The title of this post is a quote from Brian Mooney’s must-read article in today’s Globe about Mitt Romney’s key role in putting Massachusetts’ health care law in place. Here’s the full context:
The question: Should adults with sufficient income be required to buy basic health insurance or pay a penalty if they refuse?
It was in many ways a conservative notion, grounded in personal responsibility, and Romney was drawn to it. At the roundtable meeting, he pressed the issue, challenging his advisers.
“Everybody in the room was very aware it was a novel approach and that it had repercussions in Massachusetts,” recalled Timothy R. Murphy, who was Romney’s point man on the legislation. “I don’t think it was lost on anyone that Mitt had an emerging national profile, but there weren’t many of us thinking there would be a national debate on this.”
And that, in a nutshell, is why Mitt Romney is never going to be president. Romney badly miscalculated how the politics of health care would play out – and so did everyone else. It’s fascinating to look back to 2006, when the health care issue came to a head in MA, and realize that just about everybody (including me) was dead wrong about the nature of the political fallout from “RomneyCare.”
At the time, the big controversy in conservative circles was the modest employer assessment – $295 per employee for companies with more than 10 employees who don’t offer health insurance. That provision looked like what was at the time the third rail of Republican politics: a new tax on business. Romney was so opposed to that section (and, presumably, so worried about its potential impact on his political future) that he published an op-ed in the Wall Street Journal explaining why he was vetoing it. (Of course his veto was overridden, as he knew it would be.) But he signed the rest of the bill, including the individual mandate, which, as Mooney’s article lays out in excruciating detail, was at the core of Romney’s vision for health care reform all along.
On the day of the elaborate Faneuil Hall signing ceremony, I wrote a post excoriating then-Speaker Sal DiMasi, then-Senate President Bob Travaglini, and then-Senator Ted Kennedy, for “handing Mitt Romney the biggest gift his presidential campaign has received to date.” I was annoyed that Romney was claiming credit for masterminding health care reform even as he vetoed one of its key components (the employer assessment), and I was afraid that, in so doing, Romney would lay claim to what I called
the “bipartisan problem-solver” myth that Romney is attempting – so far pretty successfully, based on the national coverage of this issue – to create for himself. Why help Romney do that, when you don’t have to?
Well, along with everyone else, I was completely wrong about how health care would play out. Today, nobody remembers the employer assessment, and nobody cares that Romney vetoed it. Everybody remembers the mandate – and nobody predicted the 180-degree turnabout that the concept of an individual mandate has experienced. Once, as we’ve discussed, it was a conservative idea, backed by the Heritage Foundation, and the cornerstone of Republican health care reform proposals at both the state and federal levels. In fact, Mooney’s article shows that Ted Kennedy saw backing a bill including a mandate as a concession to Romney, not as a key component of the “liberal” vision of health care reform.
In early December 2005, Kennedy weighed in publicly, endorsing none of the competing versions but making clear that he supported the individual mandate Romney had proposed if it was part of a broad compromise.
“I’ve never been one for individual mandates in the past, but I do think that the way this has been proposed, in that everybody will do their part, that’s a compromise,” Kennedy said. “I can buy into that.”
Also, at the time, nobody saw much difference between a state- and federal-level mandate, and, as we have shown, Romney actually backed a federal mandate as a US Senate candidate in 1994.
Now, as we know, the idea of the federal government requiring people to buy health insurance has surpassed just about everything else as the third rail of Republican politics. Romney, who has no doubt been as surprised by this development as everyone else, has finally (after months of hemming and hawing) settled on a strategy of stoutly defending the MA law, even as he decries a federal version of the same law as a national catastrophe.
