Heritage Denies Ties to Obamacare

April 23rd, 2010 at 11:15 am | 40 Comments |

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On Monday, Dr. Robert Moffit, the director of the Heritage Foundation’s Center for Health Policy Studies, disavowed his organization’s old ideas in a Washington Post editorial titled “Obama’s health reform isn’t modeled after Heritage Foundation ideas”.

Moffit, who was part of the Heritage Foundation team which drafted a plan including the individual mandate as a response to President Clinton’s proposal in the early 1990s, now rejects the individual mandate as “operationally ineffective and legally defective”.

In an exclusive interview with FrumForum, Moffit denied that the Heritage Foundation’s shift was political, asserting that it had happened over the course of several years, and that Heritage had rejected the individual mandate before President Obama had even come to office.

According to Moffit, healthcare reform as a central political issue “largely disappeared, for the most part” between President Clinton’s efforts in the early 1990s and around the time of Massachusetts’ healthcare reform. When the issue of an individual mandate came up again, Heritage had changed its mind on the issue.

In talking about the Massachusetts system, Moffit emphasized the Foundation’s efforts in planning the state-based health insurance exchanges. Asked whether Heritage was involved in the individual mandate aspect of the reform, Moffit said, “Well, not very much.”  Moffit insisted that he had been against the individual mandate for several years, pointing to an article that he wrote in 2006 which blasts the individual mandate.

According to Moffit, the crystal clear shift in Heritage healthcare policy came in 2007:

In 2007, my boss, [Heritage Foundation Vice President of Domestic & Economic Policy] Stuart Butler had written a major article for Brookings… and he basically started making it clear that the individual mandate was not the way to go.

But why the shift? If Heritage had decided that the individual mandate was necessary in the 1990s, why did they find it untenable fifteen years later? In his Washington Post editorial, Moffit claimed that Heritage changed its stance because of new facts and deeper analysis.

What new facts? Moffit said that the key data Heritage looked at was compliance data, and the effectiveness of government mandates in ensuring high levels of compliance:

One of the things we started looking at was: does the individual mandate get you to universal coverage? Or, is there another way to do it? We looked at the data for [things like] auto insurance and federal mandates for tax filing, and registration for the draft, for example. None of these mandates give you universal coverage.

One of the studies that Moffit cites as evidence is an article by the National Center for Policy Analysis, which claims that 14.6% of American drivers remained uninsured, despite mandates in every state; it also says that some of the least punitive states featured the lowest levels of noncompliance.

With ideas like this in mind, Moffit claims that Heritage reevaluated their goals thusly in 2005/2006:

So the question [was]: what are we trying to do here? We’re trying to get as many people “insured as possible. There are other ways to do this!

Asked what the Heritage Foundation would propose to do in order to increase coverage, Moffit said:

Our [current] view is that there are better ways to [expand coverage]: through positive tax incentives and things like options for enrollment at the place of employment, auto-enrollment with the right to refuse, is going to get you the same level of coverage.

Of course, experience has shown that state-based healthcare mandates have been more effective than auto insurance mandates. In Massachusetts, where there is a healthcare insurance mandate, 97% of its residents are now covered.

So if we actually look at the experience of the health insurance mandate in Massachusetts, we find that health insurance mandates can actually lead to very high compliance. Despite this, Heritage remains staunchly against the concept. As such, it seems as though the shift in Heritage’s stance towards the individual mandate is not based on “new facts”, as Moffit claims, but rather a new focus.

Indeed, it appears as though Heritage’s primary goal with regards towards healthcare reform has shifted from simply expanding coverage to preferring more ideologically pure reforms that place a healthy “bias towards liberty”.

The notion that President Obama’s federal health insurance exchanges were built off Heritage’s Massachusetts plan is also something that the Foundation’s top healthcare scholar vehemently denies. “‘Exchange’ is a word, which can mean many different things… [President Obama] uses the word in one way, we use the word in another way,” he said.

Moffit also dislikes the President’s healthcare exchanges primarily because they would serve as a platform for a federal public option:

The only reason why he would create a national health insurance exchange is to have a platform for a public plan that would compete against private plans… We have a national market in lettuce. You don’t need a lettuce exchange.

