Original 1989 document where Heritage Foundation created Obamacare’s individual mandate

Republicans are on a renewed kick to try to repeal, or at least delay (in the hopes of killing), the “individual mandate” that’s included in the President’s health care reform law, aka the Affordable Care Act, aka Obamacare.

The irony, of course, is that it was Republicans, via their premiere think tank, the Heritage Foundation, who came up with the idea in the first place.

As you know, the “individual mandate” requires that every American buy health insurance, if they don’t have it through their work, or pay a penalty.

The individual mandate really is one of the key underpinnings of Obamacare, because without it there’s concern that everyone’s policies might be too expensive.  Here’s more on the mandate from Kaiser Health News:

The health law was designed to extend insurance to nearly all people, including those who have medical conditions that require expensive care and are often denied coverage today. But to pay for their care, insurance companies need to have a large enrollment of consumers, especially young and healthy people who use fewer services. The mandate was adopted to guarantee a broad base.

Topher Spiro, the vice president of health policy at the Center for American Progress, a left-leaning nonprofit that supports the law, says it will be more effective with the mandate than without it. “This individual mandate is to keep premiums low for everyone,” he said, noting that “if you don’t have incentives for everyone to sign up for coverage then only the sick people will enroll which will drive up premiums.”

But others suggest the mandate won’t be effective because the penalties are set so much lower than the cost of coverage.

As you also know, the Republicans shut down the entire federal government, and were on the verge of forcing the United States to default on its debt, likely sending the world into a Depression, in order to force the outright repeal of Obamacare, its defunding, or at the very least a delay in the individual mandate.

The funny thing is that it was the Republicans who came up with the idea in the first, as first described by Stuart Butler in a publication for the very conservative Heritage Foundation in 1989.  And what group took the lead in pushing for the federal government shutdown in order to stop Obamacare?  The Heritage Foundation’s political arm, Heritage Action.

Here’s the cover of Heritage’s 1989 publication:


And in a section called “The Heritage Plan,” Butler sets the premise for a form of guaranteed universal health care that would be anathema to the far-right Tea Party that controls the Republican party today:


A few pages down into the “Heritage Plan,” Butler proposes the individual mandate:

heritage-foundation-invidual-mandateSo, the next time you hear a Republican talk about how the individual mandate simply must be stopped, or at least delayed.  Ask them why they’re so opposed to a plan that they came up with in the first place?

CyberDisobedience on Substack | @aravosis | Facebook | Instagram | LinkedIn. John Aravosis is the Executive Editor of AMERICAblog, which he founded in 2004. He has a joint law degree (JD) and masters in Foreign Service from Georgetown; and has worked in the US Senate, World Bank, Children's Defense Fund, the United Nations Development Programme, and as a stringer for the Economist. He is a frequent TV pundit, having appeared on the O'Reilly Factor, Hardball, World News Tonight, Nightline, AM Joy & Reliable Sources, among others. John lives in Washington, DC. .

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128 Responses to “Original 1989 document where Heritage Foundation created Obamacare’s individual mandate”

  1. ShannonA says:

    Thank you for elucidating a basic fact that some people prefer to pretend isn’t one. Single-payer is government-run, the ACA is absolutely not.

  2. Taryn Kane says:

    I don’t think you understand the situation – there is no government run health care system under ‘ObamaCare’. That system would have been single-payer, and has NOTHING to do with the regulations now in place under the ACA. It drives me batty that this lie keeps being spread about with no regard for the actual truth.

  3. philmon says:

    “So, the next time you hear a Republican talk about how the individual mandate simply must be stopped, or at least delayed. Ask them why they’re so opposed to a plan that they came up with in the first place?”

    The answer is that it doesn’t matter who came up with the idea or published it as a plan 20 years ago, it is as wrong as it was back then. Who is not important. What … is.

  4. gharlane says:

    Textbook example of “post hoc” fallacy. That is all.

  5. gharlane says:

    That ain’t a “rebuttal”, toddtharp. That’s backpedaling and spin you’re looking at. The actual words are right above, reproduced in the OP. It’s 20 years too late for Butler to start spinning and backpedaling and prevaricating and doing his “Oh, what I **really** meant was….” dance now.

  6. gharlane says:

    deleted and reposted as reply under toddtharp’s comment

  7. thomas nash says:

    I read that and basically came up with the idea that they changed their minds. Guess that was okay unless you condemn someone else for taking on your idea. I want to see single payer. I see it coming sooner than later and probably a Republican will introduce it.

  8. thomas nash says:

    I have been in touch with the HF and found that they changed their minds about the mandate (I am wondering just what precipitated that. Hmmm.). Amazing amount of waffling going on there.

  9. Freddie King says:

    …”It would be disingenuous to hold a candidate to everything they say on the stump in an election year”……LOL

  10. brownie19 says:

    Reading the rebuttal, the Supreme Court did not find it unconstitutional toddtharp…spin is like you will

  11. DoubleHelix says:

    Pretty sure Bob Dole ran on a very similar healthcare platform in 1996

  12. USSHelm says:

    So, what about the time Republican’s opposed government healthcare during the Clinton Administration? Didn’t Rerublicans strongly oppose Obamacare in the first place? Butler has actually opposed government run health care. I cannot agree with his idea of forcing people to buy health care, but his proposal shown above makes no mention of a government run health care system as found in Obamacare. Furthermore, the Heritage Foundation is not an arm or member of the Republican party, their ideologies are similar, but they are not connected. So, Republican didn’t really design Obamacare as this article claims.

    A little bit about Butler that is rather relevant in this discussion.


  13. fm1969 says:

    The reason car insurance is required is that you can cause property damage, injury, or death to OTHER PEOPLE. It isn’t there to pay for the damages to your Porsche – it’s there to pay for the damage to the car that you hit with your Porsche. It has nothing to do with whether you have a choice to have a car or not.

