I have kept the true story of the Heritage Foundation and the
individual health insurance mandate under wraps for almost 20 years
now, because up until now it has been too costly to tell it. But
now it is too costly not to tell it.
This is not an attack on Heritage, which has long since
mended its ways. But the story is now centrally relevant to the
Republican presidential primaries.
In 1993, I was a refugee from the failed George H.W. Bush
Administration, where I had served as Associate Deputy Attorney
General of the United States, after my service in the White House
Office of Policy Development, where I had worked for President
Reagan. I was the Heritage Foundation John M. Olin Distinguished
Fellow in Political Economy.
There I discovered the wonders of the Heritage health
plan, devised to stop the Hillary health plan. Except that it
followed the outlines of the Hillary plan far too closely. Worse,
where it differed, it was destined to fail politically.
For example, the Hillary plan was based on an employer
mandate, requiring employers to buy the health insurance plan for
their workers the government specified they must buy. The Heritage
plan was based on an individual mandate, requiring each worker to
buy the health insurance plan the government specified they must
buy. So the issue was framed as who should have to buy the health
insurance, the employer as the Hillary plan required, or the
worker, as the Heritage plan required. Not a winning issue for the
Heritage plan.
Another key difference was that the health insurance plan
Hillary would require the employer to buy would be a broad generous
plan covering everything. But the health insurance plan Heritage
would require the worker to buy would be a cheap bare bones basic
plan. So the issue was framed as which do you want: broad, generous
health coverage paid for by the employer, or cheap, bare bones
coverage paid for by the worker? It seemed more like the Heritage
plan was designed to fail politically.
Socialized Medicine
But that would be the best possible outcome. For if it
passed, the individual mandate would inevitably lead to full blown
socialized medicine. As I tried to explain to then Heritage
Director of Domestic Policy Stuart Butler, once the government
enacts an individual mandate for health insurance, then it must
specify exactly what health insurance, with what benefits and
coverage, would satisfy the mandate. Once the government enters
that political minefield, then politics would inevitably force it
to specify a broad, extremely expensive plan that covers everyone
and everything.
What and who could you leave out? Not mental health
benefits, drug and alcohol rehab, any uninsured no matter how sick
and costly once he or she first showed up, not any possible service
or treatment, each with its own little politically intractable
platoon of the afflicted expecting to benefit, and service
providers expecting to be paid to serve them.
The result would consequently inevitably be a mandate
requiring purchase of the most expensive health insurance possible,
as we will now see from Obamacare. That would inevitably lead to
outcries from those mandated to purchase the monster for government
help with the expense. We see that in Obamacare, too, with an
enormously expensive new entitlement program providing subsidies
for families earning close to $100,000 a year, and soon more than
that under an automatic index.
The explosive cost to the government of that assistance
would require the government to get involved in directly
controlling health care, in order to try to control costs. That
would result ultimately in government imposed health care
rationing, with bureaucrats ultimately deciding who gets what
health care and when. Hence we see in Obamacare the Independent
Payment Advisory Board, the entering wedge of the death panel,
eventually effectively supervising not just Medicare, but the
entire health care system. And we see already under Obamacare
government bureaucracies getting with the program, raising
questions for the first time about tests for breast and prostate
cancer, seeming to say that at a certain age if you have those life
threatening illnesses, the government doesn’t want to know about
it, or you to know about it either. And for the first time the FDA
is considering whether to approve therapies for life threatening
illnesses considering what they cost.
I had been close friends up until then with Stuart Butler,
even double dating a couple of times with our girlfriends and then
wives. Before he became Director of Domestic Policy, Heritage had
offered the job to then another friend of mine, Tony Pellechio. But
I wanted Stuart to get it, because I thought Stuart was more hard
core. So I talked Tony out of taking the job when he came to me to
ask what I thought he should do. Sure enough, Stuart was next in
line. Stuart does not know about this history almost 30 years ago
to this day.
Stuart had no response to my objections to the individual
mandate. But he was passionately devoted to the brilliance of the
Heritage health plan. I told him it was so close to the Hillary
plan, and so poorly framed as an alternative, that I predicted that
President Clinton would come to point to it as the GOP alternative
plan, and seek to get the Hillary plan passed as a compromise just
ironing out the differences (employer pays or worker pays, generous
health insurance or cheap health insurance).
Sure enough, a year later, as the Hillary plan was about
to go down to defeat, President Clinton arose to point to the
Heritage plan as the true GOP alternative, and offer to pass health
reform by just ironing out the differences. Fortunately by then, I
had already killed the Heritage health plan.
The Conservative Revolt
I fled Heritage near the end of 1993 to join John Goodman at
the National Center for Policy Analysis (NCPA). Together, Goodman
and I became the leaders ringing the alarm bells for the
conservative movement about the Heritage plan, and the dangers of
the individual mandate, as described above. My assignment at NCPA
was to kill the Heritage health plan.
Heritage had convinced then stalwart conservative Senator
Don Nickles from Oklahoma to introduce the Heritage plan. I went
through that long bill line by line and wrote up a summary section
by section of everything that was wrong about the bill from the
conservative perspective. I then got 37 major conservative leaders
to sign on to the petition. It was the only document in history to
be signed by both Phyllis Schlafly and Ed Crane. It was signed by
Grover Norquist and Paul Weyrich. It was a who’s who of the
leadership of the conservative movement at the time.
I then hand carried the document to the health policy
staff of Sen. Nickles. When Nickles saw the document, he abruptly
withdrew the bill. He thought in introducing the Heritage plan he
was providing leadership for the conservative movement. My
document/petition convinced him that was wrong.
To this day, my relationship with Stuart Butler and
Heritage has never recovered. Before then, I wrote regularly for
Heritage, contributing numerous Backgrounders, and writing whole
chapters of Mandate for Leadership I and II. Since then, I am lucky
if anyone from Heritage even talks to me, least of all Stuart
Butler.
I received rewards for my work in killing the Heritage
health plan from the American Conservative Union and Eagle Forum. I
now have the reward now of the whole conservative movement agreeing
that I was right all along.