Finally, suggestions that Heritage only opposes Obamacare because it was proposed by a Democrat are “low blow[s],” said Moffit.

In fact, Moffit continued, the most cynical political maneuvering was pulled off by the president, who sought political cover by using terms and phrases which conservative groups like the Heritage Foundation could agree with, even as he had no intention to negotiate:

He used broad themes … like we need to expand coverage to people who don’t have coverage today… [but] broad phrases like the use of ‘health insurance exchanges’ and ‘cost control’ mean absolutely nothing… It’s the details that determine where you end up. And it was very clear from the beginning that Obama’s agenda was radically different from that of the Heritage Foundation.

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40 Comments so far ↓

  • CO Independent

    Man, you can almost hear the crickets chirping on this blog. Prison Rape, Fiorina, blah, blah, blah, Fat Soldiers, Toenail Fungus (ok, I made that one up). Does anyone care?

    I think it’s time to trot out the wife for another Palin-bash or another excerpt from our fictional gay soldier friend RD (or was is JD or JR, I can’t recall). That’ll get the hit count up.

  • Moderate

    Healthcare reform as a central political issue “largely disappeared, for the most part” between President Clinton’s efforts in the early 1990s and around the time of Massachusetts’ healthcare reform.

    Hmm. Health care reform disappeared as an issue between 1994-2006. The exact years when Republicans controlled Congress. A striking coincidence.

    I’m sure the Republicans had more pressing issues to attend to. Like… Bill Clinton getting a blowjob.

  • Rabiner

    Moderate:

    Good pointing out how the years health care wasn’t an issue are in direct correlation with the years Republicans controlled Congress. Pretty funny when you think about it.

    I find the author does a good job of pointing out the hypocrisy of Heritage disowning their own policy proposals when ‘new data’ came along that would go against their original analysis (car insurance compliance) but ignore ‘new data’ that deals with the actual issue (Mass Health Insurance compliance).

  • TerryF98

    Flip flop, flippity flop,Flip flop, flippity flop,Flip flop, flippity flop,Flip flop, flippity flop,Flip flop, flippity flop, Nothing to see here.

    Black is white, up is down, all is well in Stalin Land

  • sdspringy

    HCR was billed as the remedy for a broken medical system which was too costly, and was reslulting in lost jobs.

    Now we know that HCR will NOT lower medical costs, will NOT reduce medical insurance premiums, and will NOT improve the healthcare delivery system.

    Maybe you don’t fix what isn’t broken. Other than no longer allowing denial of coverage, which would not have taken 2000 pages of legislation, what improvement will there be??
    Your costs will go up, your premiums will go up, your access to medical care will be affected.

    I sure am glad the medical system was fixed.

  • sinz54

    It’s important to understand how insincere these “plans” often are.

    A favorite tactic of the political opposition to some plan from an Adminstration is to quickly come up with their own reasonable-sounding but strawman “plan.” It’s never really intended to be passed, and the opposition doesn’t really believe in it anyway. It’s simply there to try to pull support away from the Administration plan. And after the issue dies down (whether the Administration’s plan is passed or not), the opposition hopes that everybody will forget about it. If the opposition wins the next election, they don’t resurrect their failed plan. They just ignore the whole thing.

    For example, in 1981, the first year of the Reagan administration, the Dems introduced their own plan for national defense, to try to undercut support for the Reagan defense plan. Does anybody remember the Dem plan? Not even the Dems. Mondale didn’t even mention it when he ran against Reagan just 3 years later.

    And in 1993, when Hillary was trying to get her health care bill through the Congress, the GOP introduced their own health care plan. It was intended to sound more reasonable than the Hillary plan. But it was just there as a strawman, to try to undercut support for the Hillary plan. After the Repubs took over Congress in 1994, they didn’t resurrect their health care plan–because they never believed in it in the first place. And the Heritage Foundation didn’t keep pushing for it.

    The conservatives who proposed a mandate didn’t really believe in it. It was just a tactic to try to undercut support for the Hillary plan–after which they dropped it.