But the reason his strategy will ultimately fail is that it makes no sense. Listen to Romney himself explain why the mandate was a good idea in MA (this is from his speech in Michigan a couple of weeks ago):
To summarize, Romney says that, faced with the problem of uninsured people, he saw three possible approaches: (1) don’t treat them unless they can pay; (2) have the government pay for it; and (3) adopt an individual mandate. He says that option (1) is “against the Hippocratic oath, and against federal law,” and he says (2) is a “big government” solution, which of course as a Republican he opposes. That leaves (3). But what Romney doesn’t acknowledge is that that reasoning applies to every state in the country, and also to the federal government. So his argument that the problem with the Obama plan is that it doesn’t let the states experiment is terribly weak, unless he thinks that anti-Hippocratic oath, anti-federal law, pro-“big government” solutions might be a good idea in some states. I’d like him to explain to Republican primary voters where that might be the case. Romney’s essential, unsolvable problem is that he says he’s against a federal mandate, but he seems to be for all 50 states imposing their own. (By the way, the “big government” solution is single-payer, which is in fact a better solution, but I digress.)
So, kudos to Brian Mooney for his fine article. It is, I suspect, directed more at a national audience than at a local one, since those of us who were around at the time remember much of what he discusses. But it’s nonetheless a great service to lay out this history once again so that those who weren’t here at the time have a recent, well-researched, and easily-accessible source to draw on. I hope that the national media will take note.
AmberPaw says
The problem I see here is judging decisions on how popular they are, rather than on:
1. How did they work?
2. Where these decisions moral, and in the best interest of the governed?
3. Were these decisions made openly, and honorably, or as the result of mone-fueled back room deals?
If Mitt Romney choose his position on health insurance, knowing health insurance is NOT health care because he was true to his own ideals, and creative, that is different than the ugly pandering to the far right that characterized Mitt Romney’s failed bid for the Republican presidential nomination.
If Mitt Romney was to find a backbone, and “be true to himself” then win or lose the nomination, he could look himself and his wife and his five sons in the face without shame.
If this next bid has Mitt Romney taking one position in one state, another position in another state, and making fun of our state and his own role as governor, he does not deserve to be anyone’s nominee or anyone’s governor.
David says
That would be interesting. Didn’t happen in 2008. I sorta doubt it will happen in 2012 either.
Ryan says
is 2 and 3 are the same thing, but people actually feel 3 much harder. An individual mandate is, in many ways, more “big government” than creating a true universal health care system, be it single payer or something more like the German system, because it’s using government as a hammer to get people nailed to more and more frequently overpriced and bad health care.
At least single payer and public options keep costs down and provide gauranteed care that won’t force people into medical bankruptcies, and while everyone’s still paying for it, it’s not the same thing as paying for your insurance bill — costs can be better shared, and you won’t get hit with anywhere near the same copays or deductibles if you have to use it.
We’ve so far been able to weather the individual mandate storm here in Massachusetts with few complaints, but that’s because we have a generous subsidy program and manage the Connector better than I think is likely with the federal government, particularly when the winds change and suddenly we have crazy Republican in office again. Plus, the individual mandate isn’t going away, even at the same time as the quality of our insurance options goes down and the prices continue to go way up. In the end, we’re all going to look back at the Massachusetts plan as a failure, and the federal government’s plan as an even bigger one, when we have to come back 5, 10 or 15 years later and fix everything all over again, and by then it’ll be single payer or bust.
AmberPaw says
Ultimately, I bought insurance via a small business association, just as I would have had to do without any so called health care reform. The Massachusetts health care over haul no doubt helped some folks – my out of work and grossly underemployed college graduate kids (over age 26) qualified for Masshealth (I think the would have in the old days too) and my husband and I pay top dollar for a basic policy from a business association independent broker for Neighborhood Health Plan with a $4000 deductible for two people at $1029.00 a month. No “whoopee” from me! We don’t buy insurance because of the mandate& penalty, but to have catastrophic care coverage in case of a heart attack, cancer, stuff like that. So, yeah, we added AARP hospital insurance too. No freebies, no subsidies, and nothing from the connector that was even close in cost or coverage.
David says
My experience was quite different from yours. When I needed to buy health insurance in the open market, I didn’t have the advantage of a small business association, like you did – those kinds of outfits will still generally get a better deal. But the Connector was great. It allowed me to one-stop-shop for a variety of different carriers and benefit levels, and compare the prices. Far, far better than in years past when I had to buy insurance without the benefit of something like the Connector, which was a total nightmare. It wasn’t cheap, but health insurance just is not cheap. That’s not the Connector’s fault.
