“Unflinching Conservative” Rick Santorum In 1993: “More Government Needed In Health Care”
Rick Santorum’s pitch to Republican voters is simple: He is the “true” and “consistent” conservative in the GOP’s presidential nomination fight. He describes himself as “a candidate who, throughout [his] career, has not only checked the box on conservative issues but has fought for conservative issues.” And he slams front-runner Mitt Romney for flip-flopping on abortion and the Wall Street bailouts and, most of all, for passing government-mandated health care reform in Massachusetts. If elected president, Santorum vows, he will end the “tyranny” of President Obama’s Affordable Care Act.
Yet as an up-and-coming congressman in the early 1990s, Santorum took a much different line. Then—like now—health care was one of the nation’s most divisive issues. In 1993, Republicans were up in arms about a health care reform bill spearheaded by Hillary Clinton and pushed by President Bill Clinton. Republicans decried the measure as excessive government intervention in the marketplace, and Santorum opposed the legislation. But his position was not so clear-cut.
During that fiery debate, Santorum said it would be a mistake to allow the delivery of health care services to be determined only by the market. He asserted that Republicans were “wrong” to let the marketplace decide how health care works. He instead argued that government should play a “proactive” role in shaping the health care marketplace “to make it work better.” (Santorum spokesman Hogan Gidley did not respond to requests for comment.)
Santorum’s call for more government intervention in health care came during a December 1993 appearance on a Pittsburgh TV program, The Editors, hosted by the Pittsburgh Post-Gazette‘s Jane Blotzer and John Craig. At the time, Santorum was running in a Republican Senate primary and looking to challenge Democratic incumbent Sen. Harris Wofford. Mother Jones obtained a previously unreported transcript of the interview made by staffers for the Wofford reelection campaign. In 1994 Santorum eked out a narrow win over Wofford, 49 percent to 47 percent, in a bitterly fought race that gained national attention.
In the 1993 interview, the 35-year-old Santorum sounds little like the unflinching conservative he claims to be today. He describes his voting record in the US House of Representatives, where he represented the eastern suburbs of Pittsburgh, as “pretty much in the middle” compared with the rest of the Pennsylvania delegation, which included 11 Democrats and 9 other Republicans. His record, he went on, was “pretty compatible” with that of Arlen Specter and the late John Heinz, both moderate Republican senators from Pennsylvania. (Specter later switched to the Democratic Party.)
In the interview, when asked about the role of government in Americans’ lives, Santorum responded, “I believe that the federal government should set up a system where we create the right incentives for you to make efficient choices.”
On health care, as he called for more government involvement, Santorum said Republicans had “dropped the ball” by not making health care reform a headline issue in recent elections. “I even said it to President Bush when he came to Pittsburgh to campaign for Dick Thornburgh [then running for US Senate] in 1991, that health care was gonna be the big issue and that we had to take responsibility for trying to solve this problem,” Santorum said. “We can’t continue to ignore it and say, ‘Oh well, you know, it will work itself out in the marketplace.’ That’s wrong.”
Government intervention, he continued, was key to creating a functioning health care marketplace. “The government helps set the marketplace up, so we have some responsibility to alter that marketplace to make it work better.”
Talking about health care, Santorum explained: “I take a much more proactive position in government in solving problems than most Republicans, because I believe government has a role. A lot of folks believe, ‘Well, just keep government out of it.’ I don’t believe that.” He added, “I think government has a role in making sure that there is equal opportunity.”
On the campaign trail these days, Santorum denounces government and maintains that it is not government’s job to help those who are suffering (because suffering has its positive consequences, he contends). His top priority, he says, is repealing “Obamacare.” He also wants to privatize Medicare and eliminate the agency that oversees it. “You want the private sector out there competing, driving down costs, improving efficiency,” he said recently.