  14. screen9999 says:

    Think about this guys. As Govt. has increasingly got more involved in health care beginning in the 40’s, the more expensive it has become. You would’nt file a claim with your auto insurance for a flat tire but that is essentially what we do with our health care insurers. And how did this “3rd party payer” come into existence? Yes…the Govt. Here is a link that explains it very well.
    Just remember,”3rd party payer”.

  15. Ace says:

    Don’t confuse him with the facts.

  16. eyeon513 says:

    It was a bad idea when it was proposed. And many of us have been criticizing Obamacare on exactly that it was a bad idea Democrats made worse. Which makes the recent attempt at spin like this by Democrats and supporters just sad and pathetic. And by the way, Butler published his own critique of the ACA’s mandate in February 2013:

    Column: Don’t blame Heritage for ObamaCare mandate

  17. Larry Clemens says:

    The Heritage Foundation published the “proposal” for a national healthcare system as a part of their lecture series. It was an idea presented to stimulate thought. The Heritage Foundation at the beginning of the lecture notes: “Nothing written here is to be construed as necessarily reflecting the views of The Heritage Foundation or as an attempt to aid or hinder the passage of any bill before Congress”.

  18. DoctorJ says:

    If that’s true, Romney didn’t seem to mind because he took credit for it, that is, until he ran for President. Your parsing is pathetic.

  19. alanstorm says:

    “As you also know, the Republicans shut down the entire federal government, and were on the verge of forcing the United States to default on its debt…”

    Two reasons to read no further, since the BS quotient has already been filled.

    The standoff shut down a small percentage of government. Apparently, The Park service Police were fully funded.

    Default on the debt? Couldn’t happen unless the executive branch, i.e. Obama decided to. There was/is enough of a revenue stream to pay the debt service.

    Nice try. I’m sure other unthinking liberals (SFTR) would eat this up.

  20. alanstorm says:

    Yes – do you have a point? Are you aware that the version put into practice was not the one Romney signed?

  21. DoctorJ says:

    M.D. is right. Nowhere in the Heritage Plan is there any reference made to “catastrophic” insurance only. Rather, the plan repeatedly calls for a mandate for everyone to have “affordable” and “adequate” health insurance. Catastrophic plans are often neither.

  22. DoctorJ says:

    The Supreme Court ruled it constitutional and thus within the enumerated power of the Fed.

  23. DoctorJ says:

    Um, ever heard of Romneycare?

  24. Bad Actor says:

    Ancient History.

  25. Dian Freeman says:

    Um, excuse me, Slight difference here…the mandate proposed by this think tank, among many other ideas proposed, was rejected. It is not representative of the Republican Party or even the organization called Heritage…it was the result of brain stoming…just ideas being tossed around by a group in a think tank. It was only proposed for those without insurance to be forced to get catastrophic insurance…cheap insurance to save taxpayers the cost of paying for accidents and grave illnesses. Still a mandate but not a mandate for everyone…just those not on welfare, SSI, Medicade, Medicare or other government assistance. Those without a job would be on Gov assistance thus would not be under this mandate. Those with insurance would not be on this mandate…just applied to those with jobs who don’t choose to pay for insurance. They would, in this proposal, have to purchase cheap catastrophic insurance from an insurance company…not government…It was an proposal that never saw light of day because the majority of Republicans would never abide by such an unconstitutional law. Forced commerce…not constitutional at all. The source of this blog…just another lying ragtag news wantabe.

  26. Mike Van Horn says:

    I guess the author of this propaganda conveniently left out the disclaimer prior to this lecturer’s (Butler’s) statement:

    “Note: Nothing written here is to be construed as necessarily reflecting the views of The Heritage Foundation…”

  27. kurtisfechtmeyer says:

    The basic idea of an “individual mandate” for minimum catastrophic coverage is a sound one. It underscores personal responsibility and moves us from an employer-based system to a portable system, which everyone agrees is the smartest way to go to create a more efficient, competitive system. It is also something within the police powers of the states, not within the enumerated power of the Federal government.

    But Obamacare is the WORST of all worlds: unconstitutional federal level mandate + attacks individual health coverage and puts more burdens on business + expands “free” healthcare thus undermining the idea of personal responsibility + builds in thousands of crony exemptions for the politically connected + administered in pure FUBAR manner.

    Maybe the room temperature IQ people in Congress should have READ the bill before VOTING for it !!

  28. friv 2 says:

    People who don’t buy health insurance get sick, go to doctor, and we all pay, yes.

  29. Scooby says:

    Amen. So tired of the “Me first!” club.

  30. Scooby says:

    Well, Scott , you certainly showed him a thing or two! Good thing 2 wrongs make a right in your world.

  31. ounceoflogic says:

    Embarrassed by the incompetence of o’bama’s “experts” in designing the grossly flawed ACA, Democrats desperately go into finger-pointing mode trying to blame conservatives for the whole thing. “Don’t blame us, we wanted Single Payer. We were just doing what you guys wanted to do.”

    Republicans have (as always) allowed the progressives to frame the issue. Democrats just want to make things better… Republicans are against heathcare reform… against insurance for the poor… against poor people in general, and, of course, Racist. What most people dislike about o’bamacare is the totally partisan, probably unconstitutional, and definitely un-American method by which it was designed and jammed into law. We don’t like the fact that the law’s namesake told so many lies. We don’t like that o’bama has once again used taxpayer money to reward his political friends. We don’t like implementing yet another massive entitlement program without addressing spending and debt issues. And so on. But Republicans – powerless against the progressive spin machine – are so very bad at telling their side of the issue… and even when they do, it never gets heard.

  32. Dania says:

    You country is develop very fast nowadays.

    tram huong

  33. BeccaM says:

    Looked pretty good to me. I’m not ready to decide yet though. I want to see in detail what the other carriers are offering.

  34. ezpz says:

    Thanks. So the deductibles and copays on that $300 a month gold plan you looked at are reasonable?

  35. BeccaM says:

    With medical tourism on the rise, I’d say that information is just a web search and a phone call away.

