Of Course Newt Gingrich Supported A Health Care Mandate
Mitt Romney continues to face all kinds of heat over his support for a health care mandate, in large part because he continues to defend it. But Sam Stein notes this week that disgraced former House Speaker Newt Gingrich, a Romney rival for the Republican presidential nomination, was just as ardent an advocate of the idea.
In his post-congressional life, Gingrich has been a vocal champion for mandated insurance coverage — the very provision of President Obama’s health care legislation that the Republican Party now decries as fundamentally unconstitutional.
This mandate was hardly some little-discussed aspect of Gingrich’s plan for health care reform. In the mid-2000s, he partnered with then-Sen. Hillary Clinton (D-N.Y.) to promote a centrist solution to fixing the nation’s health care system. A July 22, 2005, Hotline article on one of the duo’s events described the former speaker as endorsing not just state-based mandates (the linchpin of Romney’s Massachusetts law) but “some federal mandates” as well. A New York Sun writeup of what appears to be the same event noted that “both politicians appeared to endorse proposals to require all individuals to have some form of health coverage.”
Neera Tanden, an aide to Clinton at the time who went on to help craft President Obama’s law, said she couldn’t recall exact speeches, but “strongly” believed that the both Clinton and Gingrich backed the individual mandate. Either way, she added, “Gingrich has been known as a supporter” of the idea for some time.
A simple newspaper archive search bears this out.
Gingrich endorsed the individual health care mandate over and over again, in public remarks, in media interviews, and in policy proposals. Ironically, he even explained the importance of the mandate in a book entitled, “Winning the Future.” Gingrich didn’t just grudgingly go along with the measure as part of some kind of compromise; he actively touted it as a good idea.
And he was right.
But that was before President Obama decided he also agreed with the idea, at which point the mandate became poisonous in Republican circles.
The point to keep in mind, though, is that Gingrich’s support for the idea isn’t at all surprising. Indeed, it would have been odd if Gingrich didn’t endorse the mandate.
For those who’ve forgotten, this was a Republican idea in the first place. Nixon embraced it in the 1970s, and George H.W. Bush supported the idea in the 1980s. When Dole endorsed the mandate in 1994, it was in keeping with the party’s prevailing attitudes at the time. Romney embraced the mandate as governor and it was largely ignored during the ‘08 campaign, since it was in keeping with the GOP mainstream.
In recent years, the mandate has also been embraced by the likes of John McCain, Chuck Grassley, Orrin Hatch, Bob Bennett, Tommy Thompson, Lamar Alexander, Lindsey Graham, John Thune, Scott Brown, and Judd Gregg, among many others. Indeed, several of them not only endorsed the policy, they literally co-sponsored legislation that included a mandate.
During the fight over Obama’s reform proposal, Grassley told Fox News, of all outlets, “I believe that there is a bipartisan consensus to have an individual mandate” — and there was no pushback from party leaders. This isn’t ancient history; it was a year and a half ago.
Newt Gingrich touted the same idea? Well, sure, of course he did.
By: Steve Benen, Contributing Writer, The Washington Monthly, May 13, 2011
Pandering To The Extremists: Mitt Romney In A Time Warp
There was something almost quaint about Mitt Romney’s speech on health careThursday, as if we were watching early sound footage of Theodore Roosevelt.
Republicans no longer talk about the virtues of government social programs, especially if they intend to run for president in a party that now considers Medicare the first cousin of socialism. Yet there was Mr. Romney defending a mandate to buy health insurance as passionately as in any similar speech by President Obama.
When he was governor of Massachusetts, of course, Mr. Romney created a health care system very similar to the one championed by the president. He could have walked away from it, as he did in the 2008 presidential race, or fecklessly repudiated it, as Tim Pawlenty, the former governor of Minnesota, did in the Republican debate last week regarding his earlier support for a cap-and-trade system to reduce greenhouse gases.
This time, to his credit, Mr. Romney is standing by his record, perhaps hoping there might still be a few primary voters who appreciate candor — assuming he doesn’t pivot again in the heat of the right-dominated primaries.
