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Smart Bombs: Mandate mavens turn mad

In last week’s episode of “Mad Men,” Roger Sterling watches Don Draper’s slinky new wife perform a French serenade, and then quips, “The only thing worse than not getting what you want is someone else getting it.”

That must be the feeling of former proponents of a health insurance mandate.

In 1989, the conservative Heritage Foundation was worried that America’s health care costs had risen to 11 percent of the nation’s gross domestic product (it’s 18 percent now), so it hatched a national health care concept that included a mandate for all people to purchase basic coverage.

Many Republicans lined up behind the plan, but nothing came of it. When Bill Clinton was elected president in 1992, he pursued a different type of health care reform. In response, congressional Republicans launched bills that revived the mandate. Neither bid was successful.

Fast forward to the present, and it’s Democrats who are holding the mandate trophy, and it’s Republicans who are hoping the Supreme Court will take it away. It gets even stranger, because as recently as 2008, Barack Obama was against a mandate, and Mitt Romney, as governor of Massachusetts, supported one as the linchpin to his state’s health care reform. Now these two politicians have swapped scripts.

Why is a mandate necessary for this particular product? The Heritage Foundation’s Stuart M. Butler made the case 23 years ago:

“If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate but 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 or 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 – even if that means more prudent citizens end up paying the tab.”

This is precisely what happens, in part, because of another government mandate known as the Emergency Medical Treatment and Active Labor Act, which Congress passed in 1986. Under this law, hospitals must provide services to anyone needing emergency care, regardless of their ability to pay. Libertarian-leaning Ron Paul is the rare politician who has expressed regret over this law, saying during a debate that hospitals should be allowed to ignore an ailing person who can’t or won’t pay.

Nobody is talking about repealing this humane mandate, and as long as it’s there, the costs for aiding the uninsured will be passed along to others. This simple fact seems hopelessly lost on the “Don’t Tread on Me” chorus. Americans are already getting trampled to the tune of $43 billion a year, according to a 2008 congressional estimate. The cost to Washington state families averages about $1,000 a year, says state Insurance Commissioner Mike Kreidler.

What’s lost in the debate is that our country already has universal care. Associate Supreme Court Justice Anthony Kennedy misses this point when he asks, “Can you create commerce to regulate it?”

Create commerce? It’s already here. According to a brief filed with the Supreme Court, about 4 out of 5 Americans participate in the health care market annually, and nearly everyone does over a five-year span. The mandate is more about getting deadbeats to pay their inevitable bills. If they don’t want to, then they can pay a penalty. It’s the same situation facing industrial polluters: Clean up or pay up, because the mess affects us all. Does this mean some polluters end up with scrubbers and other equipment they otherwise wouldn’t buy? Yep. That’s the whole point.

In 1994, Robert E. Moffitt of the Heritage Foundation wrote a response to libertarian critics of the mandate who were complaining that it infringed on individual liberty. His essay concluded: “It is idle to talk about personal freedom outside of personal responsibility.”

But, guess what? The Fathers of the Mandate – and the conservative leaders who touted it – have turned against their progeny. Currently at the Heritage website, you can read an essay about why such an idea is unconstitutional. It’s the longest-delayed “never mind” in policy history.

If you find this change of heart puzzling, I’m sure Roger Sterling can explain it.

Associate Editor Gary Crooks can be reached at or (509) 459-5026. Follow him on Twitter at @GaryCrooks.


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