The French Revolution
Mitt Romney’s Health Care Advantage?
“RomneyCare” shouldn’t be a liability in 2012. It should be an asset. Here’s why.
Conservative pundits are in high dudgeon over Mitt Romney’s May 12th health care address. Their explosions of indignation, sadly, have shown contextual ignorance and ideological incoherence. Romney has grappled with health care in greater depth than any other Republican contender and has unique and powerful insights into ObamaCare’s procedural and substantive flaws. As a long-time supporter of Romney, I predict that he will not only survive this round of demagoguery, but he will prevail in the primaries and his health care experience will be a tremendous advantage in the general election.
But let’s back up. In order to understand RomneyCare, ObamaCare, and the health care debate in general, one must first understand basic principles and fundamental political realities. We do not currently have a free market medical system. We already have a form of federally mandated universal health care. The 1986 Emergency Medical Treatment and Active Labor Act requires all hospitals receiving Medicare and certain other government funds (which is to say, almost every hospital in the nation) to provide ambulance and emergency medical care to all patients regardless of their ability to pay.
Such a mandate (signed into law by Ronald Reagan) destroys any semblance of a truly free market. Imagine how radically it would distort the automobile market if you could enter a dealership and demand a car regardless of your ability to pay. Yet despite its profound market-altering effects, the universal care mandate is relatively uncontroversial. Why? Because it taps into a common moral sensibility. It is deeply offensive to a culture that preserves and protects human life to deny medical care to the sick or injured. But as you might imagine, the cost effects of this law have been significant.
Let’s make this concrete. Imagine a Cambridge hipster named Brian. Brian is 27 years old, has never had a serious illness or injury, runs four miles a day, plays ultimate Frisbee on the weekends, and doesn’t have health insurance. One day, as Brian rides his bike to Whole Foods, a Chevy Volt broadsides him. The electric engine was just too darn quiet. He never heard it coming.
Three days later, Brian wakes up in a hospital room and realizes that the entire apparatus of modern medicine was mobilized to save his life, from EMTs to ER physicians, to neurosurgeons, to hospitalists, to nurses who watch him night and day. He’s had MRIs, CAT scans, X-rays, and three rounds of extensive surgery.
What should happen to Brian? The hospital has spent $100,000 saving his life, but he has no insurance. Should it yank out the IVs, put him out on the street, slap a lien on his assets, and commence collection proceedings? Federal law says no. Brian stays and Brian gets care—and I’m glad he does. No one wants poor Brian to die.
However, while we are morally, culturally, and legally obligated to provide a certain level of health care to our citizens, health care is extraordinarily expensive, and our country is poised on the edge of fiscal ruin. The delicate dance between these truths defines any serious health care debate, the kind of debate we should be having—and reconciling these truths within our constitutional framework is one of the central policy challenges of our time.
How did Mitt Romney handle this challenge in Massachusetts?
First, he recognized his state’s unique assets and nature. Massachusetts has an extraordinary concentration of health care assets, with some of the finest hospitals and doctors in the world. But “the best” typically means “the most expensive,” and for a very long time health care has cost more in Massachusetts than anywhere else.
Fortunately, Massachusetts is also a wealthy state. One of the wealthiest. It also has among the highest percentage of residents with health insurance in the country.
The (very) liberal Massachusetts legislature looked at these realities and tried to further expand coverage through a substantial, direct tax on businesses that did not already offer health care. In other words, the legislature was prepared to directly and punitively burden small business to expand health care coverage. Mitt Romney offered an alternative—the individual mandate—that would narrow the coverage gap while providing much less direct burden on the small businesses that often fuel the engine of economic growth.
The hope (the never-before-tried idea) was that the newly-insured Bay Staters would start making health care decisions more like their previously-insured neighbors. Once covered, it was thought, people like Brian would make better use of primary care physicians and place a lesser burden on costly emergency rooms.