    The truly fascinating detail when my wife first had to go to the Bangalore hospital was that as soon as we checked in, a very nice lady came over almost immediately and said she would be our concierge. She started by giving us her card, identifying her as part of the hospital staff specifically tasked to assist foreigners seeing care and listing her mobile number if at any time we needed help or to have questions answered.

    In both cases, the torn retina and the cataract surgery, we knew before the procedure exactly how much each would cost — including any necessary prescriptions.

  36. Scott H says:

    Michael, so you too are grasping at straws? Let me sum this up for you, the PPACA (Obamacare) is more about Medicaid, and the Heritage Plan from 1989 is a Free Market alternative to healthcare reform!

    Research the ENTIRE publication, instead of a myopic article from the liberal media who highlighted only two sections with hand drawn red circles around the part they want people to read which is probably the only thing you read… They could have simply made a new layer, then selected the pixels in the image above the text, painted it yellow which is the standard/default color for highlighting text, and then blended the two layers with a simple “darken” setting in just about any graphic design or photo editing software program! Instead they chose red on purpose…

    That is a common tactic of the liberal media and Democratic party. They quote a small portion and use drama to incite outrage over a perceived flaw or exaggerate flaws and quite often claim it is purely for bad intentions just to gain supporters. It’s why I call the the Dramatic party now! Because it is a common defense mechanism of humans, and is known as splitting in psychology. The former topic of perceived flaws and exaggerating flaws is common with OCD. Why else are they constantly talking about a few people who need medical help, and children? Furthermore, why else are they constantly dividing up their “support” of various groups and political topics that are controversial and even trying to make them sound highly controversial? For example, the liberal media hated the very first male and female African-American Secretary of State claiming it was because they are Republicans but as soon as a half-white Democratic President is in the office they claim Republicans hate him because he is black and not because he is a Democrat and does everything Conservatives have been fighting against, like higher taxes!!!

    Right after you attacked Ipsophakto on a personal level instead of the topic, the Heritage Plan from 1989 says the following right after what you quoted from that hand drawn red circle: “health care is the responsibility of individuals, not businesses.” The PPACA is about everyone including businesses, it also is about the Democratic party beating a dead horse of raising taxes on business and workers, and expands Medicaid eligibility when the Heritage Plan was about the Free Market!

  37. Drew2u says:

    India seems rather far for a procedure like that. Is it really that much of a price discrepancy to warrant a notable savings? Why not, say, Canada?
    (and how does one look for prices of procedures short of international phone calls to clinics)?

  38. Jimmy Cahill says:

    FL is not alone. I grew up in Boston, MA and moved to Manchester, NH. In Boston, I never learned to drive, never had a reason to. In NH it is a different world. I cannot get anywhere without a car as buses stop running before the workday is over. Taxis are not an alternative since the wait is sometimes upward of an hour. Granted NH is one of 3 states that do not mandate auto insurance, but the point is, sometimes driving is the only option.

  39. Jimmy Cahill says:

    And that is the problem. Insurance companies set rates, and they know that an increase in price will not affect the demand, unlike most other things in this world that see demand drop as prices increase. We have always been told fairy tales about how our health care is the best and how people come from other countries to have things done. This may have been the case… a long time ago. Now, however, Americans are the ones leaving to go get taken care of elsewhere. We have been indoctrinated to believe that America is the greatest, freest nation in the world and that we have the best education, healthcare, etc… when the truth is we are really about middle-of-the-pack in most areas.

  40. Jimmy Cahill says:

    And try living in a place like Maine, Montana, Wyoming, the Dakotas, where public transportation is basically nonexistent and Taxis are few and far between. It seems to me that sometimes people live in an alternate reality.

  41. Jimmy Cahill says:

    But that’s not how it works. People who don’t buy health insurance get sick, go to doctor, and we all pay. How is that fair?

  42. Jimmy Cahill says:

    Actually, driving in some states is a necessity. And one thing we do share is health care costs. I’m tired of unemployed people driving up the rates for the rest of us.

  43. Jimmy Cahill says:

    Haha I just asked the same thing

  44. Jimmy Cahill says:

    Why no stink when they mandated insurance for anybody driving a car?

  45. Jimmy Cahill says:

    I agree, the insurance companies are the problem, and they have no business in health care

  46. BeccaM says:

    From what I could see, it was just like applying for insurance, if one went directly to the insurance seller — they have their online directories of physicians, detailed descriptions of the plans including coverage amounts, co-pays, deductibles, etc. (Believe me, I’ve had a lot of experience shopping fruitlessly for insurance over the years…)

    The only thing you can’t do, that Healthcare.gov is supposed to do, is let you compare between different insurance carriers in one place.

  47. ezpz says:

    Did it give you particulars as to deductible and copay amounts?
    Also, did it go into any detail of providers (assuming it’s not a PPO)?

    In Maryland, there are inexpensive bronze plans, but the deductibles start at $6,300. I don’t even know how much the copays are; nor, do I know what health providers are in their networks. I understand that the cheaper the plan, the higher the deductible, and the smaller the network.

  48. ezpz says:

    You know what? I really don’t care what the ‘argument’ of the Heritage Foundation is. Perhaps you missed that this has been my point all along. I didn’t agree with them then, and I don’t agree with them now. I don’t like the ACA – not now, not then. That the faux/neo-libs have decided to adopt it, pass it into law, and defend it is one (of many) reasons I’m no longer a democrat. When I voted for Democrats, and specifically Obama in 2008 (not 2012), I didn’t vote for the Heritage plan because he didn’t run on it and it was not part of the democratic platform. Fool me once….

    Pointing to the hypocrisy of the gop is itself the height of hypocrisy.

  49. Michael Dodson says:

    EZPZ, you might believe the auto liability argument is invalid. The Heritage Foundation folks did not. They use the argument in this document propounding the Affordable Care Act precedent.

