Blue Mass Group

Good grief … people have some funny ideas about what Massachusetts is like, and who Mitt Romney was, and the story of our health care law.

[This is why Romney is] best qualified for the job of health-care czar: He's basically already done it. In fact, he's the only executive who has done it. As countless commentators have noted (Alex Knepper from the right, Brad DeLong from the left, and David Frum from the spurned right), Obamacare largely is Romneycare. The concept of attaining near-universal health insurance in a defined geographic area using a combination of a mandate, subsidies, and cost-control efforts is essentially what Romney did in Massachusetts earlier this decade.

Ooooohkay, where do we start with this? First, squint real hard and pretend that Mitt didn't say all that stuff about how the law is an evil usurpation of American freedom yadda yadda. Still doesn't cut it.

But let's just revisit history, and the myth of Mitt as the Ur-Creator of Massachusetts health care. As I mentioned a while ago, back in 2004-2005, momentum was building towards a ballot initiative that would have created a pay-to-play system for health care: Either employers would have to offer health care, or pay into a pool to pay for a big (not universal) expansion of health care coverage. 

The legislature saw this coming, and realized if this passed, it would not be they who were making the policy. The players reacted in a couple of different ways: as the progressive hero of that moment, House Speaker Sal DiMasi took up the banner of ambitious health care reform. Senate Prez Travaglini seemed to be interested in watering down the employer mandate as much as possible, and shoring up the community hospitals in his district, Cambridge Health Alliance and Boston Medical Center.

Mitt? Well, he probably realized that whatever happened in the legislature was going to roll over his veto whether he liked it or not. So he got involved in the negotiations — actively and positively. He added the personal mandate — making possible the grand bargain of [theoretical] universality. (Somewhere I think I've got a PowerPoint presentation of his original proposal … it wasn't that great, but it was something.)

And in the end, he signed the legislation — even while vetoing the meager non-insuring-employer contribution, which veto was overridden by the lege. Big signing ceremony for everyone: Mitt, Sal, Trav, Ted Kennedy. (Our David called all those Dems “rubes” for letting Mitt take his share of credit; I remember feeling more sanguine about the political dosido.) 

And that was April 2006. Eight months later Deval Patrick took over the job of implementing the law. And of course, there were no cost controls in the 2006 law: The first legislative attempt at that passed in 2008, with a big assist from Sen. Prez Murray.

The only point of consistency with Romney is that he's been a political opportunist and market-seeker. He thought health care might catapult him to national recognition; he was right, for better or (now) worse. He was never “health care czar” in any meaningful sense: There are at least half a dozen people who have had more claim to that role that Mitt, not least of all Deval Patrick. (Or if you like: Sal DiMasi, Terry Murray, Jon Kingsdale, Judy Ann Bigby, Leslie Kirwan, etc. etc)

I never begrudged Mitt that nice 2006 signing ceremony. But let's not overstate his role in health care. Without a strong, organized health care movement,  an invested Speaker, and a responsive legislature, this never would have happened.