Has it worked? Yes and no. The plan has absolutely worked to increase health insurance coverage. Massachusetts has by far the lowest rate of uninsured citizens in the country. At the same time, however, patients still go to the emergency room too often, and Massachusetts still struggles with health care costs. Yet those costs have hardly spiraled out of control. The idea (spread in some circles) that the individual mandate has bankrupted the state or led to uncontrolled cost growth is simply a “myth.” The Massachusetts Taxpayer Foundation has calculated the additional financial impact as roughly 1.2 percent of the state budget. The increased cost is not good, but it’s hardly backbreaking.
Now, let’s contrast Mitt Romney’s approach with President Obama’s.
First, the President took an approach (the individual mandate) that had previously been tried only in one of America’s wealthiest states with a relatively low percentage of uninsured and imposed it on the entire country.
Compare this chart, showing relative state median income, with this chart, showing percentages of uninsured by state. See any differences? Arkansas is relatively poor ($37,823 median income, 48th in the country), with a high percentage of uninsured (19.2 percent in 2009). California has high income ($58,931) and a high percentage of uninsured (20 percent). Then there’s Massachusetts, with high income ($64,081) and a low number of uninsured (4.4 percent). With higher percentages of uninsured come much, much higher costs in an individual mandate.
In fact, one of the prime reasons for initial cost concerns with RomneyCare was that so many people signed up for subsidized insurance so quickly that policymakers were concerned that they’d undercounted the uninsured (the numbers eventually leveled off). Start imposing the mandate on states with uninsured percentages three, four, or five times greater than Massachusetts, and costs will rise astronomically—to the point where either the budget breaks or cost controls become so draconian that the quality of care suffers and real rationing ensues.
Second, President Obama’s individual mandate represents a dramatic change in the concept of federal power—a change so momentous that the Supreme Court is quite likely to strike it down. The Constitution entrusts the states with the so-called “police power,” a generalized power to enact laws and regulate behavior, limited of course by state and federal constitutional constraints. The federal government, by contrast, is limited to “enumerated powers,” having only those powers specifically granted by the Constitution.
Why the difference? America’s founders had experienced both the centralized authority of the British Empire and the near-chaos of the Articles of Confederation. They chose a middle way that granted authority to the states but also created a federal government strong enough to defend and unify a vast and diverse country. Their wisdom echoes to this day, as the one-size-fits all approach of ObamaCare has not only been rejected by the 26 states who’ve filed suit against the law, but even by the Obama administration itself, which has granted, at last count, nearly 1,400 waivers from the law’s requirements.
Finally, it’s also critical to note that Mitt Romney turned his attention to health care only after transforming a projected $3 billion state deficit when he entered office into a $600 million surplus by 2006, the year he signed his health reform legislation. Romney fixed an economic crisis before he reformed health care. Did President Obama do this? Did he first deal with our deficit and high unemployment? Our financial reality speaks for itself.
If President Obama were Mitt Romney, he would have immediately dealt with our economic crisis, halted the explosive growth of our deficit, and then and only then reached across the aisle to design a bipartisan health care reform package.
Last week, The Onion (a satirical magazine) wrote that Mitt Romney was “haunted by past of trying to help uninsured sick people.” Like any good satire, it has the bite of truth. In the strange world of American politics, Mitt Romney is “haunted” by his health care past—not so much because voters or pundits know all that much about Massachusetts, but because they hate ObamaCare so much that anything that faintly smells like it (no matter the contextual differences) is immediately and angrily rejected. Massachusetts’ health care isn’t perfect, as Governor Romney freely admits, but it was and is a serious and creative effort designed to address the unique needs of the state he governed.
These two sentences sum it up:
In Massachusetts, Mitt Romney balanced the budget then reached across the aisle to create a popular health reform program that was specifically designed for the unique needs of his state. Barack Obama, on the other hand, created a huge new entitlement program in an era of record deficits by ramming an unconstitutional, one-size-fits-all mandate through a reluctant congress and over the expressed objections of a majority of the American people.
Are we really going to ignore these differences? Is this really a reason, in the midst of long-term national and global economic distress, to disqualify from the Presidency the foremost economic expert in the Republican field?
David French is a lawyer, writer, soldier, and veteran of the Iraq war. He is Senior Counsel at the American Center for Law and Justice. Follow him on Facebook.
French’s column, “The French Revolution,” is published every Monday on the Evangelical portal. Subscribe via email or RSS.
