focus of the Democrats at the time."
This is also confirmed by Newt Gingrich (link
“In 1993, in fighting ‘Hillarycare,’ virtually every conservative saw the mandate as a less dangerous future than what Hillary was trying to do,” Newt Gingrich, the former speaker of the House, said at a debate in December, casting his past support of a mandate as an antidote to the health care overhaul proposed by Hillary Rodham Clinton during her husband’s administration.
As carefully illustrated recently by Ezra Klein (link
), moderate Republicans were accepting this mandate idea until June of 2009. This included plans endorsed by a majority of Republican senators in 1993 (link
) and bipartisan bills introduced in January 2007 and February 2009 (link
) By December of 2009, after the Affordable Care Act was introduced, the mandate idea was suddenly unconstitutional:
KLEIN: Six months later, in December 2009, every single Senate
Republican voted to call the individual mandate unconstitutional, every
single one. That included many who has supported the individual in the
past, like Senator Hatch from Utah and Senator Bond from Missouri, and even
some supporting the mandate at that very moment, with their names on the
Health Americans Act like Senators Lamar Alexander and Mike Crapo.
It was just previous to this sudden change of heart by Republican party leaders that Governor Mitt Romney introduced what has come to be known as “Romneycare” in 2007. At the signing of Romneycare, Robert Moffitt, who worked for the right-wing-think-tank Heritage Foundation, came to speak:
Besides the support from the Heritage Foundation, the plan was approved by two conservative Republicans who were secretary of the Health and Human Services Department under George W. Bush, Tommy Thompson and Mike Leavitt. (link) In 2007, even conservative icon Jim Demint had glowing comments about Romneycare and proposed it as a solution for the nation:
Needless to say, the Affordable Care Act, aka Obamacare, was based on Romneycare, which was based on an idea proposed by moderate Republicans and accepted even by conservative Republicans like Jim Demint. Accepted, that is, until it was co-opted by President Obama.
Romneycare, not long ago openly lauded by many Republicans, and Obamacare are nearly identical. President Obama’s signature proposal is based on the same Republican ideas. (link, link) The most convincing discussion of this may come from extremely conservative Republican Peter Ferrara (link), who calls out Ann Coulter (link) when she tries to deny the similarities:
No, Ann, it's a lot more than that. Where did you get that excessively speculative rationalization? Romney's health care bill is perceived as virtually the same thing as the widely detested Obamacare because it is virtually the same thing as the widely detested Obamacare.
Both Romneycare and Obamacare include the individual mandate. Both Romneycare and Obamacare include sharp increases in Medicaid. Both Romneycare and Obamacare include guaranteed issue and community rating (like requiring fire insurers to insure homes that have already caught fire, and at the same standard rates as for everyone else). Both Romneycare and Obamacare include welfare subsidies for the purchase of health insurance well into the middle class. And both Romneycare and Obamacare include the latent government power for price controls on health insurance and rationing of health care.
The problem is not that President Obama is a raging socialist/leftist/fascist trying to force a health care mandate on hapless stalwart Republicans. No, the problem is that the Republican party leadership has become so immoderate that President Obama’s obviously moderate Republican idea is no longer acceptable to them even though the contents of his legislation are, mostly, accepted by rank and file Republicans.
Answer number 3: Negative propaganda.
Back before Mitt Romney was the Republican nominee, his rivals and their supporters were more than willing to lament the negative impact of Romneycare on the Massachusetts economy. As a case in point, Newt Gingrich, who lauded Romneycare in 2006 (link) said in December of 2011 that (link):
“Why doesn’t Mitt admit it? He’s still for the mandate in Massachusetts. It doesn’t work, it’s going to bankrupt the state.
Peter Ferrara, of anti-mandate fame, said (link
That means the mandated health insurance will inevitably be extremely expensive, as we are just starting to see with Obamacare.
The best antidote to negative propaganda is a good dose of reality. Romneycare is succeeding (link
Currently, Massachusetts has the highest level of healthcare coverage in the country with more than 98 percent of its residents having healthcare insurance, but ranking as the 48th lowest state in the nation in healthcare expenditures.
The combined saving of last year and this year will save the state approximately $91 million with no benefit reductions or member co-pay increases, the report said.
More success here
and from the Frumforum here
And, since Obamacare is very similar to Romneycare, Obamacare will also likely succeed in the end.
Conclusion: Agree with yourself
Republican party leaders have clearly lost their moral compass. One way of saying this is that they no longer agree with their former selves. In stark contrast, Mark Pauly, recognized by many as the father of the individual mandate has maintained his Republican values over the years. Snippets from various interviews show that he still prefers a non-mandate solution but thinks it is the only way to insure everyone. This is what rational Republicans sound like:
And how does economist Pauly feel about the GOP's retreat from the individual mandate they used to promote? "That's not something that makes me particularly happy," he says.(link)
“My view was, I still agree with myself,” he said in an interview. (link)
I have mixed feelings about the mechanics of the current bill. Our idea was to have tax credits and very little additional government control over insurance markets, and the legislation has an awful lot of that. I believe you could achieve almost the same reduction of the uninsured with the subsidies and without the mandate. But CBO says that you leave about 40 percent of the uninsured population without coverage in that scenario. If we want to close that gap, then either we have to have a mandate or make insurance free for everyone and run by the government.(link)
Incidentally, Pauly, in an interview that predates (February 2011) the recent Supreme Court decision on the mandate, also confirms that the mandate was originally considered as a tax back when it was first proposed by Republicans (link
Was the constitutionality of the provision a question, either in your deliberations or after it was released?
I don’t remember that being raised at all. The way it was viewed by the Congressional Budget Office in 1994 was, effectively, as a tax. You either paid the tax and got insurance that way or went and got it another way. So I've been surprised at that argument. But I’m not an expert on the Constitution. My fix would be to simply say raise everyone’s taxes by what a health insurance policy would cost -- Congress definitely has the power to do that -- and then tell people that if they obtain insurance, they'll get a tax break of the same amount. So instead of a penalty, it’s a perfectly legal tax break. But this seems to me to angelic pinhead density arguments about whether it’s a payment to do something or not to do something.