Bob Schwartz

In 1989, Stuart Butler and others at the conservative Heritage Foundation laid the groundwork for Obamacare/Romneycare in the publication A National Health System for America. Chapter 2 by Butler, A Framework for Reform, outlines and explains “the key elements of a consumer-oriented, market-based, comprehensive health system for America.” Element #1 is “Every resident of the U.S. must, by law, be enrolled in an adequate health care plan to cover major health care costs.” (page 51):

The requirement to obtain basic insurance would have to be enforced. The easiest way to monitor compliance might be for households to furnish proof of insurance when they file their tax returns. If a family were to cancel its insurance, the insurer would be required to notify the government. If the family did not enroll in another plan before the first insurance lapsed and did not provide evidence of financial problems, a fine might be imposed.

In other words, a mandate.

Agree or disagree with the Heritage Foundation or this proposal, Butler deserves credit for putting together a cogent, well-written primer on health care history, a report on the shortcomings of the current system, and a set of well-reasoned and creative proposals.

But no good or at least well-intentioned deed goes unpunished. In the time since, and especially in the past year, Butler and others have taken pains to explain how this Heritage Foundation proposal isn’t Obamacare and, in any case, how the proposal has been misunderstood and misapplied. The document itself can still be found on the Heritage Foundation website, though it is not shown and linked as one of Stuart Butler’s documents.

No matter what is argued to the Supreme Court today, no matter what the Justices ultimately decide about the constitutionality of mandates, and no matter how the complicated political dance involving Obama, Romney, Obamacare, and Romneycare turns out, Heritagecare was there first. It is essential reading.