  50. Michael Dodson says:

    Ipsophakto, you lack basic reading skills, dontcha? Right there in the Heritage Foundation document, as a chapter heading, it says, “Mandate all households to obtain adequate insurance.” The Heritage document says that a goal of the Heritage plan is that “All citizens should be guaranteed universal access to affordable health care.”
    Better luck next time.

  51. Nuriah says:

    You cannot live or have a job in FL without a car, just FYI. Public transport is crap, there are few sidewalks or bike lanes (it’s too damn hot). A car is sadly a life necessity. No car = no job.

  52. Guest says:

    Another anti-civilization supporter of unemployed liberterians who refuse to exercize their “privilege” to drive. Thank you for paying their food, rent, etc, so they don’t have to rely on “entitlements”. LOL

  53. Nuriah says:

    So I guess you’re a staunch supporter of unemployed liberterians who refuse to exercize their “privilege” to drive? Please, when you make an argument, try to reference reality a bit. LOL

  54. Ipsophakto says:

    Driving is a privilege, not a right. We share the roads, we don’t share spleens.

  55. Ipsophakto says:

    You’re grasping at straws. The heritage plan was for a mandate limited to catastrophic coverage, not the unqualified and sweeping mandate and death panel debacle that obamacare is. Furthermore, heritage recanted and did so on the basis of studies showing the mandate would fail and was unconstitutional.

  56. Naja pallida says:

    May have been limited in time, but they still chose to squander that time rather than try to take advantage of it to get something done.

  57. LittleBritches says:

    Dems only had a actual super majority for less than 6 months, between Kennedy’s illness and Al Franken not being confirmed….


  58. ezpz says:

    Oh please, now you’re delving deep into the realm of ridiculousness.

  59. jazzbo says:

    You keep ignoring the “in the Heritage plan” part of my original statement.
    Show me Democrats that have dissed the individual mandate in the Heritage plan and supported it in the ACA.

    Contortions averted.

  60. BeccaM says:

    BTW, I think I’ve found an even better workaround for the broken Healthcare.gov site, including its not-helpful and probably inaccurate data:

    If you know some of the names of the health insurance providers in your area, just go to their websites. Sometimes — not always, but often — you can get policy and premium information right there, and in at least two of the cases that I just checked (Blue Cross of New Mexico and Presbyterian), the plans listed appeared to be PPACA-compliant. Didn’t have as good luck with Lovelace — they don’t post their info and erroneously list their plans as possibly excluding pre-existing conditions (won’t be legal come Jan 1).

    Just from the BC of NM site, I was FINALLY able to learn that I can get a decent Gold level plan for a little over $300/month — before any subsidies. (This price is actually less than my current PPACA high-risk pool premium, by about 20%. For better insurance.)

    That post the other day about the hassles I went through on Healthcare.gov? This bit of information was all I wanted — the ability ACTUALLY to browse the available plans without signing up for anything.

  61. BeccaM says:

    Indeed, including the building of lots of new ultra-modern “super-specialty” hospitals. The one in Bangalore is quite remarkable and was where my wife went both for a retina tear ($38 US to repair it, including follow-up visits) and cataract surgery ($1500 total, but would’ve been less than half if we’d not gone with U.S.-made lenses; our optometrist upon returning to the country said the surgery was absolutely top-notch).

  62. BeccaM says:

    My wife and I have already decided that if something expensive-but-non-urgent comes up, there’s a good chance we’ll head to Southeast Asia somewhere. Possibly India or Thailand, although I’ve heard that even Singapore has been getting into the biz.

  63. Swami_Binkinanda says:

    India is making a push for this as well. http://www.patientsbeyondborders.com/india

  64. ezpz says:

    Oh, so you’re saying that Hillary’s individual mandate is not the same as the Heritage’s im. I see….

    Any other contortions you want to spin yourself into?

  65. jazzbo says:

    I stated: “If a Democrat dissed the individual mandate in the Heritage plan and now supported it in the ACA, it would be hypocritical of them.”

    You gave one example of President Obama dissing the individual mandate in Hillary Clinton’s plan, which is not the Heritage plan.

    President Obama obviously preferred not to endorse Hillary Clinton’s plan in a hotly contested presidential race. It would be disingenuous to hold a candidate to everything they say on the stump in an election year. I wish that wasn’t the case, but it is and it is totally bi-partisan.

    It seems as if every time President Obama embraces an idea from the right, the right runs away from it. Why is that?


  66. ezpz says:

    If a Democrat dissed the individual mandate in the Heritage plan and now supported it in the ACA, it would be hypocritica of them….

    Okay, here y’go…. I won’t document them all as you suggest, just the DIC (Democrat In Chief):

    Candidate Barack Obama, February 28, 2008 to Ellen DeGeneres talking about his health care plan as opposed to Hillary’s:

    “Both of us want to provide health care to all Americans. There’s a slight difference, and her plan is a good one. But, she mandates that everybody buy health care. She’d have the government force every individual to buy insurance and I don’t have such a mandate because I don’t think the problem is that people don’t want health insurance, it’s that they can’t afford it,” So, I focus more on lowering costs. This is a modest difference. But, it’s one that she’s tried to elevate, arguing that because I don’t force people to buy health care that I’m not insuring everybody. Well, if things were that easy, I could mandate everybody to buy a house, and that would solve the problem of homelessness. It doesn’t.”

    – See more at: http://cnsnews.com/news/article/obama-degeneres-why-he-opposed-individual-mandate-forcing-uninsured-buy-insurance#sthash.uuszLnTn.dpuf

    Hypocritical enough?

  67. Tuftz says:

    I think that the first problem with this entire issue and all of the discussions is that we refer to “Insurance”. Insurance really has no place with healthcare because EVERYBODY, EVERYWHERE, SOMETIME will have a health related incident or need and that totally defeats the entire notion of insurance which is a “profit motivated gamble on the outcome of a described and covered issue, action or event”. To put the cap on it, for insurance to work there must be a MAJORITY of policy holders who will NEVER utilize the coverage. Get the word and concept of “Insurance” out of the frame and we can begin to address the real subjects of quality healthcare and how it paid for (governmental supported by individual taxes or individual by personal payment) and how much it costs (negotiated by the group as in a governmental plan or by the individual at the time services are to be rendered – I have done both by the way and I prefer to have a group negotiate in my stead)

  68. Surly Shirley says:

    Apparently, using standard English is a choice as well.