At a November 2011 debate, Santorum boasted about his unwavering conservative record on health care. “I was always for having the government out of the health care business,” he said, “and for a bottom-up, consumer-driven health care, which is different than Governor Romney and some of the other people on this panel.” Yet Santorum, who has attacked Romney for reversing his positions, has flip-flopped as well.
“Mitt’s Legacy”: Health Reform Worked In Massachusetts
On February 8 the Center for American Progress hosted an event featuring Massachusetts Attorney General Martha Coakley, where she discussed the success of the Massachusetts health care reform law signed by former Gov. Mitt Romney (R) in 2006.
Attorney General Coakley discussed the framework of the law and explained how it’s played an essential role in providing unparalleled access to health care coverage for Massachusetts residents. She and CAP President Neera Tanden also discussed why the Affordable Care Act’s adoption of the Massachusetts framework fits comfortably within the United States’ constitutional authority.
In her introductory remarks, Tanden said that “the Massachusetts law, though sometimes maligned in our national debates, is actually an incredible success story, and has really demonstrated to the country how effective health care reform can be, and the Affordable Care Act can be.”
She mentioned the new CAP report “The Case for the Individual Mandate in Health Care Reform,” and said that Massachusetts’s embracing of the individual mandate in addition to its nondiscrimination over preexisting conditions has allowed its health care reform to flourish.
Flourish so much, Tanden said, that “98.1 percent of the state’s residents were insured at the end of 2010, compared to 87.5 in 2006, when the health care law started. Almost every child in the state is insured, and premiums in the individual market dropped 40 percent as the Massachusetts law was fully implemented.”
In her speech, Attorney General Coakley described the Massachusetts health care law, saying that “in some, but not all particulars, the Massachusetts Act of 2006 was really the prototype for what has become the Federal Patient Protection and Affordable Care Act.” Like the Affordable Care Act, Massachusetts’ reform includes a state-operated health insurance exchange, subsidies for low- and moderate-income individuals, and a mandate that all individuals who can afford health insurance purchase coverage, or an individual mandate.
Coakley said, “The law has resulted in the highest health care access rates in the nation, it has improved both access to and affordability of health care for hundreds of thousands of residents, while maintaining a high level of quality, and I think that’s important.
“We don’t talk about quality so much, but it’s part of what we are concerned about. Access, cost, quality: Ensuring two is relatively easy, if you want to do all three, not so much. And this has been, and is still, our challenge and our goal, and as a work in progress, I think the facts demonstrate that rather than our experiment proving a risk to the rest of the country, Massachusetts as a test laboratory has a lot to offer.”
She said, “We’ve seen significant improvements in the care of our residents. From 2006 to 2010, adults from all income groups, but in particular lower-income adults, experienced a significant decline in reported unmet health care needs due to cost. … we also have seen significant overall economic benefits for our state as a result of this.”
In terms of costs, she said, “[w]e’ve seen a sharp decline in the amount of spending on the so-called ‘free care,’ [when an uninsured person visits an ER, for example, and costs get passed on to the insured in higher rates] about $300 million, and that’s 33 percent less than we spent in 2006.” And nongroup or individual insurance premiums cost 40 percent less.
Attorney General Coakley also discussed why she believes the Supreme Court will not overturn the individual mandate. Massachusetts, she said, is giving a very positive endorsement for the mandate, and it is “a constitutional act by Congress.” It would be quite surprising if the Supreme Court overturned “the 70 years of precedent that have been set” by case law establishing what Congress has constitutional authority to regulate, including commerce such as health care.
After her speech, Attorney General Coakley spoke with Tanden about health reform. In response to an audience question about the constitutionality of the mandate, Tanden said that “when you say that people have coverage when they go to the emergency room, that immediately means that they’ll be cost-shifting, and the individual mandate is just a way in which people have the same responsibility for their own health care so they’re not shifting costs anymore.”
As Attorney General Coakley asserted, Massachusetts is an essential—and the only U.S. example—of the importance of the individual mandate in ensuring affordable access to health care for all.
By: Center for American Progress, February 27, 2012
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
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