• Stuart Butler’s change of mind

    Stuart Butler of the Heritage Foundation had a piece in USA Today over the weekend defending his opposition to the individual mandate and the ACA in spite of advocating for an individual mandate in the past. In fact, virtually all of the undergrads in my Fall 2011 Intro to the U.S. Health System class identified Butler and the Heritage Foundation as the ‘intellectual fathers’ of the mandate in their final semester long research paper on the mandate and the ACA (post at semester beginning, follow up post at the end).

    One of the most interesting things about Stuart’s piece in USA Today is that it doesn’t actually link to the initial document he wrote on the individual mandate in 1989 (his piece contains many other links). You can read it for yourself and his reasoning for changing his mind and then decide for yourself whether you think his (and Heritage’s) consistent and vociferous opposition to the ACA is consistent with their past views.

    In Suart’s piece, he says there are three key reasons that his past support of an individual mandate does not make his current opposition ironic or inconsistent.

    • Deep Motivation. He says he supported an individual mandate to protect everyone else from the uninsured (cost shifting), whereas the motivation behind the ACA’s individual mandate is to get persons to purchase expansive coverage for themselves.
    • Corollary policies. He proposed modification of the tax treatment of employer paid insurance and then providing subsidy to encourage persons to purchase catastrophic insurance on their own, encouraged by an individual mandate. And instead of a penalty/tax as in the ACA, he says his preferred option was someone who did not comply would simply not get the subsidy to purchase insurance.
    • Tactical Motivation. The individual mandate was most actively pushed in opposition to the Clinton Plan, which had an employer mandate at its heart. Opponents of the Clinton Plan needed something through which to oppose the Clinton Plan, and the individual mandate fit the bill.

    I completely believe the last reason noted above that motivated Butler and others to support the individual mandate in the past. On the first two, I am not so sure the distinctions warrant the degree of opposition to the ACA, but of course I can’t know the mind and motivations of another person, and my own perspective is cooked into that assessment. One of my goals as a blogger is to give people the benefit of the doubt (I like it when they do the same for me), and one thing I want to totally concur with Butler about is the correctness of being able to change one’s mind:

    Changing one’s mind about the best policy to pursue — but not one’s principles — is part of being a researcher at a major think tank such as Heritage or the Brookings Institution. Serious professional analysts actually take part in a continuous bipartisan and collegial discussion about major policy questions. We read each other’s research. We look at the facts. We talk through ideas with those who agree or disagree with us. And we change our policy views over time based on new facts, new research or good counterarguments.

    It is actually a bad sign if you never change your mind about anything. I appreciate Stuart giving an account for why he did so in this case, even if I don’t find it to be totally convincing.


    • His denial is very strange. He says he did not support or create the individual mandate, then goes on to say that they needed it to oppose Clinton’s plan. This denial does not ring true at all. I think it pretty clear from his own words that they supported a mandate, they just wanted it to require a more limited insurance product.

      I think it is fine if he changed his mind, and now thinks it would be wrong to use a mandate to require any level of insurance. However, if he chooses to address this issue, then I think it also fair to say that a Democratic proposal that used the mandate was not some far out socialist idea. It is truly based upon the Heritage idea, but with a more comprehensive insurance plan and a larger subsidy.


    • I think you guys are being mostly fair, even if in the end you aren’t buying Butler’s change of heart. But, are you doubting that if not for Obama, Heritage would still favor a mandate? That is certainly not likely as Heritage has never been a proponent of government meddling in health insurance market. It is quite one thing for Heritage to try to make a bad policy somewhat less objectionale — quite another to then say that Heritage favored the whole mess. Why is context so hard to grasp?

    • @art
      the 1989 piece from Heritage comes long before the Clinton proposal so it seems that Heritage was proactively pushing a health reform notion. Their materials were USED to block another proposal. I think that the balance of evidence suggests that the Republican party is very good on defense when it comes to health reform, but doesn’t know how to play offense (which would mean committing political capital to push ideas and plans).

      I agree that context is key, and that is why the vociferousness of the opposition to the ACA makes little sense outside of my side v. yours. In policy terms, there were plenty of ways to say I am opposed but would rather use soft mandates instead of penalties/tax etc. that would have oriented the convo to the policy