In her opening remarks at the Western Republican Leadership
Conference Debate, Minnesota Rep. Michele Bachmann quipped, “And
this is one night when I hope what happens in Vegas doesn’t stay in
Vegas.” The eventual Republican nominee will probably hope
differently, but to no avail.
The Las Vegas debate featured a fascinating exchange, sure to
come up in the general election, where GOP presidential candidates
sparred over who was in favor of the government forcing people to
buy health insurance first.
“So there’s a lot of big government behind Romneycare,” former
House Speaker Newt Gingrich said in reference to Massachusetts’
state health care reform law. “Not as much as Obamacare, but a heck
of a lot more than your campaign is admitting.”
“Actually, Newt, we got the idea of an individual mandate from
you,” former Massachusetts Gov. Mitt Romney replied in his
rebuttal. “That’s not true,” Gingrich shot back. “You got it from
the Heritage Foundation.”
“Yes, we got it from you,” Romney repeated, “and you got it from
the Heritage Foundation and from you [sic].” “Wait a second,”
Gingrich again corrected. “What you just said is not true. You did
not get that from me. You got it from the Heritage Foundation.”
“And you never supported them?”
“I agree with them,” Gingrich conceded, “but I’m just saying,
what you said to this audience just now plain wasn’t true.”
“OK,” Romney answered. “Let me ask, have you supported in the
past an individual mandate?”
“I absolutely did,” Gingrich said, “with the Heritage Foundation
against Hillarycare.”
To recap: two leading candidates to replace President Barack
Obama, in an election that will be fought in part on the issue of
repealing and replacing Obama’s health care plan, highlight their
past support for the individual mandate and argue over who thought
of it first. The individual mandate is one of the most unpopular
provisions of Obama’s Patient Protection and Affordable Care Act.
It is also the most constitutionally dubious, which is why it has
been the main focus of the multi-state legal challenge to
Obamacare.
Not only did these two Republican presidential candidates
emphasize their own history with the individual mandate. They also
implicated the Clinton-era Republican congressional leadership and
the country’s leading conservative think tank. Politically, this
could make anti-Obamacare arguments seem more partisan than
principled. Legally, it could undermine arguments that the
individual mandate is outside the mainstream even for post-New Deal
commerce clause jurisprudence.
It is true that neither the Heritage Foundation nor the
Republican congressional leadership supported an individual mandate
as unqualified as Obamacare’s. It is also the case that much of
this support was tentative and relatively short-lived. Wall Street Journal editorial board member
and TAS Presswatch columnist
James Taranto was a public relations associate for Heritage when
the mandate was being proposed. “Whatever the particular
differences, the Heritage mandate was indistinguishable
in principle from the ObamaCare one,”
Taranto wrote this fall in his WSJ column. “In both cases, the federal
government would force individuals to purchase a product from a
private company—something that Congress has never done before.”
“What’s done is done” is an old cliché. But there is a larger
problem at work here, illustrated by Gingrich’s offhand comment
that he supported an individual mandate “against Hillarycare,” that
puts Republicans on the defensive when it comes to health care
reform. “Rather than make a prolonged case for health policy that
does not involve endless expansion of entitlements and insurance
subsidies,” observed Reason’s
Peter Suderman, “the GOP has instead focused primarily on reacting
to Democratic proposals.”
When Republicans wanted to block Hillary Clinton’s health care
plan in 1993–94, with its dreaded employer mandate, they tried to
achieve universal coverage on their own with an individual mandate.
Liberal Republican Sen. John Chafee of Rhode Island, a disciple of
Nelson Rockefeller, was Bob Dole’s point man for crafting a bill to
preempt Hillarycare. Chafee’s proposal naturally contained an
individual mandate. (It should be noted that many conservatives
inside and outside Congress opposed the Dole-Chafee alternative as
well.)
MITT ROMNEY was hardly the only Republican to join forces with
Ted Kennedy on health care. In 1996, Kansas GOP Sen. Nancy Landon
Kassebaum paired with the Massachusetts liberal (Kennedy, not
Romney) to advance a bill that aimed at increasing the portability
of health insurance between jobs and limiting insurer exclusions
for preexisting conditions. The following year, Kennedy teamed up
with Utah Republican Sen. Orrin Hatch to create the State
Children’s Health Insurance Program (SCHIP).
President Bill Clinton signed both bipartisan measures into law.
