April 2, 2012 4 Comments
Avik Roy notes that most liberals have hated the individual mandate as a means of expanding health insurance coverage since the idea came about in the early 1990s, which is correct. As I wrote a couple of weeks ago, the flip flop on the individual mandate is telling for both conservatives and liberals.
For liberals and progressives, universal health insurance coverage is the holy grail, not just of health policy, but public policy. Many were willing to take the other sides idea becasue it was what could pass the House and the Senate and be signed by the President. They were willing to invest much political capital pushing the ACA even as they held their nose over many of the details, because it moved toward universal coverage.
The change of mind around the individual mandate is just as telling for Conservatives. I think the story that more Republican politicians were supportive of the individual mandate that rank and file conservatives, and conservative health policy types is likely true. For one thing, there really aren’t that many Conservative policy types that focus on health policy, and it is not a core issue that most conservative voters think a great deal about. And as Stuart Butler notes, one of the reasons that Republicans likely supported a mandate in the 1990s was so that they would have something with which to argue against the Clinton plan.
Progressives and liberals have shown a clear commitment to using any feasible approach to expand insurance coverage toward their ultimate health policy goal. Conservatives have mostly shown a clear commitment to arguing against the policies of progressives and liberals in the health policy realm. There is nothing about the historical record to suggest that Conservatives will be willing to expend political capital to advance a health reform proposal (briefly: idea, white paper, commerce and ways and means committee hearings and mark ups in the House, CBO, PR and political rallies, parsing of the plan by the other side, bazillion blog posts, full House vote, then to the SENATE!, etc).
I could be proven wrong and perhaps there will be a conservative health policy flourishing soon; only time will tell.