Sunday, July 30, 2017

Heritage On Health, 1989 By Paul Krugman



Every once in a while people make the point that much of what eventually became Obamacare came from, of all places, the Heritage Foundation – that is, the ACA is basically what conservatives used to advocate on health care. So I recently reread Stuart Butler’s 1989 Heritage Foundation lecture, “Assuring Affordable Health Care For All Americans” – hmm, where have I seen similar language? — to see how true that is; and the answer is, it really is pretty much true.

First of all, this wasn’t just one guy at Heritage writing: Butler referred to his proposal as “the Heritage plan”, referring to a monograph that lays it out and does indeed present it as the institution’s policy, not just his opinion.

Second, while the Heritage plan wasn’t exactly the same as ObamaRomneycare, it was pretty close. Like the ACA, it imposed a mandate requiring that everyone buy an acceptable level of coverage. Also like the ACA, it proposed subsidies to make sure that everyone could in fact afford that coverage. That’s two legs of the three-legged stool.

Where the plan differed was in the handling of pre-existing conditions. Butler opposed community rating, viewing it as an indirect tax on the healthy – but called instead for big subsidized high-risk pools to cover those private insurers would otherwise shun.

I have real doubts about whether this would have been workable. But two things about it are notable. (1) The Heritage plan would have required bigger, not smaller, government spending; that is, on-budget outlays would have been larger. (2) The piece of the ACA Heritage didn’t want was the part that’s actually most popular with the public.

Overall, what’s striking about the Heritage plan is that it’s not notably more conservative than what Obama actually implemented: a bit less regulation, a substantial amount of additional spending. If Obamacare is an extreme leftist measure, as so many Republicans claim, the Heritage Foundation in the 1980s was a leftist institution.

NYT

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