The World That Was

Via Bruce Bartlett, here’s the Heritage Foundation’s Stuart Butler laying out the framework for a regulate/mandate/subsidize approach to universal health care back in 2003 congressional testimony:

But as part of that [social] contract, it is also reasonable to expect residents of the society who can do so to contribute an appropriate amount to their own health care. This translates into a requirement on individuals to enroll themselves and their dependents in at least a basic health plan — one that at the minimum should protect the rest of society from large and unexpected medical costs incurred by the family. And as any social contract, there would also be an obligation on society. To the extent that the family cannot reasonably afford reasonable basic coverage, the rest of society, via government, should take responsibility for financing that minimum coverage.


The obligations on individuals does not have to be a “hard” mandate, in the sense that failure to obtain coverage would be illegal. It could be a “soft” mandate, meaning that failure to obtain coverage could result in the loss of tax benefits and other government entitlements.

Now of course I’ll grant that neither Butler’s plan nor the version of this plan touted by Ron Bailey in Reason in 2003 is exactly the same as what you find in the Affordable Care Act. But that’s exactly the point. Conservatives could, if they wanted to, have offered something like what Butler or Bailey favor as an alternative and then compromised between Obama’s ideas and this Butler/Bailey alternative. That would have probably meant a less-generous minimum benefits package and less reliance on Medicaid expansion. But instead the right chose to gamble on the idea of totally defeating the Obama administration and they wound up with a more leftwing policy than otherwise would have been the case. And they have only themselves to blame.