Republicans Spurn Once-Favored Health Mandate The provision in the Democrats' health overhaul bills requiring every American to have health insurance is abhorrent to many Republicans. But several GOP senators now opposed to the "individual mandate" backed a 1993 bill that would have required it.

Republicans Spurn Once-Favored Health Mandate

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But as NPR's Julie Rovner reports, that wasn't always the case.

JULIE ROVNER: For months now, Republicans have been hammering away at the proposed requirement that every American have health insurance. Here was Utah Republican Orrin Hatch, during the Senate floor debate in December.

ORRIN HATCH: Congress has never crossed the line between regulating what people choose to do and ordering them to do it. The difference between regulating and requiring is liberty.

ROVNER: And here is Iowa's Chuck Grassley during the Senate Finance Committee's consideration of the measure, last fall.

CHUCK GRASSLEY: For the first time in the history of our country - 225 years - the federal government saying, you have got to buy something. That's never been before.

ROVNER: Len Nichols of the New America Foundation says the individual mandate was actually created by Republicans and only later embraced by Democrats.

LEN NICHOLS: It was invented by Mark Pauly to give to George Bush, Senior, back in the day, as a competition for the employer mandate focus of the Democrats at the time.

ROVNER: He is referring to health economist Mark Pauly of the Wharton School at the University of Pennsylvania. Pauly says it wasn't him alone, he was actually part of a small group of conservative health economists and lawyers who cooked up the idea in the late 1980s.

MARK PAULY: In some ways it was kind of like a Judy Garland/Mickey Rooney movie.

ROVNER: Except instead of putting on a show...

PAULY: A group of economists and health policy people, market-oriented, sat down and said, let's see if we can come up with a health reform proposal that would preserve a role for markets, but would also achieve universal coverage. And I think the individual mandate was derived, mostly, from the power of logic.

ROVNER: That logic being that even the most generous subsidies or enticements, he says, could only get you so far.

PAULY: There'd always be some Evel Knievels of health insurance, who would decline coverage, even if the subsidies were very generous, even if they could afford it, quote unquote, "if you really wanted to close the gap, that's the step you would have to take."

ROVNER: Now one of the key justifications for requiring everyone to have at least catastrophic health insurance is what economists call the Free-Rider Effect. If you're in an accident or you come down with a dread disease, you're going to get taken to the hospital and someone's going to pay. And that was something that appealed to Republicans, at least back then, says Pauly.

PAULY: We called this responsible national health insurance, so there was a kind of an ethical and moral support for the notion that people shouldn't be allowed to free-ride on the charity of their fellow citizens.

ROVNER: Len Nichols, of the New America Foundation, says he's depressed that so many issues that used to be part of the Republican health agenda are now being rejected by Republican leaders and most of the rank and file.

NICHOLS: And how does economist Pauly feel about the GOP's retreat from the individual mandate they used to promote?

PAULY: That's not something that makes me particularly happy.

ROVNER: Julie Rovner, NPR News, Washington.

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