Talk to most health care policy experts and your head will start spinning in a matter of moments. It's a complicated issue, often in public discourse boiled down to the simplest, and sometimes incorrect, form.
Two recent milestones in health care law -- the first anniversary of the Affordable Care Act and the five-year anniversary of the Massachusetts health law -- have given me reason to look back at the trajectory of the health care debate through one group of experts.
The Heritage Foundation, a conservative think tank, is a leading voice opposing the national health care law and, in particular, the requirement that most Americans buy health insurance. The group's experts have written extensively on the idea that the mandate is unconstitutional. In a primer for the new Congress, it suggested blocking funding to the Internal Revenue Service to implement the mandate.
But in 1990, the Heritage Foundation published a document that one expert said was among the first proposals to include a national mandate. Robert Field, a Drexel University health policy professor pointed this document out to me. The authors propose a "health care social compact." Individuals would receive tax breaks for buying health insurance and "government would require, by law, every head of household to acquire at least a basic health plan for his or her family."
Field, who has written about this issue on his blog for the Philadelphia Inquirer, wondered why they changed their mind.
ďThe cynical take on this is that it's all partisanship," he said. "Itís not really ideology. It's not really free market versus government." As soon as the Democrats take up an idea, "all of a sudden it's socialism."
I posed the question to Robert Moffit, senior fellow at the Heritage Foundation Center for Policy Innovation and author of a new book, "Why ObamaCare is Wrong for America."
He said the idea that the foundation jumped the mandate ship as soon as the Democrats came on board is wrong. The group was pulling back on it a decade ago, he said. They had decided that the mandate was unnecessary, that reform could happen by automatically enrolling people in their employer health plans and allowing for individual tax benefits.
But the Massachusetts law includes a state-level mandate and the Heritage Foundation was "front and center" promoting the bill, said Brian Rosman, research director at Health Care For All.
Moffit himself spoke at the celebratory signing. He supported the state's effort, he said, but not the mandate. And three months after the signing, he and a colleague published on that point.
He said the central question is this: How much of your personal liberties are you willing to give up in order to reach the goal of insuring more people?
ďMost of our fellow Americans donít like being pushed around," he said.
How did they feel about it in 1990?, I asked.
"You're question is, 'Well didnít you think about this before?' And the answer is, 'Yes, we did,' " he said. But the foundation chose to support a mandate then. With more research about the uninsured and the nature of the market, "we changed our minds."
We changed our minds - not something you hear a lot, though it happens often. Afterall, Moffit points out, President Obama changed his mind on the mandate, too.
What all this demonstrates to me is the trouble with bumper sticker political rhetoric: Repeal and replace - but remember who thought of it first.
About white coat notes
|White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at email@example.com. Follow her on Twitter: @cconaboy.|
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