  • mlloyd

    The conservatives who proposed a mandate didn’t really believe in it. It was just a tactic to try to undercut support for the Hillary plan–after which they dropped it.

    Probably true, Sinz. I believe Orrin Hatch admitted as much. Just like they don’t believe that death panels are real, or that the financial reform bill will lead to more bailouts, or that the stimulus hurt the economy. They just lie all the time because that’s how they roll.

  • CAPryde

    “Other than no longer allowing denial of coverage, which would not have taken 2000 pages of legislation, what improvement will there be??”

    Stopping denial of coverage is precisely why you have to have a mandate (or some similar mechanism). If insurance companies can’t deny coverage, then the most logical and economical thing to do is to wait until you get really sick, then apply for coverage (or buy cheap coverage and then upgrade it), then drop it as soon as you get healthy. So if you want to prevent insurance companies from denying coverage, you have to provide them with some assurance that people will not just game the system in that fashion, or their business model totally falls apart.

  • balconesfault

    Now we know that HCR will NOT lower medical costs, will NOT reduce medical insurance premiums, and will NOT improve the healthcare delivery system.

    But it will significantly reduce the number of Americans who go without health insurance.

    If you want government to guarantee the first or second thing – you should favor a single-payer system, or at least a public option.

    If you want government to guarantee the last thing, you need to just nationalize the whole healthcare system, and that’s going way further than about even most Democrats would be willing to go.

    Meanwhile, the analogy to auto insurance is heavily flawed … because mandates for auto insurance don’t contain government subsidies for those who can’t afford auto insurance.

    Personally, I’m quite comfortable with the idea that people who can’t afford auto insurance shouldn’t drive. I’m much less comfortable with the idea that people who can’t afford medical insurance shouldn’t live.

  • Oskar

    Heritage is a joke.

  • balconesfault

    Heritage is a joke.

    The Bartlett piece on “The End of the Think Tank” in Forbes doesn’t say exactly this – but it does give a pretty good summary of Heritage’s purpose:

    Feulner resolved to fill the gap between the think tanks of that era and the fast-changing needs of Congress. The idea was to have an institution that wouldn’t take years to study an issue to death and not deliver its research until it was too late, but that would produce its research on a much faster schedule, in time to influence congressional debate.

    From Feulner’s vision the Heritage Foundation was established in 1973. Rather than fill its staff with aging Ph.D.s, he hired people with master’s degrees who had perhaps studied with the small number of conservatives in academia. Their job wasn’t to do original research, but to take the research that had already been done by conservative academics, summarize it and apply it to the specific legislative issues Congress was considering.

    As bottom line pressure increased at think tanks, many found themselves becoming ever more closely aligned with politicians and political parties. I recall one conversation I had with a very rich contributor to a think tank where I was working. He told me that the money he contributed to the organization came from the same pot of money he budgeted for political contributions.

    As the think tanks became more political and donations from extreme partisans became a bigger source of revenue there was increased pressure on their staff to conform to the party line. Usually this took the form of self-censorship, as a former Heritage staffer recently told me. He understood that the organization was closely aligned with the Republican Party so he just avoided ever saying anything publicly critical of Republicans. No one needed to tell him to do so; it was part of the corporate culture that was simply understood.

  • Rob_654

    The Far Right got caught with their collective pants pulled down around their ankles and the old guy is trying to spin his way out of it as fast as he can – but it just ain’t working.

  • SpartacusIsNotDead

    Sinz wrote: “The conservatives who proposed a mandate didn’t really believe in it. It was just a tactic to try to undercut support for the Hillary plan–after which they dropped it.”

    Not true at all. The Heritage Foundation strongly supported the mandate in the MA plan, which came well after Hillary Clinton’s attempt at reform. And, Sen. Grassley has long supported an individual mandate, in large part, because it was consistent with the ideal of personal responsibility. Conservatives opposed the mandate only after it became part of Democratic proposals.

    All of this is just more evidence that the GOP is more interested in winning elections than it is in enacting good public policy.

  • Rob_654

    sinz54 // Apr 23, 2010 at 9:39 am
    The conservatives who proposed a mandate didn’t really believe in it. It was just a tactic to try to undercut support for the Hillary plan–after which they dropped it.

