The conservative Heritage Foundation indignantly denies influencing Obamacare.
By Timothy Noah
Updated: Apr 19, 06:54 PM
It's no surprise that Mitt Romney bent himself into a pretzel to disavow the
portions of Obamacare that derive from his own reform in Massachusetts. Romney
is a politician, and even politicians with more spine than Romney (i.e., nearly
all of them) are sometimes forced into awkward postures by the shifting
dynamics of electoral politics. But naif that I am, I figured the conservative
think tanks that developed these same policies would, if they couldn't bring
themselves to claim authorship, at least maintain a discreet silence. I was
wrong.
"Obama's Health Reform Isn't Modeled After Heritage Foundation Ideas" reads the
headline of an April 19 op-ed in the Washington Post. The author, Robert
Moffit, is director of Heritage's Center for Health Policy Studies. Moffit's
piece is a response to President Obama's comment, in a March 30 an interview
with Matt Lauer on NBC's Today, that the idea for health-insurance exchanges
"originated from the Heritage Foundation." Actually, Heritage didn't invent the
exchanges idea, but it certainly helped develop it. In his new book No Apology,
Romney writes:[T]o make it easier for insurers to service individual customers,
the state would create a "connector" or "exchange" that would collect premiums
and pass them on to the insurers. The Heritage Foundation helped us construct
an exchange that would make individual premium payments tax-advantaged,
lowering costs even further.
Until recently, Heritage was quite willing to associate itself with Romneycare,
but that appears to have changed. The words Romney and Massachusetts appear
nowhere in Moffit's op-ed, probably because the Conintern has lately concluded
that Obamacare renders Romney damaged goods. (See this withering Fox News
interview with Chris Wallace, this dismissal from the libertarian Club For
Growth, this video from David Boaz and Michael F. Cannon of Cato, and this
editorial from the Wall Street Journal, which called Obamacare and Romneycare
"fraternal policy twins." Ouch!)
Obama's comment to Lauer clearly alarmed Heritage. Its president, Ed Feulner,
posted a blog item that same day to protest "this misuse of our work and abuse
of our name." He wrote, "True exchanges are simply a market mechanism to enable
families to choose their health insurance. President Obama's exchanges, by
contrast, are a vehicle to introduce sweeping regulation." But under
Romneycare, as under Obamacare, government sets minimum standards (i.e.,
creates regulations) concerning what health insurers may cover. Feulner steered
around this by avoiding, like Moffit, any mention of the now-leprous Romney.
The next day, Heritage posted a snippet from Rush Limbaugh's radio show to
refute yet again the president's scandalous attribution. Limbaugh said:[Y]ou
just heard it, [Obama] tried to explain that the insurance exchange he
envisions being built by government is an idea that came from Heritage in the
first place! And nothing could be further from the truth! Heritage approves of
a market-driven approach that allows families to choose their own health
insurance, not government bureaucrats. … There's nothing in this that
Republicans suggested. Nothing at all! The Heritage Foundation never once has
proposed government-run exchanges.
Wrong. Under every exchange proposal ever considered, including Heritage's,
health insurance exchanges are "built by government" at either the state or the
federal level.
Moffit's op-ed is Heritage's third attempt at damage control. "For us," Moffit
explains, "the health insurance exchange is to be designed by the states
[italics mine]." The federalist argument that health exchanges are good if
created by states but bad if created by Washington is one Romney's tried, too.
Moffit had better hope it sounds more plausible to the Conintern coming from
him than it does from the former Massachusetts governor. Anyway, the idea that
Heritage has never advocated a health exchange created by the federal
government simply isn't true. As recently as Nov. 2008, Heritage's Stuart
Butler described the exchange as "a nonprofit organization chartered by the
government." The "government" Butler referred to was clearly the federal
government. A 1993 Heritage paper by Butler offering an alternative to the
Clinton plan ("Why Conservatives Need a National Health Plan") was similarly
focused at the federal level.
Butler did caution that "it's better to have exchanges operate at the state
level." But he added: "Sure, general goals could be set at the national level,
but if state health experts can figure a better way to reach those goals, let
them try." Under Obamacare, the exchanges operate at … the state level. They
must abide by national coverage standards that constitute more than "general
goals." But under language inserted by Rep. Ron Wyden, D-Ore., the
health-reform law further provides that if any given state can find a way to
achieve the same outcome with some alternative mechanism, it is more than
welcome to do so. (See Section 1332, "Waiver For State Innovation.")
What about the individual mandate, which requires everyone to purchase health
insurance? Here Moffit tries a different gambit. He admits that in the early
1990s, "we, along with other prominent conservative economists, supported the
idea of such a mandate." But "[o]ur research in the ensuing two decades has led
us to realize our initial idea was operationally ineffective and legally
defective." Feulner made similar reference to "further developed research."
One pictures Louis Pasteur peering into his microscope. But to judge from the
2008 journal article Moffit cites in defense of this claim, the "research"
Moffit cites consisted mainly of observing that the individual mandate had
proved very controversial in the presidential election. The proposal Moffit
offered in its place required that "every individual should explicitly accept
or reject health insurance coverage, and those who reject coverage should be
required to demonstrate that they are willing and able to pay their medical
bills and formally acknowledge the potential consequences of their failure to
do so." This strikes me as somewhat more intrusive than the individual mandate,
from which it is otherwise not appreciably different. How can you "demonstrate"
your ability to pay medical bills if you lack any foreknowledge of what those
bills might conceivably be? Only by acquiring a health insurance policy.
Ironically, in his Nov. 2008 paper, Butler stated precisely the opposite of
what Moffit, Feulner, and Limbaugh are screaming at the top of their lungs now.
"The president-elect didn't invent the idea of a health exchange," Butler
wrote. "He came up with his own version of an idea that's been refined by
people like us at the Heritage Foundation and already field tested." If
anything, back then Heritage seemed slightly miffed that it wasn't getting
credit for having developed the idea. There's just no pleasing some people.
E-mail Timothy Noah at [email protected]
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