  69. Houndentenor says:

    I’m with you on Medicare and drug prices, but we’re all being price-gouged by the pharmaceutical companies. Why are asthma inhalers over 10x the price in the US that they cost in Europe? We are being screwed over by companies and they can do it because they have bought off Congress.

  70. Chris says:

    I feel the choice is yours as driving is a privlage not a requirement there’s taxi’s and buses. Dont wanna buy auto insurance sell your car!!!! dont wanna buy health insurance? die?

  71. Barbie K says:

    You are right, in many parts of the US, you MUST have a car. Not everyone lives in the city! I drive 45 minutes one way every day to work. A car is necessary in my part of the world. As is health insurance! ACA may not be perfect, but it’s a good start!

  72. Naja pallida says:

    Oh, I get your point, and I’ve always taken issue with the car insurance example too, for the exact same reason… but realistically, in many parts of the US, not having access to a car is a significant barrier to employment, and even health care if your insurance makes you go any distance to see a doctor, as well as other things necessary for quality of life. The public transportation system where I live is ridiculous. If I had to rely on it for my daily needs, I’d have to plan for hours of extra time every day, just to get around. Biking is taking your life into your own hands, because the roads are not designed with it in mind, and American drivers are psychotic and seem to think that everyone else on the road with them is in some kind of suicide pact. I’ve gone without a car in cities with good public transportation, and that was still inconvenient, at best. Try carrying a load of groceries on the subway a few times, and you’ll understand.

  73. Drew2u says:

    I take issue with the car insurance example. We have a choice to not have a car at all, I bet I know several people, personally, who don’t have a license and don’t plan on getting one – using bikes, walk, or public transportation.
    There’s no alternative to life other than death – and despite the TeaOP’s support, that’s no real option in any sane, rational, and civilized nation.

  74. Drew2u says:

    I’m sure if I look elsewhere I’d be able to find another country that’d make it even cheaper. It kind of makes me mad that medical tourism isn’t talked about more often in the news.
    (BTW, I found a few medical tourism sites while searching for prices of the procedures in different countries; which is really difficult to find)

  75. Naja pallida says:

    That’s one of the things I hate the most about the ACA (and more the inadequate defense of it from the administration and the Democrats). It has essentially made health care reform a hot potato political subject, that no legislator will want to seriously touch, for at least another generation. Which is why I said in my post below to ezpz, that we had better damn well figure out a way to make the best of it, because it’s all we’re going to get.

    I’ve lived in Germany too (I went to school in Baden Baden). I’d take their system over ours any day. One major thing that the ACA needed was to allow Medicare to negotiate for prices – like every other sensible nation in the world does. That alone could make a huge difference in health care costs. We all know it doesn’t actually cost 80 bucks a dose to produce any medication. Or actually cost ~1,000 dollars to do an MRI, or perform a colonoscopy. They charge that much because they can. Because the law lets them.

  76. Houndentenor says:

    Because screwing customers is how insurance companies make a profit. That in a nutshell is what’s wrong with our system. And in order not to be screwed by the insurance companies, clinics and hospitals have ridiculous billing methods that make it even worse for everyone. What we have sucks. ACA doesn’t actually address the suckiest parts. The only reason I’m in favor of it is that it fixed some problems for young people being able to stay on their parents’ insurance for a few years longer and helping people who have pre-existing conditions. There are horror stories around the latter where companies tried to avoid paying on claims that were not really related to an earlier problem. Again, screwing customers.

  77. maria says:

    So how do you feel about state governments requiring you to have automobile insurance as a condition for driving?

  78. Houndentenor says:

    The reason I’m clear on that (even though it ought to be self-explanatory) is that whenever we talk about health care reform the right wingers make it sound like the only option besides what we have is the British system which I really don’t want (and don’t hear anyone advocating). I used the German system when I lived there. They complain about it (the way people complain about everything) but it was far more efficient than what I was used to in the US (and cost me less than 1/2 of what a similar doctor’s visit plus tests plus prescription…I had an ear infection…would have in the US).

    If it were possible to have a sane, rational conversation about health care we could come up with a good system. Instead we got a lot of screaming about death panels and “I don’t want the government taking over Medicare”. #facepalm If there’s any country left after the Teabaggers have run their course, maybe we can have a national discussion and come up with a plan that meets the needs of Americans in the 21st century.

  79. Naja pallida says:

    The Democrats had a super majority, and this is the best their cowardly asses could come up with. That speaks volumes about how broken our Congress has been over this last generation.

  80. Naja pallida says:

    I think it’s a ridiculous law. Poorly written, terribly thought out, and I don’t think it has a squirrel’s fart chance in hell at being long-term effective, because the insurance industry always finds a way to screw customers… but I also think it’s the best we have any hope of getting with the politicians we have. So we might as well try to figure out a way to allow the most people to get the most out of it.

  81. Houndentenor says:

    I fully acknowledge that car insurance is an imperfect analogy. The main difference is that I am only required to have liability insurance. If I total my own car and can’t get another one, that’s on me. The other difference is that if I have a car accident I can’t show up at the body shop and insist they fix it even though I don’t have any ability to pay the bill. If I have a medical emergency I can go to an ER and insist that they give me medical care even if I can’t pay for it.

    And also, I don’t know where you live, but I couldn’t get to my jobs without a car. That’s true of a lot of the country. not driving isn’t an option which means I am required to have car insurance. As for state vs federal, I’d rather it had been handled that way. That argument would carry more weight if any state other than Massachusetts had made any attempt to deal with the issue. Where I live 1 out of 4 people has no health insurance. What that means is that people who pay for their health care have to foot the bill for those who never pay. That’s fucked up.

