Turns out the personal mandate was a 'conservative' response to nationalized health care in 1991. It has been a Republican talking point until just recently.
"So in 1991, a group of conservative academics proposed an alternative: the individual mandate, which says that everyone who can afford health-care insurance has to buy it. That means no free riders, no healthy people waiting until they get sick to buy insurance or stick the rest of us with the costs of their care. â??We did it because we were concerned about the specter of single-payer insurance, which isnâ??t market-oriented, and we didnâ??t think was a good idea,â?? says Wharton economist Mark Pauly, one of the ideaâ??s authors.
For the next 18 years or so, thatâ??s the role the individual mandate played. It was what Republicans proposed as a smaller-government alternative to the health-care plans favored by liberals. In November 1993, Sen. John Chafee, a Republican from Rhode Island, proposed the Health Equity and Access Reform Today Act. The legislation became the GOPâ??s semiofficial response to President Bill Clintonâ??s health-care bill, and it was eventually co-sponsored by such influential Republicans as Bob Dole, Richard Lugar, Chuck Grassley, and Orrin Hatch. The other major Republican alternative, the Consumer Choice Health Security Act, included Jesse Helms and Trent Lott as cosponsors, and also included an individual mandate."
"But when Republicans failed to stop Obamaâ??s health-care law in Congress, they decided to try convincing the courts that the individual mandate represented something new and unprecedented: a regulation of economic inactivity. The Constitutionâ??s Commerce Clause gives Congress authority to regulate your actions when youâ??re engaged in commerce, argue these conservatives, but not when youâ??re not engaged in commerceâ??like when youâ??re choosing not to buy something. Someone deciding not to buy something is, almost by definition, not engaged in commerce, the argument goes.
That strikes many health-care policy experts as an oddly narrow understanding of what the individual mandate does in the context of the free-rider dilemma. As 38 of themâ??including a few Nobel Prize winnersâ??wrote in a brief to the court, â??There is no such thing as â??inactivityâ?? or non-participation in the health care market.â?? Eventually, we all end up as participants in the health-care system, whether we want to or not. The question is simply whether we participate responsibly or irresponsiblyâ??whether we pay for ourselves or have others pay for us."