    So, you are saying that they lied. But then how do we know that what they saying NOW isn’t a lie in order to just distance themselves from Obama?

  • SpartacusIsNotDead

    Rob_654 wrote: “But then how do we know that what they saying NOW isn’t a lie in order to just distance themselves from Obama?”

    That is exactly what they are doing.

    http://www.slate.com/id/2251317/pagenum/all/#p2

  • mlindroo

    Sinz54 wrote:
    > The conservatives who proposed a mandate didn’t really believe in it.
    > It was just a tactic to try to undercut support for the Hillary plan–after which they dropped it.

    Good point! I think Bob Dole also pledged that the GOP Senate would revisit health care reform later if Congress agreed to kill HillaryCare. Of course, nobody lifted a finger.

    The cold, hard truth is that conservatives are not very interested in HCR, whereas universal health care is one of the fundamental core goals of American progressives. Read NATIONAL REVIEW, THE WEEKLY STANDARD, COMMENTARY, WSJ, RedState.com etc. and you quickly notice that the current “repeal and then reform!” talk almost exclusively deals with the former. These guys only care about health care from a meta-ideological point of view, i.e. the impact of “statism” and “collectivism” on federal spending and the American national psyche.

    MARCU$

  • balconesfault

    These guys only care about health care from a meta-ideological point of view, i.e. the impact of “statism” and “collectivism” on federal spending and the American national psyche.

    Yep … not to far off the mark to say that right now Democrats biggest fear is that healthcare reform won’t work … and Republicans biggest fear is that it will.

  • sinz54

    SpartacusIsNotDead: The Heritage Foundation strongly supported the mandate in the MA plan, which came well after Hillary Clinton’s attempt at reform.
    The Heritage Foundation supported Mitt Romney, you mean.

    In 2006, then governor Romney had proposed universal coverage for MA. In this case, the Heritage Foundation wasn’t proposing strawmen to undercut Dems–they had to stand up for who was perceived as a rising star in the GOP.

    But you notice that now, even Mitt Romney has run away from his own healthcare reform package!

    And that certainly sent a signal to the Heritage Foundation: If the Republican who created such a mandate no longer wants any part of it, they’re not going to get a lot of GOP customers by pushing for it themselves.

  • balconesfault

    Sinz … really?

    So the sum total of value of the Heritage Foundation really is supporting Republican politicians and avoiding conflict with the Republican base?

    That’s a more damning indictment than any I’ve even heard leveled at them from the left!

  • SpartacusIsNotDead

    Sinz wrote: “The Heritage Foundation supported Mitt Romney, you mean.”

    After all this time I still can’t tell if you’re lazy, dishonest, unintelligent or simply too insecure to admit you’re wrong about something.

    The Heritage Foundation supported an individual mandate BEFORE Romney supported health care reform in MA. Having lived there and claiming to have followed the issue closely, you should know this.

    http://www.heritage.org/Research/Testimony/Laying-the-Groundwork-for-Universal-Health-Care-Coverage

  • sdspringy

    Mak criticizes Heritage’s stance that positive tax incentives will get you to a higher level of enrollment. Failing to address the cost issue completely and then throwing Massachusetts healthcare system out as the shining light.

    Lets review some of Massachusetts’ problems:

    For an individual earning $31,213, the cheapest plan can cost $9,872 in premiums and out-of-pocket payments

    Low-income residents, previously eligible for free care, have insurance policies requiring unaffordable copayments for office visits and medications.

    Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009, which is not sustainable.

    Now we begin to hear the actual costs of the Obama HCR. Now we hear costs will not be reduced, and Medicare will be severely affected.
    Heritage is not being political now, given the fiscal nightmare in Massachusetts, to back away from a study done fifteen years ago. However Mak appears partisan to his current paycheck to author this article as cover for Frumm

  • sdspringy

    HCR will NOT improve the healthcare delivery system:

    Balcon: If you want government to guarantee the last thing, you need to just nationalize the whole healthcare system,

    Balcon there is no current government, nationalize, medical delivery system that is considered an improvement. Even our VA, and medical services on reservation are considered poor, in fact very poor.