  82. Naja pallida says:

    If you consider the number of people on Medicare (~50 million), combined with the number of people on Medicaid (~66 million), and the VA (~9 million), our single-payer health care system is already larger and serving nearly twice the number of people of the largest European system. There is absolutely no reason why it couldn’t be possible… but I do agree, a hybrid system would make the most sense, but such a system would still leave poor people with the most disadvantage.

    For the cost of our wars of choice, we could have implemented a full single-payer health care system, as well as entirely eliminated hunger and homelessness in this country.

  83. Houndentenor says:

    Of course they are. I have a relative who is on disability who is perfectly capable of holding down a job so long as it’s one she can sit on her morbidly obese fat ass all day doing, but she can’t get a job because she’s a hateful bitch that can’t work with anyone (and thinks she’s too good to work anywhere that has too many minorities…oy). So she sits around all day long feeding her pie hole, living on the government dole and listening to Glen Beck. If the people she votes for were in the majority she’d be homeless. I just don’t understand people like that. I hated being on unemployment but I was sure glad it was there when I needed it and hope I never have to again. I don’t begrudge people who need help from taking some. Yes, there are people (like my right wing idiot relative) who abuse the system, but there are also a lot of people who need those programs.

  84. Naja pallida says:

    Heritage specifically compares their mandate to the requirement to wear seat belts and car liability insurance. And what do we do with people caught not wearing their seat belt, or those who don’t buy car insurance but are caught driving anyway? We fine them. They may not have explicitly written it out, leaving the scope of that little detail to those who would draft the legislation, but they obviously intended that to be a key element of making sure the mandate worked. To suggest otherwise is either disingenuous or blatantly ignorant.

    Besides, one of the most right-leaning, corporatist Supreme Courts in generations had plenty of time to specifically debate the mandate, and they found it to be constitutional. So, where’s the transformation? Would a single-payer system be a transformation? Would people dying in the street because they have no access to health care be a transformation?

  85. jomicur says:

    If you think the Heritage Foundation is trying to help anyone but corporations and the plutocrats who run them, you are even more delusional than the average Christian.

  86. Naja pallida says:

    Medical tourism is something like a 30 billion dollar industry. Somewhere around a million Americans will travel abroad, to dozens of countries, for all manner of procedures this year alone. It used to be limited mainly to cosmetic surgery, and procedures that weren’t easily obtainable in the US, but it’s changed over the last twenty years or so, to even routine things.

  87. michael1968 says:

    answer: BigFedGov requiring people to buy things is a bad idea and bad precedent regardless of (R) or (D)

  88. Drew2u says:

    homeschooled, maybe?

  89. Drew2u says:

    Hey John!

    We’re buddies, right? Sharing recipes and what-not (speaking of which, any idea when the next food-post is to arrive?)

    So let me ask you about this .pdf from Ireland: http://irishpatients.ie/news/wp-content/uploads/2013/04/HTA-Tonsillectomy-April13.pdf

    If I am reading it correctly, the average price of a Tonsillectomy and Adenoidectomy in Ireland is USD$2,125 (pg. 15).
    According to Kayak, I can get a relatively localish round-trip flight to Ireland for $650 (apparently with taxes included? Dang cheap!) for 9 days.
    There’s a hotel in Dublin that has online pricing of $70/night. ($630)
    Other fees and expenses, such as renting a car, food, etc. let’s say $600.

    That’s $4,000, give-or-take, to go to Ireland and get those done.

    My deductible is $7,500. My clinic charges $8,000-$9,000 for the surgery, not including doctor’s fees, apparently.

    At first glance it looks like it’s cheaper for me to go to Ireland to get this surgery done than to drive to my clinic 25 miles away!

  90. ezpz says:

    Stay away from worthless talking points.

    Practice what you preach.

    I’ve paid attention to this from the beginning – close attention – and I saw what went on, including the back room dealings between the president and the pharma/insurance/private hospital industries, who, by the way, contributed heavily to his campaign.

    It took ‘nearly two years’ because there were a lot of moneyed interests to please. Let’s not forget that Liz Fowler of Wellpoint literally wrote the bill. As if that wasn’t enough, the same Liz Fowler was then chosen to implement the oversight of the law.

    These are not talking points. They’re hard, cold facts. Facts that are obviously inconvenient to those who DO spew talking points ad nauseum.

  91. Monoceros Forth says:

    I just have to say, as crummy as the Heritage Foundation plan (and the ACA) is, at least it starts with an acknowledgment that there is a problem and that all citizens need some sort of health coverage. Right-wing orthodoxy these days, however, is that it’s seditious and treasonable to suggest that there’s any sort of problem to be solved at all.

  92. Monoceros Forth says:

    Conquer and divide? It’s divide and conquer. What do they teach you children in schools these days…

  93. leepermax says:


  94. IPAfan says:

    The ACA was not “shoved down our throats.” The debates went on for nearly two years.
    Stop the law was shoved because it just is not true. Also, during 2008,
    the democrats had a super majority and the bill was still up for debate
    for years. Stay away from worthless talking points.

  95. ezpz says:

    …Like, I believe, a vast majority of us on the left, am totally stumped for a logical reason for the far right to oppose the Affordable Care Act on a policy basis….

    What ‘stumps’ me and other real liberals is that they (Ds) passed something they once opposed. Not only did they pass it, but they are vehemently defending it as the best thing since SS and Medicare. It’s nothing like either of those two beloved programs. Nothing. In fact, it takes us far away – to a point of no return – from the possibility of ever having something like what most industrialized, humane nations enjoy.

