He has answered the question. And answered it again, and again. Still it comes up in every debate, and practically every conversation about him. Early in that last campaign, I heard him do a radio interview (not sure now where it was, but it may have been on Hugh Hewitt’s show, which led to my reading Hewitt’s book on Romney).
I am not a health care expert; I am just a regular citizen, involved in health care just as a regular consumer. I have some heath issues that have led me to be very distrustful of anyone making my health care decisions except for myself. So I am maybe more against central planning than average. But my discussion here is just my thoughts on how I have worked through this issue.
First let’s start with a review of the situation in Massachusetts. Romney was governor there 2003-2006 (he ran for only one term). When he came into office, the state was in dire straits—due to overspending and bad management, the very things you see in the wake of liberal administrations everywhere. The health care situation in Massachusetts was somewhat similar to other states, a combination resulting from federal mandates and cultural deficiencies. It is a desire of a civilized people to succor those in need; if someone comes into a hospital with an urgent need, they should be cared for, regardless of ability to pay. But when the federal government mandates how caregivers must give that service—without a way to be recompensed—then two things happen: state and local governments must pay the expense, or the costs will have to be spread out on those who are paying patients, raising costs for all. Usually it's a combination of these.
And with higher costs, there is a tendency for more people to claim they can’t pay. Add to that the tendency for insurance (a third party) to do the paying, which has also contributed to rising costs. State and federal laws interfere with free market insurance sales and take medical services out of the mindset of market decisions, so it’s not surprising states face the difficult task of paying the bill for patients who get services without paying.
States with more illegal aliens and higher poverty tend to notice the problem more than others, so it might be that we have less sympathy for Massachusetts. Nevertheless, in their near bankrupt economy, they needed a way to stop the outflow of money to medical care. One thing they identified was that people who had income to buy insurance were opting not to buy insurance, because they knew the state was required to allow them to get care. So getting people who could buy coverage to get coverage was a goal, with the purpose of decreasing unnecessary state spending. Romney brought in many sources to help come up with solutions; among these was the reliably conservative Heritage Foundation, which approved of the final version as the best that could be gotten under the circumstances.
There are various ways of persuading people to buy insurance (a way of saying, in today’s medical economy, pay for medical services). Romney’s preference was an incentive—a subsidy or discount for those who made the choice the state preferred. But he was working with a very Democrat legislature (85% Democrat, only 15% Republican); they disallowed that option in favor of a penalty for failure to buy—because Democrats generally prefer using the power of the state to coerce. Romney countered with a compromise, a carrot and stick approach—an incentive for choosing to buy insurance, a penalty for failure to buy insurance. The Democrats rejected the compromise. In order to stem the flow of money to health care, Romney gave in to what is now referred to as the mandate. It was neither his idea nor his preference, but he has stood by it in loyalty to those who worked together to develop Massachusetts Care.
Besides the penalty for failure to buy insurance, the state does provide subsidies to help those who had previously been unable to purchase insurance. They work with private insurance companies to help lower income people to be able to afford insurance. Additionally, there are efforts to make insurance portable when a person changes employers—something most people see as a positive direction for insurance. I think there were also efforts to make insurance more easily purchased across state lines, another good thing. There was no state health care insurance, in competition with free market sources; all insurance was purchased from private, existing companies.
Did this program cost the state? Yes—but not as much as it was costing to pay for people who were essentially sending their medical bills to the state. It was a net gain economically for the state—among a number of policies Romney implemented that brought the state from deep in the red to fully in the black.
The Massachusetts health care bill was 70 or so pages, and specifically limited. While it included the mandate (penalty for failure to purchase), and we lovers of freedom find that offensive, the mandate did not violate the Massachusetts constitution. There were a number of changes made to Massachusetts Care implemented by Governor Duval Patrick, Romney’s successor, which raised the costs beyond initial estimates. But, even so, the citizens of Massachusetts (a highly Democrat populace) still approve of the program and want to keep it.
How does Massachusetts Care compare to Obamacare? Obamacare was a monstrous 2700 pages, with tentacles reaching into schools (clinics set up in schools that could dispense birth control without parental knowledge or consent), additional taxes on home sales, and multiple other intrusions that don’t have anything to do with health insurance and don't have support among the population.
Obamacare adds taxes, penalties, and fees, placing a greater burden on businesses during economic times that already discourage economic growth. There is incentive for businesses to stop offering health insurance as a benefit to employees, and just let employees fend for themselves or go into the national socialized system. The federal insurance (and medical insurance, in the form of Medicare and Medicaid, has never been anything but an economic drain) is in competition with private insurance—and Obama has admitted that this is an incremental approach to converting to eventual total socialized medicine, as you see in Europe or Canada. Always that means costs rise, care decreases, innovation is discouraged. And those who have other than standard needs often fail to get care. Also people tend to pay in time and inconvenience in exchange for higher costs. And government gets to make decisions that have previously been made by patients and their doctors.
Doctors are already on the verge of refusing to participate in government-required care, such as for Medicare patients; it isn’t cost-effective for them to offer the service. In a free country, they cannot be forced to give care for no pay, so if the government tries to require that, doctors will leave their practices, retiring early or changing careers.
Obamacare was implemented without any bipartisan consultation. With control of Congress and the Senate, Democrats could push through whatever they wanted without a single Republican having a say—and that was their approach. But they couldn’t even get all Democrats on board, because the program was so unwanted among the American populace. They had to resort to bribing a number of legislators to get their vote, and they had to do it using shady, unethical technical procedures, over a weekend, because an honest straightforward vote was unwinnable.
The federal mandate is at the heart of the bill; there was no attempt to persuade people without coercion. But the US Constitution is limiting; the federal government is only given certain enumerated powers—absolutely not including the power to force citizens to make a purchase simply because they have been born. The 11th Circuit Court ruled the entire bill unconstitutional earlier this year, so there is hope that through legal and legislative means it will be ended before too many of the insidious tentacles take hold. (See Heritage Foundation, Impact of Obamacare.)
Is there a similarity between the two health care programs? A very small and limited similarity, plus another 2630 pages of dissimilarities. Romney has frequently pointed out that Massachusetts Care was a specific state solution to a state problem. It absolutely could not and should not be a federal program. He is consistently and firmly against Obamacare. His approach as president would be to use an executive order on his first day in office to give every state an exemption to opt out. Then he would work with the legislature (preferably a friendly conservative legislature) to repeal Obamacare in total, ASAP. He would then work to find market solutions to health care costs—many of which have been offered by conservative legislators but have been ignored.
Was “Romneycare” a model for Obamacare? No, but it has been used as an excuse. And Obamacare is so widely despised that the very existence of “Romneycare” has made it an effective attack on Romney.
I personally would prefer that Massachusetts Care not be part of Romney’s record. I understand his point of view, the position he was in at the time, and the wide ranging powers granted to states that are not granted to the federal government. But I would prefer looking at Romney without the challenge of having to defend anything even remotely socialist.
While I think I understand enough about the whole of Massachusetts Care that it is not disqualifying to Romney as a conservative presidential candidate, I would like to sit down with him and ask a couple of specific questions. I would like to know he has read Bastiat’s The Law, and/or Benson’s “The Proper Role of Government,” and then I would like to be reassured that he agrees—that, even though states are not prevented from acting in ways they can set up for themselves, that he believes there are things states simply should not do. I think, from other things I’ve heard Romney say, that he understands limited government philosophically, heartfelt. But I would like to hear it in language that is clear and unequivocal.
So far almost all we’ve covered on Romney has been to debunk attacks. It will be a pleasure to spend the next post covering his unique qualifications.