Kennedy-Kassebaum mostly expanded regulations, while SCHIP spent
federal money to provide state governments with matching funds to
buy health insurance for families with children who earned too much
to qualify for Medicaid. A block grant rather than an open-ended
entitlement, SCHIP was expanded over Republican objections—and
following two Bush vetoes—by the Obama administration in 2009.
These Republican excursions into health care were at best only
secondarily about improving real problems with the medical system.
The main objective, it seemed, was to make the issue go away until
the next election. But these cheaper knock-offs of Democratic
proposals at least had the benefit of being relatively small. Not
so the Medicare prescription drug benefit.
In the close 2000 presidential race, ultimately decided in
Florida, both George W. Bush and Al Gore supported Medicare
coverage of prescription drugs. Rising drug costs were a problem
for senior citizens and the lack of a drug benefit seemed a defect
in the Medicare system. The idea polled well, especially among
older Americans. Bush’s version was supposed to avoid price
controls and as large a government program as the Democratic
alternative.
What we ended up with was the biggest new entitlement since the
Great Society. To be sure, the plan Bush signed into law contained
some free-market elements, like Medicare Advantage, and was
projected to cost less than the Democratic bill. But Medicare Part
D still added anywhere from $8 trillion to $15.5 trillion to the
federal senior health program’s already substantial unfunded
liabilities. Not for nothing did former U.S. Comptroller General
David Walker call the bill “the most fiscally irresponsible piece
of legislation since the 1960s.”
“It’s important to remember that the congressional budget
resolution capped the projected cost of the drug benefit at $400
billion over 10 years,” Bruce Bartlett later wrote in Forbes. Otherwise the bill was vulnerable
to a point of order under congressional rules. But Richard Foster,
Medicare’s chief actuary, believed it would cost more than $534
billion over the same period.
Foster later alleged that a Republican appointee in the Bush
Health and Human Services Department had threatened to fire him if
he blew the whistle on the prescription drug benefit’s cost. Foster
wasn’t the only one that Republican leadership had to sway by
extraordinary means. Michigan GOP Rep. Nick Smith claimed that his
colleagues promised that his son would be guaranteed to succeed him
in Congress if he voted for the bill. House Republican leaders had
to extend the vote past the standard 15-minute window to get the
legislation enacted.
Yet it is beyond dispute that the new benefit was entirely
unfunded by new revenues or spending cuts. This fact later weakened
Republican arguments against Obamacare, which the Congressional
Budget Office (rather implausibly) scored as deficit-neutral.
Republicans then simultaneously complained both that Obamacare
increased federal expenditures and also that it cut $500 billion
from Medicare (I explored the implications of the latter in detail
in the November issue).
EVEN WHEN IT became clear that Paul Ryan was going to become
chairman of the House Budget Committee, Republican leaders appeared
reluctant to spell out specific proposals for entitlement reform or
embrace the details of Ryan’s health care proposals as contained in
his early budget blueprints. “Is it any surprise that most
Republican politicians failed to sell the Ryan budget to the
public?” Reason’s Suderman
asked after the NY-26 special election, in which a Republican
supporter of the Ryan plan was defeated. “It was never clear that
most of them actually bought it themselves.”
An accurate appraisal of Republican Medicare failures, this is
even truer when it comes to health care reform more generally. In
2008, John McCain included in his platform a fairly ambitious
free-market health care plan. Its centerpiece was an insurance tax
credit for individuals, to replace the untaxed health care benefits
largely provided by employers. Obama relentlessly attacked it as a
tax increase on employer-provided health insurance (such a tax
eventually became part of Obamacare). McCain was largely silent in
response and after the election consigned his proposal to the same
fate as other Republican presidential candidates’ health care
plans: unveiled during the campaign season and then ignored
afterward, not least by the candidates’ themselves. Paul Ryan, who
is trying to revive the tax credit, would later say, “He did a
very, very poor job of explaining the idea.”
Ryan is very, very much an outlier in his own party. After
Hillarycare was defeated, costing Democrats control of Congress in
1994, many Republicans appeared to think they would never have to
tackle the health care issue again or that co-authoring small
SCHIP-style programs with Kennedy would do the trick. Others ended
up tinkering with health care reform ideas that ended up looking a
lot like Obamacare. But that just assured that when health care
returned to the political forefront, it would be when the Democrats
were in power—and would be done exclusively on Democratic
terms.
It is a sad irony that many ambitious Republicans wasted two
decades toying with the system of exchanges, subsidies, and
mandates that eventually became Obamacare. It would be even sadder
if continued Republican short-sightedness contributed to making
this state of affairs permanent.
