The Political History of the Individual Mandate

Avik Roy of Forbes has an interesting post outlining how numerous liberal politicians and activists vociferously opposed the individual health insurance mandate until it was incorporated into the Obama administration’s health care plan. As Roy notes, Obama himself strongly opposed the mandate when Hillary Clinton proposed it during the 2008 presidential campaign. He was far from alone. A few liberal politicians and activists continue to oppose the mandate today, most notably Howard Dean. Most others have fallen in line with the administration.

In an earlier post, Roy covered the “tortuous” history of conservative and libertarian attitudes to the mandate. Many conservatives did indeed support the idea during the 1990s and early 2000s, including Newt Gingrich, and Mitt Romney, who made it the centerpiece of his Massachusetts health care plan. The conservative Heritage Foundation first developed the mandate plan back in 1989, though their proposal was in some respects different from Obama’s and Romney’s. On the other hand, as Roy notes, many other conservatives – and the vast majority of libertarians – opposed the idea all along. I was a college student intern at Heritage back in 1994, not long after the political battle over Bill Clinton’s health care plan. Although I didn’t work on health care policy myself, I well remember the ongoing war of words between Heritage and the libertarian Cato Institute over the Heritage individual mandate plan, which Cato opposed. So too did leading free market health care and entitlement experts such as John Goodman and Peter Ferrara.

In sum, there are plenty of politicians in both parties who have switched sides over the mandate for what may well be opportunistic reasons: Gingrich, Romney, and Obama are all good examples. On the other hand, it is not true that all or even most opposition to the mandate on the right is purely opportunistic. Many conservatives and libertarians have opposed the idea for almost twenty years now, including back when it was advocated by Republicans. On the left, it is fair to point out that some of those who endorsed Obama’s plan have done so because they see it as a lesser evil compared to the previous status quo.

UPDATE: Co-blogger Jonathan Adler covered some of the relevant history in this post.