AmberPaw says
After all, my husband and I are in our 60s – but too young for medicare, and make more than the cutoff but not enough to absorb the cost without pain, to put it mildly. We were also willing to use our 401k to self insure for a large deductible, in so far as the law would allow; however, I kid you not, for us, perhaps “an unusually tough case” the connector had almost nothing. I note, too, that unless something “awful” happens (and I hope it does not) we pay $1029 a month to an insurance company for $200 a month in actual health care. Except for physicals and medications such as synthroid, we don’t need health care at the present time, despite “pre-existing conditions”. Health insurance does NOT equal health care.
David says
Of course, that is how insurance works. Someone else is paying $1029 a month for $10,000 a month in actual health care because that someone is getting chemotherapy, or had bypass surgery, or something else.
I’m not saying that your premiums are “reasonable” – about that, I have no idea. I am saying, though, that the fact that your outflow is more than your intake right now doesn’t mean that the system isn’t working properly.
AmberPaw says
“health insurance is not healthcare” and the real question is whether or not there is universal access to the health care that actually is needed, and that is not a question I can answer.
As to “that is how insurance works” – it is always a kind of bet, is it not, insurance, with winners and losers of all kinds with all insurances. Better to have insurance but not need it, to be sure.
David says
Exactly so
dont-get-cute says
what’s the difference between a medical bankruptcy and paying an insurance premium every month? Aren’t they both payment plans? I’m guessing a bankruptcy means your other creditors don’t get paid as soon or as much, because a court says you’ve got to pay your medical bills a certain amount a month. That actually seems like a good system, assuming the medical bills are for ethical medical care that everyone deserves. Why not just wait until you need medical care, and then pay for it like paying back a loan?
HR's Kevin says
Most people really aren’t going to save enough to pay for the medical care they will need when they are older, much less for any catastrophic illness or injury. Without some sort of insurance system, what will happen to those people?
David says
“Medical bankruptcy” is just a catch-phrase for a bankruptcy filing that is brought on by large medical bills. It’s the same as every other bankruptcy, which means:
1. the bankrupt’s credit is destroyed for many years, making it difficult for that person/family to buy a home, etc. in the future; and
2. many unsecured creditors, probably including the hospital, end up receiving pennies on the dollar.
It’s not a “good system.” It’s a terrible system. We should do whatever we can to make medical bankruptcies less frequent.
Trickle up says
No, I am not talking about His Expediency. I’m thinking of the whole conservative “movement” and its casual deployment of ideas like individual mandate or cap-and-trade when it suits the strategy du jour, only to disown them when they might actually be realized (with all the consequences that would entail).
Do these people believe in anything besides “our team should have power?”
flounder says
Yeah, this is my own gotcha–He supports federally mandated medical malpractice reform. He wants to force state court systems into a one size fits all system. I would love it if the next time he starts going off about how he is such a Federalist and states should get to experiment and find solutions, a reporter was keen enough to ask him why he wants to shove federally mandated tort reform down every single state’s throat. The dude would flip out. I guarantee it.
jconway says
This is clearly going to be the albatross around his neck for the duration of the campaign, the real question is who is the credible alternative that can rally the base and be credible as a general election candidate? Is it T-Paw by default? Is Huntsman’s time as Ambassador less anathema to the base than Obamacare? Will Sarah or Michelle (or maybe even Ron!) ride the base into the worst GOP general election showing in decades, acting as right wing McGoverns? This is going to be a fascinating campaign regardless. At this point I really see no way that any Republican can get excited about Romney or credibly view him as a competent conservative due to his inconsistencies*.
*That said T-Paw, Gingrich, and Huntsman all favored cap and trade and individual mandates at one time or another, quite recently in some cases, so it might end up neutralizing the field.
David says
nt
stomv says
david — does the “more below the flip” option not work with the new rollout?
David says
It’s proved a bit trickier than we had expected.