RomneyCare: Conservatives Attempt To Rescue Mitt From His Past
Now that Mitt Romney is well and truly inevitable, it is becoming imperative for conservatives to begin the arduous work of explaining why his Massachusetts health care plan is in no way similar to the evil, bureaucratic, freedom-destroying Obamacare monstrosity. Ann Coulter gives it a go, as do Yuval Levin and Ramesh Ponnuru in National Review.
The latter brush aside any purported similarities by quickly noting that “policy experts of various political stripes have claimed that Obamacare is essentially Romneycare taken national.” Right, one of those policy experts is Jonathan Gruber, the guy who designed Romney’s health care plan and then designed Obama’s. Let’s see what he has to say:
He credited Mitt Romney for not totally disavowing the Massachusetts bill during his presidential campaign, but said Romney’s attempt to distinguish between Obama’s bill and his own is disingenuous.
“The problem is there is no way to say that,” Gruber said. “Because they’re the same fucking bill. He just can’t have his cake and eat it too. Basically, you know, it’s the same bill. He can try to draw distinctions and stuff, but he’s just lying.
Any attempt to explain why Romneycare is so vastly different than Obamacare really ought to explain why the economist who designed both plans thinks they’re the same fucking bill.
Coulter, Levin, and Ponnuru all defend Romney by arguing that he was operating within the constraints of a distorted federal system. “There’s not much governors can do about the collectivist mess Congress has made of health care in this country,” writes Coulter. But of course Obama was also operating within the confines of a distorted system, including many interest groups and voters deeply resistant to change.
Levin and Ponnuru urge Romney to vigorously press the argument that his plan has no resemblance to Obama’s. Their advice centers on the one area of difference:
So what, then, should Governor Romney say, if he is the nominee and President Obama suggests that his health-care plan is modeled on the one the Republican enacted? Something, we suggest, like the following:
“Nice try. Your health-care plan, Mr. President, spends a trillion dollars on yet another uncontrollable federal entitlement program and on a massive expansion of a failing Medicaid system. It has an unconstitutional rationing board cut hundreds of billions from Medicare without being answerable to the public, without giving seniors more options, and without using the money to shore up the program or reduce the deficit. It raises hundreds of billions in taxes on employment, investment, and medical research; and after all of that, it wouldn’t even reduce the growth of health-care costs, which is the heart of the problem. And your defense of all that is that it was based on a state program that doesn’t actually do any of those things?
But that is what Romney is already saying, right down to the “nice try.” And what it’s saying, basically, is that Obama was fiscally responsible. Romney, owing to a quirk of federal funding, was able to finance his plan with a windfall grant from Washington, meaning he didn’t need to come up with any painful cuts to cover his insurance expansions. Obama raised taxes and found inefficient spending within the Medicare system to finance covering the uninsured. And one of the biggest elements of his tax increase was a reduction in the tax deduction for expensive private plans – basically, the strongest version Obama could get through Congress of a staple idea urged by conservatives, which is to eliminate the tax code’s favoritism for employer-sponsored insurance.
Now, you could argue that this should go even further, and I’d agree. If you had Republicans willing to continue advocating the health care principles they used to advocate before Obama tried to implement them, you could form a stronger political coalition for tearing up the status quo and combining market pressure with universal coverage. But rational reform is pretty hard when the opposition party is able to convince itself that anything you do, including things they favored just the other day, are the death of freedom.
By: Jonathan Chait, Daily Intel, February 2, 2012
Plaintiffs Challenging Affordable Care Act In The Supreme Court Admit That The Law Is Constitutional
One of the oddest arguments made by the plaintiffs now challenging the Affordable Care Act before the Supreme Court is a claim that, if just one small part of the law is declared unconstitutional, the whole law must fall with it. The overwhelming majority of judges who have heard ACA cases rejected the ridiculous claim that any part of the law is unconstitutional. And, of the handful of judges to strike part of the law down, only one — the guy who included an explicit shout-out to the Tea Partyin his opinion — accepted the legally indefensible position that the whole law must fall.
In their attempt to see the entire Affordable Care Act fall, however, several of the plaintiffs challenging the law committed what should be a fatal blunder — they effectively admit that their entire constitutional challenge to the law is garbage.
The primary attack on the ACA targets its provision requiring most Americans to either carry health insurance or pay slightly more income taxes — the so-called “individual mandate.” This insurance coverage provision exists because without it, the law’s other provisions ensuring that people with preexisting conditions can obtain insurance cannot be implemented. If patients can wait until they get sick to buy insurance, they will drain all the money out of an insurance plan that they have not previously paid into, massively driving up costs for the rest of the plan’s consumers.
