Once Upon a Time, Liberals Hated the Individual Mandate

There’s a lot of talk—much of it inaccurate—about the minority of conservatives who supported the individual mandate in the past, but oppose Obamacare’s requirement that all Americans buy health insurance. But these critics have devoted less attention to the fact that many liberals—including President Obama—opposed the individual mandate in the past. “The liberals hated it,” notes Jonathan Gruber in a recent New York Times profile. “People forget that.”

If you think about it for more than a minute, liberal support for the mandate does seem strange: Why, after all, would liberals favor a provision that forces people to hand their money over to private corporations?

“This is not real reform,” said Howard Dean of Obamacare’s mandate in December 2009. “You’re going to be forced to buy health insurance from a company that’s going to take on average 27 percent of your money so they can pay CEOs 20 million dollars a year…and there’s no choice about that. If you don’t buy that insurance, you’re going to get a fine. This is a bill that was fundamentally written by staffers who are friendly to the insurance industry, [endorsed] by Senators who take a lot of money from the insurance industry, and it’s not health care reform. And I think it’s too bad that it should come to this…I’d kill the bill entirely.”

Dean, to his great credit, has been consistent all along in his criticism of the mandate. Not so for President Obama, who on the campaign trail in 2008 ridiculed Hillary Clinton’s support of the mandate. “I don’t think the problem is that people don’t want health insurance,” he told Ellen DeGeneres in 2008, “it’s that they can’t afford it…if things were that easy, I could mandate everybody to buy a house, and that would solve the problem of homelessness. It doesn’t.” As President Obama’s staffers began pushing for a mandate, Ron Suskind reports, Obama expressed concern about Constitutional challenges to the provision. As we know now, he was right to have done so.

Former AFL-CIO President John Sweeney, representing the core Democratic constituency, was even more ardent than the President in his hatred of the individual mandate. In 2006, when Mitt Romney was about to sign his Massachusetts legislation, Sweeney went ballistic. “Who would have thought that Massachusetts—long considered a bastion of progressive thinking—would take a page out of the Newt Gingrich playbook for health care reform?” he asked. “Forcing uninsured workers to purchase health care coverage or face higher taxes and fines is the cornerstone of Mr. Gingrich’s health care reform proposals. And it is unconscionable that Massachusetts has adopted this misguided individual mandate.”

Sweeney instead favored an employer mandate, which had long been the liberal alternative to single-payer (the employer mandate was, for example, the cornerstone of Hillarycare in 1993). Romneycare ended up with both an individual mandate and and employer mandate; Romney had vetoed the employer requirement, but the Democratic state legislature overrode his veto.

In 2009, however, when President Obama was making the big push for his signature health bill, Sweeney swung the other way, organizing an intensive grass-roots effort to rally Congressional support for the bill. “Congress’ choice comes down to this,” said Sweeney, in a letter to union officers. “Side with insurers and vote for legislation that continues their control over health care in America, or vote for reform that puts people in charge of their health care.”

Labor leaders and Democratic Presidents are allowed to change their minds. But so are people on the other side.

Follow Avik on Twitter at @aviksaroy.

UPDATE 1: Don Taylor makes the following observations about this topic at his "new" old blog:

Avik Roy notes that most liberals have hated the individual mandate as a means of expanding health insurance coverage since the idea came about in the early 1990s, which is correct. As I wrote a couple of weeks ago, the flip flop on the individual mandate is telling for both conservatives and liberals.

For liberals and progressives, universal health insurance coverage is the holy grail, not just of health policy, but public policy. Many were willing to take the other sides idea because it was what could pass the House and the Senate and be signed by the President. They were willing to invest much political capital pushing the ACA even as they held their nose over many of the details, because it moved toward universal coverage.

The change of mind around the individual mandate is just as telling for Conservatives. I think the story that more Republican politicians were supportive of the individual mandate that rank and file conservatives, and conservative health policy types is likely true. For one thing, there really aren’t that many Conservative policy types that focus on health policy, and it is not a core issue that most conservative voters think a great deal about. And as Stuart Butler notes, one of the reasons that Republicans likely supported a mandate in the 1990s was so that they would have something with which to argue against the Clinton plan.

Progressives and liberals have shown a clear commitment to using any feasible approach to expand insurance coverage toward their ultimate health policy goal. Conservatives have mostly shown a clear commitment to arguing against the policies of progressives and liberals in the health policy realm. There is nothing about the historical record to suggest that Conservatives will be willing to expend political capital to advance a health reform proposal (briefly: idea, white paper, commerce and ways and means committee hearings and mark ups in the House, CBO, PR and political rallies, parsing of the plan by the other side, bazillion blog posts, full House vote, then to the SENATE!, etc).

I could be proven wrong and perhaps there will be a conservative health policy flourishing soon; only time will tell.

David De Los Angeles makes a similar point in the comments below. However, as John Goodman points out, it's not that conservatives haven't proposed their own plans, but that they have been largely ignored.

UPDATE 2: Ezra Klein reiterates the case that Democrats were being nice, and Republicans cynical, when it comes to the mandate. I deliver my comprehensive response here.

 

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