The Heritage Uncertainty Principle

In physics, there is a fundamental limit to the precision with which the properties of a small particle can be known simultaneously. For instance, the observer cannot know both the position and the momentum of a particle like a photon at the same time. This principle is known as the Heisenberg Uncertainty Principle.

Similarly, in politics there is a limit to knowing where one lays on the political spectrum and how quickly you are moving to or from that position. A tweet from Amitabh Chandra which posed the question: “Why have Democrats embraced HDHP [high-deductible health plans], Mandates and Exchanges, but Republicans turned on them?” allows us to illustrate the point.

In 1989, Stewart Butler, the Director of Domestic Policy Studies at the Heritage Foundation delivered a speech to Meharry Medical College based upon their recently published manuscript A National Health System for America. The Heritage plan was to guarantee all citizens universal access to affordable care through the following key components:

1. Ending the personal tax exclusion for employer based health insurance and replacing it with a tax credit

2. Mandating that all households obtain adequate insurance coverage

3. Providing refundable tax credits to help families pay for insurance coverage

4. Allowing Medicare enrollees to use a voucher to obtain private insurance

 

“[N]either the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement.”

In later years, conservative thinkers would go on to champion consumer-directed health plans – specifically high deductible plans coupled to health savings accounts. The thinking went that if patients had more “skin in the game” that they would find ways to visit less expensive health care providers and bring down the price of health care. Liberals generically disliked the idea as something that would benefit the rich, the healthy, or would impose too great a financial burden on others who adopted such insurance plans.

If you had blasted off into outer space in 1989 and made a trip to Pluto and back, you might be returning to Earth right about now. Not only would you be surprised that Pluto was no longer a planet (I personally was dismayed when I heard the news), you would also be flabbergasted that a law containing a “health care social contract” between the citizen and the federal government received no support from the Republican party.

“Under this social contract, the federal government would agree to make it financially possible, through refundable tax benefits or in some cases by providing access to public-sector health programs, for every American family to purchase at least a basic package of medical care, including catastrophic insurance. In return, government would require, by law every head of household to acquire at least a basic health plan for his or her family.Thus there would be mandated coverage under the Heritage proposal.”

So now, as Chandra alludes, HDHPs are essentially the Affordable Care Act’s bronze option, the individual mandate is alive, and families can purchase health insurance in exchanges instead of through their employers. But for some strange reason Republicans and the conservative think tanks that have fed them ideas have changed positions.

We know what the position of politicians such as Newt Gingrich was in the early1990s (and up to the early 2000s) but we cannot simultaneously know how quickly he (and others) would move away from that position. That’s a little political principle many people like to call The Heritage Uncertainly Principle.