This problem doesn’t just make the insurance coverage requirement good policy, it also makes it constitutional. The Constitution doesn’t just give Congress sweeping authority to regulate the national economy, it also authorizes it “[t]o make all laws which shall be necessary and proper for carrying into execution” regulations of interstate commerce. As conservative Justice Antonin Scalia explains, this means that, “where Congress has the authority to enact a regulation of interstate commerce, it possesses every power needed to make that regulation effective.”
So, with this background in mind, consider the following passage from the private plaintiffs’ brief arguing that the entire law must fall if the insurance coverage rule goes down:
The mandate was intended to be a direct subsidy to insurance companies, as compensation for requiring them (in the guaranteed-issue provision) to insure against “risks” that have already come to pass and forbidding them (in the community-rating provision) from using actuarially sound insurance premiums. The mandate thus works to counteract the powerful inflationary impacts of these other provisions, which would otherwise make premiums in the individual insurance market prohibitively expensive, thereby frustrating Congress’ goal of affordable health insurance. And Congress further viewed the mandate as necessary to prevent “adverse selection” to “game” the new insurance rules, which proponents warned would spark a “death spiral” in insurance.
The guaranteed-issue and community-rating requirements thus cannot operate without the mandate in the manner intended by Congress. Rather, “their associated force—not one or the other but both combined—was deemed by Congress to be necessary to achieve the end sought.” To strike the mandate alone would impermissibly eliminate a central quid pro quo of the Act. If the mandate falls, the guaranteed-issue and community-rating regulations must therefore fall with it, as the Government itself has conceded.
So the plaintiffs admit that, without the insurance coverage requirement, premiums will become “prohibitively expensive” and that the ACA’s provisions protecting people with preexisting conditions or who otherwise are highly likely to need health care (what are known as “guaranteed-issue” and “community-rating” laws in the jargon of health policy) “cannot operate without the mandate in the manner intended by Congress.” This is a flat out admission that the Scalia Rule applies in this case. Guaranteed issue and community rating are regulations of interstate commerce, and thus Congress has “every power needed” to make them effective — including the power to enact the insurance coverage requirement.
I discuss this rather breathtaking admission at greater length in an amicus brief I filed Friday on behalf of several health provider organizations, which also includes some more details about why the plaintiffs’ attempt to take out the entire ACA has no basis in law. Ultimately, however, there is no need whatsoever for the justices to consider how much of the law stands or falls without the coverage requirement. The private plaintiffs already gave away the farm when they admitted that their entire legal challenge rests on a crumbling foundation.
By: Ian Millhiser, Think Progress, January 30, 2012
Romney Describes Healthcare Mandate As Conservative Principle
GOP presidential candidate Mitt Romney said the insurance mandate included in the Massachusetts healthcare law he signed is fundamentally a conservative principle.
Speaking Wednesday on “Fox and Friends,” Romney defended the Bay State’s healthcare law, which includes a version of the individual mandate, as inline with the Republican world view. The individual mandate was the centerpiece and most controversial aspect of the Obama administration’s Affordable Care Act, which has widely been blasted by Republicans as governmental overreach.
“I’m happy to stand by the things that I believe. I’m not going to change my positions by virtue of being in a presidential campaign,” Romney said. “What we did was right for the people of Massachusetts, the plan is still favored there by 3 to 1 and it is fundamentally a conservative principle to insist that people take personal responsibility as opposed to turning to government for giving out free care.”
On Tuesday, Romney and rival Newt Gingrich jabbed at each other over the matter after The Wall Street Journal uncovered a 2006 memo in which Gingrich said he “agreed entirely” with Romney’s healthcare bill.
Buzzfeed also uncovered a 2008 video in which Gingrich passionately defended the idea of an individual mandate and called it “immoral” for those who can afford to have insurance not to buy it.
“I knew that [Gingrich] supported the plan in the past, and I believe he supported it until he got into the race this year, but maybe before that he changed his view,” Romney said. “Look, our plan was right for our state, and in my view it was based on conservative principles that frankly came from Newt Gingrich and the Heritage Foundation, which was that instead of people relying on government to provide their care, they should take personal responsibility.”
But Gingrich said he now realizes that there are aspects of the law that are “unacceptable,” and that unlike Romney, he has the courage to say so.
“There are a lot of details of ‘Romneycare’ that are unacceptable,” Gingrich said Tuesday on CNN. “And the difference between me and Romney is I’ve concluded — and I’m prepared to say publicly — I’ve concluded, just as the Heritage Foundation did, that the idea didn’t work. Romney’s still defending the mandate that he passed.”
Both Romney and Gingrich have vowed to repeal Obama’s healthcare law if elected president.
Romney is battling Ron Paul for the lead in polls of Iowa voters less than a week before that state’s GOP caucus. Gingrich had been in the lead, but has faded under attack from Romney and other GOP candidates.