    Britain’s own nationalize healthcare system has worse outcomes than our system.

    I really am surprised you would have that opinion. And while we can agree on legislation to prevent denial of coverage this current HCR will be a disaster.

  • balconesfault

    Even our VA, and medical services on reservation are considered poor, in fact very poor.

    I have substantial experience with the DOD healthcare system, having grown up an army brat, and seeing the coverage that my father and mother received for decades after his retirement.

    It was universally excellent.

  • sdspringy

    I was in the military as well, and received medical care, no complaints. But that isn’t the VA.
    And though you provided a single example of passable care, it fails to negate the many other stories which have a different ending.

  • balconesfault

    I was in the military as well, and received medical care, no complaints. But that isn’t the VA.

    You’re right. And sensible policy would be to ask “why is the DOD system so good, and the VA system flawed?”

    Rather, you wrote Balcon there is no current government, nationalize, medical delivery system that is considered an improvement.”

  • sdspringy

    Balcon, you are right I should have been more specific by stating there is no Public government run system.

    Possibly the reason for the differences is in the incentive side. While in the Military there exist a built in incentive, while the public sector has only the profit motive.

    Which begs the question can you have a well run Public sector healthcare system were there is no motive for improvement. The answer, as I see it, resides in Britian, where the answer is NO.

  • Rabiner

    sdspringy:

    “Britain’s own nationalize healthcare system has worse outcomes than our system. ”

    Where is your proof for this claim? Every ranking I found on health care outcomes has the United States as 37th best in the world while the UK is 18th.

  • sdspringy

    The survival rate for cancers and other serious conditions are higher in the US. We have the best healthcare in the world. We may however have problems paying for it.

    We wait less for procedures, we recieve better care, we just pay more than we want to in order to recieve it.

    This cost issue is not something the Brits deal with daily. They lose, on average, 9% of their gross wages to their healthcare system. Proving nothing is free, just preception of payment.

  • balconesfault

    The answer, as I see it, resides in Britian, where the answer is NO.

    You do realize, I hope, that Britain spends less money per capita on government provided healthcare than we do in the US?

    Yet with that, they manage to provide government healthcare to their entire population, while we provide it to about 1/2 our population, the rest of us relying on private insurance.

    In fact, in total societal expenditures, Great Britain spends about 35% of what the US does on healthcare.

    So if you are concerned about not only results, but about costs (which most conservatives claim to be) you should be taking a serious look at what Great Britain is doing better than us.

  • sdspringy

    Balcon, you are right, of course concerning cost. Britain however taxes all wages, are the Dems willing to implement an across the board wage tax on all earners.

    And since we have 4 times the number of people, not counting the illegals, our tax would be considerably higher. Are the Dems ready to go to the UAW and pull 10% of their gross wages to pay for healthcare.

    If you can state that you are willing to support a 10% tax on all earners, which I believe you are and what may surprise so would I, then lets roll to socialized medicine. Otherwise it’s not going to happen.

  • Rabiner

    Sdspringy:

    Our infant mortality rate is higher, our life expectancy is lower and we spend twice as much and get poorer results. Seems that we don’t have the best health care system in the world.

    “Balcon, you are right, of course concerning cost. Britain however taxes all wages, are the Dems willing to implement an across the board wage tax on all earners. ”

    You mean like medicare payroll taxes?

    You argue that we have 4 times the people than the UK and our tax bill would be considerably higher due to that without even looking at the per-capita expenses for health care in this country versus theirs. You’d expect tax receipts in a country 4 times larger, that has the same expenses for health care to be the same per-capita, size isn’t an issue. And I’m surprised by your willingness to move to socialized medicine while at the same time arguing that our private health care system is the ‘best in the world’.

