Back in October 1989 the conservative Heritage Foundation published Stuart Butler’s seminal work in support of the individual mandate concept. I disagree with the popular media’s characterization that the individual mandate is the lynchpin of the Affordable Care Act, but that is probably because I’m one of the few people who actually read the entire Act.
It is still noteworthy that the IM concept made its way from Butler’s effective argumentation in the Heritage Lectures to 1993 legislation introduced by Republican Sen. John Chafee of Rhode Island: the Health Equity and Access Reform Today (HEART) Act of 1993. The IM provision of the HEART Act was to take effect in January of 2005 (more than a decade after enactment). It was introduced as an option to the Clinton plan, which included a mandate on employers to provide insurance for their workers – a provision that many Republicans found very troubling.
It’s an inaccurate and implausible leap to posit that Republicans introduced and supported the IM before they were against it. You need to have political context to understand the IM concept included in the ACA is not the same as what was contemplated in 1993. Nonetheless, the HEART Act attracted 19 Republican senator sponsors or co-sponsors, including then minority leader Bob Dole. So it is also inaccurate to assert the IM is anathema to Republican thinking, and it is certainly more than a tad ironic that the current lot of Republicans would shut down the government over an issue they were previously willing to include as at least part of the US healthcare financing solution.
So now fast forward to 2013, and those crazy Republicans are at it again. But this time they’re sights are set on a much more difficult challenge: financing long-term care expenditures. At a hearing this past week on the future of long-term care care and how to pay for it, Senator Susan Collins (R-Maine), ranking member of the Special Committee on Aging, stopped well short of endorsing an IM mechanism to fund long-term care. But she sure sounded like it could be a viable alternative (see reference to HEART Act, above).
Senator Collins noted that long-term care is the, “major catastrophic health expense” facing seniors today. She added that, “families can only do so much…” and that, “a viable insurance mechanism” that could be public, private or some combination is needed to address this challenge. “Even when people are educated about the risks of long-term care and are presented with long-term care insurance policies, we will not truly address financing without requiring everyone to participate,” she said.
Gee, I dunno, but that sure sounds like being in favor of a mandate to me. And it’s probably the only reasonable and pragmatic solution to ultimately addressing the realities of financing a comprehensive and compassionate approach to long-term services and support for those unable to afford such care. I wonder if Collins will be hung in effigy by the Tea Party for thinking about the contingent realities that must be addressed by a caring society when the failure of self sufficiency manifests in a loved one unable to care for themself.