Tearing it down might help him politically, he said, but “it wouldn’t be honest.” He said he did what he “thought would be right for the people of my state.” A mandate to buy insurance, he said, makes sense to prevent people from becoming free riders, getting emergency care at enormous cost to everyone else.
Where he went off the rails, however, was in not acknowledging that that same logic applies to the nation. Mr. Romney tried desperately to pivot from praising his handiwork in Massachusetts to trashing the very same idea as adapted by Mr. Obama. His was an efficient and effective state policy; Mr. Obama’s was “a power grab by the federal government.”
He tried to justify this with a history lesson on federalism and state experimentation, but, in fact, said nothing about what makes Massachusetts different from its neighbors or any other state. And why would he immediately repeal the Obama mandate if elected president? Because Mr. Obama wants a “government takeover of health care,” while all he wanted was to insure the uninsured.
That distinction makes no sense, and the disconnect undermines the foundation of Mr. Romney’s candidacy. At heart, he is still the kind of old-fashioned northeastern Republican who believes in government’s role while trying to conceal it under a thin, inauthentic coating of conservative outrage. But in its blind abhorrence of President Obama, the party has also left behind former centrists like Mr. Romney, and it is unlikely that any amount of frantic pandering about the free market will change that. He is trapped not only between the poles of his party but between eras, a candidate caught in an electoral time warp.
By: The New York Times, Editorial, May 12, 2011
Health Care Hypocrisy: How Paul Ryan And House Republicans Are Contradicting Themselves Over Medicare
In the debate over the House Republicans’ budget plan championed by Representative Paul Ryan, it’s been remarkable to watch the contortions and contradictions in the GOP on the issue of health care. The cornerstone of the Republican critique of the Affordable Care Act over the past year or so has been that it would lead to rationing. While Republicans initially manufactured lies about this issue—anyone remember death panels?—they eventually focused on one provision in the bill that was focused on cutting costs: the Independent Payment Advisory Board (IPAB). As specified in the legislation, the IPAB is a 15-member board of medical experts who are appointed by the president, confirmed by the Senate, and tasked with cutting costs in the Medicare system, unless Congress acts to alter the proposal or discontinue automatic implementation. The legislation also specifies that a goal of such cost-cutting should be to actually improve access for beneficiaries. At a time when rising health care costs are a concern for families’ pocketbooks and the federal budget, the IPAB was a means to maintain public oversight of Medicare but insulate it from the normal politics of congressional decision-making, thus helping ensure that best medicine was the driver of cost reductions.
Republicans, however, viciously attacked the IPAB as being a bunch of unelected bureaucrats making decisions to cut costs at the expense of the quality of care seniors would receive. The rhetoric became quite heated: Congressman Phil Roe went so far as to call the IPAB the “real death panel.” Other Republicans, like Representative John Fleming, likened the IPAB to communism, saying, “It will take you back to the old Soviet Union, that’s the way they did things—with a central planning committee that set prices, targeted costs.”
Now, more than a year after health care reform passed, Paul Ryan, facing stiff opposition to his plan to end Medicare as we know it, has taken to attacking the IPAB as a way to rebut his critics. He’s arguing that, while his plan would keep Medicare the same for current beneficiaries, the IPAB “puts a board in charge of cutting costs in Medicare” that will “automatically put price controls in Medicare” and “diminish the quality of care seniors receive.” It’s this sort of dishonest vitriol that has led to 73 House Republicans, as well as some Democrats, to cosponsor legislation to eliminate the IPAB.
What’s fascinating about the posture of these cosponsors is that it runs into direct conflict to the vote the House took mere days ago on the overall Ryan budget, which passed thanks to broad Republican support. Indeed, the budget, which the co-sponsors voted for, changes Medicare into a voucher program in which seniors can only choose from among private insurance options, eliminating the public insurance that is currently at the heart of Medicare. In other words, rather than public officials, elected or unelected, making decisions as to what is covered in Medicare, the Republicans just voted to more or less privatize the program. So, , after all of their complaining about how the IPAB moved too far away from public accountability, they’ve just proposed eliminating all such accountability, insisting instead that private insurance companies know best.
