Stuart Butler explains his change of heart on the individual mandate

Stuart Butler, one of the lead health-policy experts at the Heritage Institute, explains why he changed his mind on the individual mandate:

First, health research and advances in economic analysis have convinced people like me that an insurance mandate isn’t needed to achieve stable, near-universal coverage. For example, the new field of behavioral economics taught me that default auto-enrollment in employer insurance plans can lead many people to buy coverage without a requirement.

Also, advances in “risk adjustment” tools are improving the stability of voluntary insurance. And Heritage-funded research on federal employees’ coverage — which has no mandate — caused me to conclude we had made a mistake in the 1990s. That’s why we believe that President Obama and others are dead wrong about the need for a mandate.

Additionally, the meaning of the individual mandate we are said to have “invented” has changed over time. Today it means the government makes people buy comprehensive benefits for their own good, rather than our original emphasis on protecting society from the heavy medical costs of free riders.

I would find this more persuasive if there were evidence that the shift predated President Obama’s embrace of the policy. But in 2006, the Heritage Foundation supported Gov. Mitt Romney’s plan to pass an individual mandate in Massachusetts. The state of health-care policy knowledge on risk pools and automatic enrollment did not change very much between 2006 and 2009, and Romney’s mandate required only slightly less comprehensive insurance coverage than Obama’s mandate: a 56 percent actuarial value versus a 60 percent actuarial value, for those who want to get wonky about it.

Here’s more commentary from Don Taylor. Here is Butler’s 1989 case (pdf) for the individual mandate. Here is Butler’s 2008 proposal for a state-by-state approach to health reform.