    It’s sad to see the neo libs trying to deflect attention away from this POS legislation by pointing fingers at the bad GOP, who really had nothing to do with the passage of this law, notwithstanding that it was originally their idea. Big deal. As I said in other comments, it’s irrelevant who hatched this idea, and it’s even more irrelevant (except, as I said, to the partisans) if or that they now oppose it. Dems are the ones who passed it and bottom line, it’s a crappy law. I would love to be wrong, but alas, time will reveal what this law actually is – corporate welfare on the backs and at the expense, literally, of the poor and middle class.

  96. war_blur says:

    so very true. thanks.

  97. Disheartened says:

    Mr. Aravosis……where does it say that individuals will have to pay a fine? Having national competition for coverage is very different than what Obama has done. The Heritage Foundation seeks to help this country and it’s citizens….Obama seeks to conquer, divide and “transform” our Constitutional Republic!!!

  98. maria says:

    Back when the idea of seat belts in cars was first promoted, protesters wailed that it was an imposition on their freedom. To promote seat belt use, Southern Mutual Insurance suggested that a clause be added auto insurance policies that denied payments for injuries resulting from the driver not using seat belts. That never flew, but at present, there is a law requiring hospitals to treat all patients that arrive in emergency rooms regardless of circumstances. Those getting big medical bills subsequently file for bankruptcy to escape them. Maybe if we amended the law so that scofflaws can’t escape these bills through bankruptcy, that would wipe the smile of WakeUpHadEnough’s Republican friend.

  99. Michael Dodson says:

    EZPZ, it’s not being defended on that basis. Like, I believe, a vast majority of us on the left, am totally stumped for a logical reason for the far right to oppose the Affordable Care Act on a policy basis. I have pointed out the ACA’s provenance over and over and over to righties, trying to learn why they oppose it. It is their. They gave birth to it. Personally, I believe they now claim to oppose it because this president is African-American and a Democrat.

    AS for me and my house, I would have much preferred a single-payer plan and hold hope that AMerica will grow up and movce to that.

  100. ezpz says:

    The auto insurance analogy is not a valid one.
    You can choose not to have a car; then you don’t need auto insurance.

    With the ACA, if you breathe, you are mandated under penalty of law to purchase an unregulated, unstandardized product from a profit driven industry that trades on the stock exchange.

    Also, auto insurance is state – not federally – regulated under an insurance commissioner for that state, not the IRS.

  101. jomicur says:

    Wendell Potter, the health insurance industry whistle blower, has said several times on the record (including at least twice in interviews on Democracy Now!) that the insurance corporations had been trying for years to get the GOP to introduce a bill similar to Obamacare, and the republicans resisted, thinking it could never fly. But Obama did it. It is one more sign, and a big one, that he is in essence nothing but a shill for Republican policies.

  102. WakeUpHadEnough says:

    I have too many folks where I live that love proclaiming that they choose not to have health insurance at the same time they embrace the fact that if they get hit by a bus, they will get care at the hospital. One right winger without insurance proudly says “I’m willing to take the risk with my health.” But when I tell her that she’s also willing to mooch off of the rest of us should she find herself needing care and can’t afford it, she smiles and walks away.

    And all of these folks are Republicans.

  103. WakeUpHadEnough says:

    I agree. Have you watched “Sick around the World” on FRONTLINE? Does a great job of showing how 5 other nations deal with health care insurance. At a minimum, if we only allowed non-profit companies to provide basic insurance, that would be a great start.

  104. Houndentenor says:

    I have a plan somewhat like that. It costs me a $20 copay to see a doctor (it’s a ppo so no referrals) and $10 for prescriptions. I can afford $20 when I get sick, especially compared to the $100 it would cost me otherwise. I have a rather high deductible for hospital stays but again I can pay off a couple thousand dollars in payments but tens of thousands of dollars would be a huge problem if I didn’t have insurance. The reason we have insurance is not for day to day issues. It would be cheaper for me to pay out of pocket as rarely as I need medical care. But it’s INSURANCE. I also pay for car insurance even though I haven’t had an accident in over 20 years. (At least not one that was my fault.) But one accident without insurance would bankrupt me. (I’m also legally required to have it, just like I now am legally required to have health insurance.) It’s not about being able to show up for freebies whenever I want. That was never the point. It was supposed to be affordable. I hope I never need my insurance (any of it) but I’d be royally fucked if I did need it and didn’t have it.

  105. Houndentenor says:

    I’m concerned about a national single payer system. We are six times the population of the largest European country. That would be a very large system if it included everyone. But I think a two-tiered system, like some European countries have were the basics are covered for everyone and if you want more than that you buy an insurance policy for that (which is how Medicare works) is the best solution for our country. I just don’t see any way we get that through Congress when the insurance companies have bribed most of our elected officials and can spread lies.

    I routinely get forwarded emails with outrageous lies about ACA from relatives. All of them are on snopes but they believe them nevertheless. (I will send them the links debunking the email only to get the same exact email again from the same folks a few months later.) Here is the latest one:


    People actually believe this crap and for reasons I don’t understand our news media is too lazy (or too bought off by advertisers) to investigate where such emails come from. (It really shouldn’t be that hard for a good IT person to figure that out.) That’s why we were lucky to get any health care bill through Congress even with Democrats in the majority. At this point, nothing is going to happen. ACA has a lot wrong with it, but I don’t know how we get the kind of health care reform that would actually work passed in the current political climate.

  106. Houndentenor says:

    Agreed. I’m single. I can afford my insurance. It’s not that bad and I just have to cut a few other things to be able to pay for it. The people with two kids? They can’t. And if the rates go up any more that will get worse. There’s a lot of good stuff in the ACA. I’m very happy now that I don’t have to fill out 12 pages of forms for every single medical claim like I did before so my insurance company can try to weasel out of paying for a single doctor’s visit and a one-time prescription due to some “pre-existing condition” (that used to happen to me regularly). But I am concerned for people I know who are just barely paying all their bills as it is and can’t afford health insurance premiums. Take a look around you. Look at all the payday loan and auto-loan places that have cropped up. People are taking out loans with their car as collateral just to pay their bills (and if they can’t pay and the car is repossessed, they won’t be able to get to work…most of the country has no public transportation). They are everywhere and that ought to be a wake-up call to everyone about how many Americans are not doing well financially. And these are people who work at least one job, many of them more than one. When are we going to address this? Companies are making record profits, and executives are being paid record bonuses and the people working for the companies are being screwed. I think I would be afraid of the political implications of a majority of Americans being in such perilous financial straits. That has not worked out well in other societies. (see: French Revolution, Russian Revolution, Cuba, et al.)