  • sdspringy

    I think Rabiner the statistics on infant mortality rates are different for reasons other than quality of healthcare. In some countries, a severely premature infant is labeled a fetal death instead of an infant death. Not in the U.S. In many nations, if a child dies within 24 hours of birth, it is labeled a stillbirth. Not here.
    American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared with 56 percent of women in Europe. For American men, the numbers are even more dramatic. Sixty-six percent of American men live five years past a diagnosis of cancer, but only 47 percent of European men do. Of cancers that affect only women, the survival rate for uterine cancer is 5 percentage points higher in the U.S. than the European average, and 14 percent higher for breast cancer. Among cancers that affect only or primarily men, survival rates for prostate cancer are 28 percent higher in the U.S., and for bladder cancer, 15 percent higher.

    If Medicare taxes were enough there would not be 32 TRILLIONS in unfunded debt. So no I don’t mean those.

    I would be willing because then based on the British system everyone pays, even the loyal Dems. No exemptions for unions, which then makes the likely hood of socialized medicine unlikely.

  • balconesfault

    I would be willing because then based on the British system everyone pays, even the loyal Dems. No exemptions for unions, which then makes the likely hood of socialized medicine unlikely.

    With a proper phase in period, I have no doubt that unions will gladly accept the US government taking over their healthcare.

    Because with their employers no longer having to pay for their healthcare, their employers would then be able to pay them more money.

    However, if you’re in the middle of a multi-year contract based on a specific legal tax incentive, you certainly don’t want the legal tax incentive removed before the contract expires. Because suddenly you would see a real cut in net income, with no increase in your benefits.

    And while I know everyone has their favorite story of fat and happy union workers making tons of money for doing nothing, the reality is that a real cut in net income would push many of them to the edge of financial problems … with no way to negotiate for increased wages except for waiting until their next contract renewal comes up.

  • Rabiner

    The discrepancy between survival rates on cancers from what I’ve read has to do with later detection in Europe, not a lack in quality treatment. The later you discover cancer the less likelihood you survive. However the costs attributed to those higher detection rates is extremely expensive and cost prohibitive.

    And I can only go by the statistics offered regarding infant mortality in this country versus other industrialized countries and one thing is that women in other industrialized countries have a far higher propensity of receiving pre-natal care which probably has a lot to do with lower infant mortality rates. Also obesity rates in those countries and other health factors such as diabetes can cause more complications for pregnancy. But the fact remains, the United States is not a healthy nation when compared to other industrialized nations.

    With regards to the unfunded liabilities of Medicare, a large portion of those liabilities are a result of Medicare Prescription drug coverage passed during the Bush administration which had no offsetting revenues to pay for it.

  • sdspringy

    Rabiner, I have always heard that early detection reduces cost. So if early detection is cost prohibitive what panel will decide who gets screening?

    Obesity rates certainly do matter but whether access to medicare will fix that is undertermined. And statistics are the most abused method for political partisan I always try to present both sides, ie.. cancer survival rate, infant mortality.

    And though the much hated Bush did sign the Med. Prescription Drug in 2003, even his evil ways could not acquire 32 Trillion in unfund liabilites in 5 years. Actually the cost as of February 2009, the projected net cost of the program over the 2006 to 2015 period was $549.2 billion

  • JonF

    Re: The later you discover cancer the less likelihood you survive.

    I would rephrase that to:
    The later you discover a terminal illness, the less time elapses between diagnosis and demise.
    The word “survival” is not a synonym for “cure”.

  • Rabiner

    sds:

    Unfunded liabilities can easily be acquired in 5 years to that magnitude. They’re liabilities that have not been realized but rather projected. By passing Medicare Part D you easily can say that over the 50 years or so that spending on medicare may increase by 32 trillion, which since there was no offsetting revenues would be an increase in unfunded liabilities of 32 trillion.

    Look at the recent panel that said they’d recommend mammograms be given at a later age than 40 due to the costs, lack of detecting cancer, and number of false-positives that lead to mental strain on individuals. Sadly politicians attacked the scientists for a cost/benefit analysis that was sound and said we wouldn’t change recommendations on when women should get mammograms. Sure you’ll find cancer earlier in women if you’re giving every single woman a mammogram in the United States from age 40 annually earlier than in Europe when its done at age 50 but the costs associated with are excessive.

    If you have a finite amount of resources you have to choose where to spend most effectively and while it has helped us in increasing survival rates of cancer it is a reflection of us spending excessively on detection, not on treatment which is equal across those nations.

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