By: Jonathan Easley, The Hill, December 28, 2011
The Republican Alternative To “ObamaCare” Is ObamaCare
On Saturday, David Fahrenthold wrote that “more than a year after Republicans first pledged to ‘repeal and replace’ President Obama’s new health-care law, the GOP is still struggling to answer a basic question. Replace it . . . with what?”
This shouldn’t be such a problem. Health care is a big issue. It’s been around a long time. The Republican Party should, in 2011, have a position on it. To understand why it doesn’t, it’s worth reading Newt Gingrich’s April 2006 comments on then-Gov. Mitt Romney’s Massachusetts reforms.
“The most exciting development of the past few weeks is what has been happening up in Massachusetts,” wrote Gingrich, or someone speaking for Gingrich, in his “Newt Notes” newsletter. “The health bill that Governor Romney signed into law this month has tremendous potential to effect major change in the American health system. We agree entirely with Governor Romney and Massachusetts legislators that our goal should be 100% insurance coverage for all Americans. … Individuals who can afford to purchase health insurance and simply choose not to place an unnecessary burden on a system that is on the verge of collapse; these free-riders undermine the entire health system by placing the onus of responsibility on taxpayers.”
In 2006, in other words, the Republican Party had an alternative to Obamacare. The only problem? It was Obamacare.
Between 1990 and 2007, the reigning Republican theory of health-care reform was that instead of handing the health-care system over to the government, they would put private insurers and personal responsibility at the core of their health-care reforms. During this period, everyone from Bob Dole to Jim DeMint to the Heritage Foundation endorsed this approach. But then Democrats, looking for a compromise, endorsed those same plans. And then Republicans, rather than pocketing the policy win, ran from their own ideas.
But insofar as the Republican Party had a plan for health-care reform, the individual mandate was it. That’s why Mitt Romney, Newt Gingrich, Tim Pawlenty, and Jon Huntsman either passed, endorsed, or expressed openness to an individual mandate. And that’s why Romney hasn’t paid for his plan: Almost every other serious candidate for the Republican nomination supported an individual mandate, too. It’s hard for Gingrich to take a clear shot at Romney for proposing what Gingrich called “the most exciting development” in health-care reform.
It’s also why the Republican Party can’t figure out an alternative to the Affordable Care Act. The Affordable Care Act was their alternative. Now they need an alternative to the alternative. But there are only so many policy approaches that make sense as an answer to our health-care problems. And Republicans have pretty much run out of them.
By: Ezra Klein, The Washington Post, December 27, 2011
Newt Praised Romneycare Before He Was Against It
From the WSJ’s use of the Internet comes a 2006 letter on the website of a former Newt Gingrich consulting company praising a then-new development in healthcare, the Massachusetts health care law – or, as it’s known today, Romneycare:
“The health bill that Governor Romney signed into law this month has tremendous potential to effect major change in the American health system,” said an April 2006 newsletter published by Mr. Gingrich’s former consulting company, the Center for Health Transformation.
The two-page “Newt Notes” analysis, found online by The Wall Street Journal even though it no longer appears on the center’s website, continued: “We agree entirely with Governor Romney and Massachusetts legislators that our goal should be 100% insurance coverage for all Americans.”
Mr. Gingrich’s rise to the top of the field has come in part from his bashing Mr. Romney for engineering a state health-care expansion that became a model for President Barack Obama’s 2010 health law. “Your plan essentially is one more big-government, bureaucratic, high-cost system,” Mr. Gingrich told Mr. Romney during an October debate in Las Vegas. He said Mr. Romney was trying to solve Massachusetts’ health-care problems “from the top down.”
R.C. Hammond, a spokesman for Mr. Gingrich, said the April 2006 essay shouldn’t be read as an endorsement of Mr. Romney’s health plan. He noted that it raised several questions about the Massachusetts effort, including whether the plan would work in the state. “Being critical…isn’t endorsing it,” he said.
Mr. Hammond said the Newt Notes essay wasn’t written by Mr. Gingrich himself.
It is true that the “Newt notes” wasn’t totally sanguine about the Romney health care plan, and Gingrich – or whoever the author was – warned its success depended on how it played out. However, there were other interesting bits in the “Newt notes,” such as this, per the original letter, flagged by Andrew Kaczynski:
The Romney plan attempts to bring everyone into the system. The individual mandate requires those who earn enough to afford insurance to purchase coverage, and subsidies will be made available to those individuals who cannot afford insurance on their own. We agree strongly with this principle, but the details are crucial when it comes to the structure of this plan…While the Commonwealth’s plan will naturally endure tremendous scrutiny from those who assert that the law will not work as intended, Massachusetts leaders are to be commended for this bipartisan proposal to tackle the enormous challenge of finding real solutions for creating a sustainable health system.
By: Maggie Haberman, Politico, December 26, 2011
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