A blog and event series led by Professors David Schanzer and Don Taylor at Duke University’s Sanford School of Public Policy
Monday, February 6, 2012
Changing one's mind
During last Thursday's class, there was some discussion of the fact that Republicans have supported an individual mandate for health insurance in the past. I have a post up this morning at The Incidental Economist that pans Stuart Butler's piece over the weekend giving account of why he changed his mind. Here is his piece from 1989 that is often credited as having "invented" the individual mandate. What do you think about his argument?
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Stuart Butler’s explanation of “why he changed his mind” is well articulated and comes off more as a piece on “why his individual mandate is not the same as Obama’s individual mandate.” The differences lie in motivation for implementing the individual mandate and the layout of the current health care environment. Butler’s original motivations with the individual mandate were to avoid adverse selection, which occurs when insurers avoid risk and the health decline coverage. Essentially, this alternative to Clinton’s proposed universal health care plan was an effort to protect the majority of Americans from what they saw as unfair shifts in health care costs. Butler has compared the health insurance market to other types of accident insurance in the past, stating:
ReplyDeleteIf a young man wrecks in his Porsche and has not had the foresight to obtain insurance…society feels no obligation to repair his car. But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether of not he has insurance. If we find that he has spent his money on other things rather than insurance, we may be angry but we will not deny him services…A mandate on individuals recognizes this implicit contract…Each household has the obligation, to the extent it is able, to avoid placing demands on society by protecting itself. (Latino, 2011)
Evidently, Butler stuck to the Heritage Foundation’s conservative pulse when he pushed for an individual mandate to make the system more of a fair playing field on which people’s costs reflected their needs, rather than the needs of others.
In his recent piece, he believes the Obamacare mandate is dead-wrong because other devices exist to increase the insured population. “Risk adjustment tools,” such as auto-enrollment through employer or nonemployer plans, can decrease our uninsured population according to Butler, and he admits that the individual mandate was a mistake in the 1990’s. He closes his argument with a statement on the unconstitutionality of the mandate because it forces “people to buy comprehensive benefits for their own good, rather than our original emphasis on protecting society from the heavy medical costs of free riders.”
Bottom line- Butler says his brainchild in the 1990’s protected the individual from fiscal inequity, while the contemporary Democratic mandate pushes the individual into economic activity.
Butler claims that his earlier mandate was ok because it had an emphasis on the free rider/adverse selection problem and that Obama's is unconstitutional because it forces people to buy insurance "for their own good." Can Butler provide any evidence that Obama or any supporters of the legislation actually hold this belief? (Hint: no, he cannot.) The amicus brief filed for the Supreme Court makes exactly the case for the mandate that Butler claims to want it to. So does he now support the mandate? It seems to me that the only people who claim the mandate is to make people buy insurance "for their own good" are opponents of the ACA. And in any case,to say that his mandate is different from the current one because the intentions behind them are different (which they aren't) is a classic case of missing the forest for the trees.
DeleteButler's other claims seem to argue more for a negotiation over the details of implementation than the illegality of the mandate. Soft mandates are fine, but hard mandates are a violation of the Constitution? Withholding tax credits are fine but small fines of the same monetary value tramples personal freedom? If Obamacare is unconstitutional, then so was the Heritage proposal of the early 90s and Butler should at least own up to this.
Yes, people certainly should have the right to change their mind. It makes for more responsive and honest policy formation. But isn't it odd that the "health research and advances in economic analysis" that helped Butler see the light about ObamaCare weren't sufficient to prevent Butler from supporting RomneyCare in 2008 without mention of the now-clearly-unconstitutional mandate? (See Butler's article "Exchange We can Believe In.")