  107. WakeUpHadEnough says:

    A perfect explanation of why we need Single Payer insurance in America. Medicare is a great insurance plan that keeps costs down since it only pays a certain amount for certain treatments and it is NOT a profit making entity.

    America is the only developed nation that allows primary health insurance to be sold for profit. We pay double the price per-capita that any other developed nation pays for health care and we have marginal to crappy outcomes overall.

    Why? Cause there is money to be made on those sick folks.

  108. ezpz says:

    Exactly so.

    The president and the dems tout low premiums – as low as cell phone plans. Magine that!

    Well, in Maryland the bronze plans DO indeed have low premiums, but guess what? Deductibles for those plans are about $6,300. So not only are you providing a monthly welfare check (or one to the govt in the form of a fine/tax), but you’re also shelling out a nice chunk of change before any benefits kick in. And I don’t even know what the copays are.

  109. Houndentenor says:

    Based on the very unscientific experiences of people I know, a lot of people are not finding good rates on the exchanges. Many others are. Some are finding the rates there considerably higher than what they are already paying. Others, especially people with children, would have to pay far more than the fine will cost for not complying with the law. They can’t afford it, and that really needs to be addressed. This is why I was against the individual mandate back in 2008. We aren’t addressing a basic problem in the US: wages for most people have not gone up in over a decade while the cost of living has. People are already squeezed and adding an extra expense just makes that worse. Yes, it would be horrible if they developed a serious condition and didn’t have health insurance. They can’t afford it either way. We talk about the poor and middle class and higher incomes, but the people above the poverty level but below the median income are ignored in our culture and politics. That’s a lot of people and they are too busy working two jobs to get politically involved or to form protests.

  110. ezpz says:

    …we defend it because it brings health insurance coverage to millions of people.

    Single payer or Medicare for all would have done that too. In fact, it would have been cheaper, more efficient, and would leave NO one out. This law will still leave millions without coverage.

  111. ezpz says:

    Your point? The republican wing of the 1% party hates the democratic wing, especially the president? That’s nothing more than a distraction and inherent excuse for the dems colluding with the repubs.

  112. WakeUpHadEnough says:

    We don’t use this as a defense, we point this out to show the HYPOCRISY of those on the Right who oppose the individual mandate and still get support from Heritage!

  113. WakeUpHadEnough says:

    You’re right!!! Most of us liberals don’t like this law because it doesn’t go nearly far enough….no public option, no Single Payer so we on the left are disappointed. So when you look at the polls showing 53% do not approve of the ACA, about 1/2 of those want it to go FURTHER!!

  114. ezpz says:

    There was also an election in 2010. That, too, was a referendum on the pending (at the time) legislation. The dems lost the house, and most notably, Scott Brown won in the very blue state of Massachusetts to oppose the ACA.

  115. David R. Wallace says:

    This is not a defense of the law, its an indictment of the rights hatred of anything Obama supports. The fact is they didn’t want any healthcare reform and only came up with the mandate as a way to oppose what Hillary was proposing.

  116. ezpz says:

    You can take part in that kind of exercise in futility. Apparently, you do.
    Me? I’ll pass. Proving which wing of the same party is more hypocritical than the other is a waste of my time and energy.

  117. jazzbo says:

    If a Democrat dissed the individual mandate in the Heritage plan and now supported it in the ACA, it would be hypocritica of them.
    Go ahead and document all of those comments and make your case.
    Then try and reconcile everyone from Demint on down calling the individual mandate every derogatory name that they can think up.

  118. leepermax says:

    FAKE FAINT clearly explained in this video.


    (Obamacare Section) … Amazing

  119. war_blur says:

    the bill was debated for fourteen months. the Repubs got major concessions, during these negotiations, primarily no gov’t insurance option. Then it was duly passed by both houses, signed into law, and deemed constitutional by the SCOTUS. We had a national election in 2012 that was largely a referendum on this law, and the POTUS was elected, again, by an historic majority. Therefore, I submit that the words in the phrase “shoved down our throats” mean things unknown to you.

    we Dems don’t defend it on the grounds that it was a Repub idea; we defend it because it brings health insurance coverage to millions of people.

  120. ezpz says:

    Please Mr. Mainstream Majority, show me a poll that shows support for this legislation.
    I haven’t seen any.
    Plus, there are few, if any in my circle of friends and family, most of whom are liberal, who support this.

    But keep on spinning and spewing those talking points.

  121. Monoceros Forth says:

    The only fringes I have anything to do with are diffraction fringes.

  122. ezpz says:

    Hypocrisy is equal opportunity.
    How many democrats supported this bill when the Heritage Foundation put it out?

    I rest my case.

  123. joe johnsson says:

    You have no clue what the ‘American People’ want, and please stop speaking of the ‘majority’.

    You represent a fringe minority opinion.

  124. jazzbo says:

    It helps to call out the hypocrisy when anyone affiliated with Heritage disses the mandate without admitting that they were wrong to push for it when the president happened to be a republican.

  125. ezpz says:

    So you’re saying that this is a good law because an uber conservative think tank thought it up?
    I don’t care if they changed their minds and don’t like it anymore. That’s irrelevant, except to the partisans inside the beltway. What matters is that a so called *democratic* president shoved a republican bill down our throats against the wishes of the majority of Americans.

    I just don’t get how anyone who calls him/herself a democrat can defend this on the basis that it was hatched by republicans.

  126. Dave of the Jungle says:

    Excuse me, but this is clouding the issue with facts, isn’t it?

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