Would Americans really feel better with insurance companies deciding whether they or their parents get the care they need? Probably not. The truth is that Republicans are not actually worried about accountability or giving Americans more health care options. They are not even worried about cutting costs: Medicare has a much lower cost per beneficiary than private health care now, so it makes no sense to privatize it in order to lower costs. What they are worried about is public health care; they can’t stand it—and are even willing to contradict themselves and hand people’s health over to unelected, private insurers to defeat it.
By: Neera Tanden, Chief Operating Officer, Center for American Progress, April 30, 2011
The Ryan Plan For Medicaid: Not Good For Low-Income Americans Or State Budgets
With Washington looking for ways to rein in costly entitlement programs and state governments struggling to balance budgets, conservatives have revived an old nostrum: turning Medicaid into a block grant program.
The desire for fiscal relief is understandable. Medicaid insures low-income people and in these tough economic times, enrollment and costs — for the federal government and state governments — have swelled.
Representative Paul Ryan, and the House Republicans, are now proposing to ease Washington’s strain by capping federal contributions. Like his proposal for Medicare, that would only shift the burden — this time onto both state governments and beneficiaries.
Still, some governors may be tempted. His plan promises them greater flexibility to manage their programs — and achieve greater efficiency and save money. That may sound good, but the truth is, no foreseeable efficiencies will compensate for the big loss of federal contribution.
Mr. Ryan also wants to repeal the health care reform law and its requirement that states expand their Medicaid rolls starting in 2014. Once again Washington would pay the vast bulk of the added cost, so states would be turning down a very good deal to save a lesser amount of money.
Here’s how Medicaid currently works: Washington sets minimum requirements for who can enroll and what services must be covered, and pays half of the bill in the richest states and three-quarters of the bill in the poorest state. If people are poor enough to qualify and a medical service recommended by their doctors is covered, the state and federal governments will pick up the tab, with minimal co-payments by the beneficiaries. That is a big plus for enrollees’ health, and a healthy population is good for everyone. But the costs are undeniably high.
Enter the House Republicans’ budget proposal. Instead of a commitment to insure as many people as meet the criteria, it would substitute a set amount per state. Starting in 2013, the grant would probably equal what the state would have received anyway through federal matching funds, although that is not spelled out. After that, the block grant would rise each year only at the national rate of inflation, with adjustments for population growth.
There are several problems with that, starting with that inflation-pegged rate of growth, which could not possibly keep pace with the rising cost of medical care. The Congressional Budget Office estimates that federal payments would be 35 percent lower in 2022 than currently projected and 49 percent lower in 2030.
To make up the difference, states would probably have to cut payments to doctors, hospitals or nursing homes; curtail eligibility; reduce benefits; or increase their own payments for Medicaid. The problems do not end there. If a bad economy led to a sharp jump in unemployment, a state’s grant would remain the same. Nor would the block grant grow fast enough to accommodate expensive advances in medicine, rising demand for long-term care, or unexpected health care needs in the wake of epidemics or natural disasters. This would put an ever-tightening squeeze on states, forcing them to drop enrollees, cut services or pump up their own contributions.
This is not the way to go. The real problem is not Medicaid. Contrary to most perceptions, it is a relatively efficient program — with low administrative costs, a high reliance on managed care and much lower payments to providers than other public and private insurance.
The real problem is soaring medical costs. The Ryan plan does little to address that. The health care law, which Republicans have vowed to repeal, seeks to reform the entire system to deliver quality care at lower cost.
To encourage that process, President Obama recently proposed a simplified matching rate for Medicaid, which would reward states for efficiencies and automatically increase federal payments if a recession drives up enrollments and state costs. The president’s approach is better for low-income Americans and for state budgets as well.
By: The New York Times, Editorial, April 30, 2011
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