The New Health Dialogue

Julie Rovner of NPR  helpfully explained that the individual mandate -- you know, the one some Republicans have been portraying as an evil, unconstitutional, liberty-squelching abomination -- was actually … a Republican idea. An idea backed in the past by some of the same senators who deem it unacceptable today.

The individual mandate (which some of my colleagues here at the New America Foundation had made a signature issue long before I ever got to New America) dates back to the Bush I presidency. It’s generally attributed to Mark Pauly a health policy expert at Penn's WhartonSchool. New America’s Len Nichols was quoted in the NPR piece saying that the individual mandate was designed “as a competition to the employer mandate focus of the Democrats at the time."

Pauly told NPR it wasn’t his idea alone. Faced with Democratic support for the employer mandate or a single-payer system, Pauly said, "a group of economists and health policy people, market-oriented, sat down and said, 'Let's see if we can come up with a health reform proposal that would preserve a role for markets but would also achieve universal coverage.'"

"We called this responsible national health insurance," Pauly said. "There was kind of an ethical and moral support for the notion that people shouldn't be allowed to free-ride on the charity of fellow citizens."

No mandate materialized during Bush I, but the concept became a lynchpin of a plan moderate Republicans put forth as an alternative during the Clinton health care push. Four of the Republican co-sponsors -- Orrin Hatch of Utah, Charles Grassley of Iowa, Robert Bennett of Utah and Christopher Bond of Missouri -- still serve in the Senate today. But they are no longer embracing the individual mandate. Not even close. That change, says Pauly, a very thoughtful conservative, is “not something that makes me particularly happy.”

Julie Rovner pointed out -- as Len has said in his recent posts on this blog -- that a lot of the ideas in the House and particularly the Senate health reform bills are ideas that Republicanswere for -- before they were against them. That includes purchasing pools, standardized insurance plans, barring insurers from excluding people with pre-existing conditions, comparative effectiveness research. But whatever agreement that existed in the past has evaporated. President Obama hopes to shake up the hardened position at the summit next week. It's not an easy task.

Len got an email after the NPR piece aired from a woman in Indianapolis. She wanted to know how to make the public more aware of this history -- particularly before the White House health summit next week. We’re doing our best, and other writers and bloggers are too. Ezra Klein did a particularly good post recently on the Republican ideas that have become part of the Democratic mainstream, and I wrote a bit about some of the bipartisan shifts in outlook during the Nixon years.

She also wondered if all the health policy experts and foundations and universities can form a coalition to support health reform. We haven’t formed a formal coalition, and there are limits (in the tax code) to what educational nonprofits can do in terms of advocacy and endorsement. But we and other think tanks and foundations and academic institutions have been writing and talking and trying to shed light on a complex topic. For some of the work we’ve done at New America, check out our health policy home page. Click on "program links" at the top right for a more detailed break down of our work here. If the woman from Indiana is reading this, we would also say, tell your friends about what you heard on NPR. Tell them about what we've been doing. And then tell your representatives in the House and the Senate that it's time for health care reform.