If you’d been out of the loop for the last three years or so and picked up a newspaper today, you might be more than a bit surprised to learn that Barack Obama’s entire legacy as president seems bound up in his administration’s defense of a health insurance purchasing mandate, in the midst of near-universal shrieking about the imminent death of freedom from conservatives.
The Washington Post’s N.C. Aizenman has the rundown, if you’re not already familiar with it:
The individual insurance mandate, which requires virtually all Americans to obtain health coverage or pay a fine, was the brainchild of conservative economists and embraced by some of the nation’s most prominent Republicans for nearly two decades. Yet today many of those champions — including presidential hopefuls Mitt Romney and Newt Gingrich — are among the mandate’s most vocal critics.
Meanwhile, even as Democratic stalwarts warmed to the idea in recent years, one of the last holdouts was the man whose political fate is now most closely intertwined with the mandate: President Obama.
You can read the whole thing, but the essential facts are that the individual mandate was born at the Heritage Foundation and became the default-drive mechanism in a generation of Republican health care reform proposals for protecting against “free riders” in otherwise voluntary, private-sector based systems for expanded coverage. It only became attractive to Democrats when they decided a similar approach could command bipartisan support—as it had in Massachusetts—as opposed to the more government-centered proposals progressives had embraced in the past.
By 2008, Republicans had begun moving away from any real interest in universal health coverage, but the mandate idea had not become actual heresy, much less toxic. And meanwhile, in the Democratic presidential nomination contest, Obama’s reluctance to accept the individual mandate—arguing that subsidies could lure enough people into a voluntary universal coverage system to make coercion unnecessary—became the single best-known policy difference separating him from Hillary Clinton. Budget realities as he took office quickly dissuaded Obama from the idea that sufficiently large subsidies could be offered to rapidly expand health coverage, so he embraced the mandate idea even as Repuoblicans turned radically against it under pressure from Tea Folk and in the pursuit of their own determination to oppose the new president’s every move.
The rest, as they say, is history.
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