National Review endorsed Mitt Romney for president during the 2008 primaries. While we objected to the individual mandate he had enacted in Massachusetts — making the purchase of health insurance compulsory for residents of the commonwealth — we were willing to look past that flaw because his proposals for changing health-care policy as president were much better.
But the enactment of Obamacare has raised the stakes on this issue. It is now of critical importance that Obama’s opponent in 2012 be able to make the case against the health-care law and for a sensible replacement. It is because of those raised stakes that Romney felt compelled to deliver a speech yesterday making the argument against Obamacare and for his own approach. The two halves of the speech, unfortunately for him, canceled each other out.
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Obamacare has three main components. It bans insurers from taking account of customers’ health status in setting premiums, requires everyone to purchase health insurance, and subsidizes those who cannot afford to meet the requirement. Thanks to the legislation Romney signed, Massachusetts law has all three features. Obama justifies the individual mandate — in political debate and in court — as necessary to keep the uninsured from raising everyone else’s premiums with their emergency-room visits. Romney advances the same justification. Much of Obamacare’s expansion of coverage is achieved through putting more people on the Medicaid rolls. That’s what Romney’s Massachusetts plan did, too.
You can see the difficulty for Romney in arguing for the one and against the other. He tried two tacks yesterday. The first was to attack Obamacare’s financing mechanisms: its tax increases and its “diversion” of Medicare funds to the new entitlement. That disagreement over how to pay for the plan is important, but it is not as important as the more basic question of whether the plan takes American health care, and government, in the right direction. It cannot mark the difference between a “government takeover” of health insurance, which is how he described Obamacare, and his own allegedly modest effort to help people get insurance.
Romney’s second gambit was to plead federalism. His plan was a valid exercise of state legislative discretion, not an attempt by the federal government to reshape the health-care industry nationally. His own federal plan — a collection of mainstream-conservative policy ideas that most of his intra-party critics would applaud — would be less intrusive. There is something to the state/federal distinction, obviously. There is no constitutional case against the Massachusetts plan, for example.
But when conservatives argue that Obamacare is a threat to the economy, to the quality of health care, and to the proper balance between government and citizenry, we do not mean that it should be implemented at the state level. We mean that it should not be implemented at all. And Romney’s health-care federalism is wobbly. The federal government picked up a fifth of the cost of his health-care plan. His justification for the individual mandate also lends itself naturally toward federal imposition of a mandate. He says that the state had to make insurance compulsory to prevent cost shifting, because federal law requires hospitals to treat all comers, insured or not. But if federal law is the source of a national problem, it makes no sense to advocate a state-by-state solution.
As it happens, the cost-shifting argument is overblown. Treatment of the uninsured probably increases premiums by something in the neighborhood of 1 percent. That number could be reduced in many ways short of forcing everyone to buy insurance. (Romney even advocates some of those methods in his national plan.) Forcing everyone to buy insurance, meanwhile, carries its own costs in subsidies and added regulatory requirements, and over time those costs are likely to outweigh the costs the mandate is supposed to eliminate.
Costs are rising in Massachusetts, price controls are in the offing, and the plan is losing popularity. We understand that Romney does not feel that he can flip-flop on what he had touted as his signature accomplishment in office. But if there is one thing we would expect a successful businessman to know, it is when to walk away from a failed investment.
I live in MA, the plan is very unpopular. On the radio they had one poor guy on the North Shore who is being fined $2K for not have insurance he couldn't afford. He's one of the families that doesn't qualify for state plan, but doesn't have enough to get a private plan. Good work Mitt. Maybe he should pay the fine for this poor guy. Plus every year while doing my taxes I have to prove I have insurance. Thanks Mitt! Yet more paper work for the tax man. In the end I think Mitt just doubled down on stupid.
It troubles me as a Democrat that Republicans will realize how flawed the Romneys and Gingriches and Bachmanns are and rally around sound, sane candidates such as Daniels. It delights me as an American that they will.
I get that Romney doesn't want to be seen as a flip-flopper by repudiating Romneycare. However, being labeled a flip-flopper is the least of his worries in a general election campaign because, as NRO's Jim Geragthy has astutely pointed out, EVERY Obama statement comes with an expiration date.
In other words, Romney is trying to neutralize a general election problem that is easy to manage and counterpunch. Instead, he hurt his chances at getting the nomination, because millions of conservatives were preparing to listen, and he could have established himself as the clear front-runner with a mea culpa. Romney is also banking on the belief that the Supreme Court will throw out the Obamacare individual mandates, thus making his 10th Amendment argument stronger at exactly the right time - next summer.
All this said, with the current and projected crop of candidates, I stand by my belief that Romney remains the strongest GOP general election candidate. Romney has the campaign experience, organization, money, and grasp of all issues to go the distance. He will also crush Obama in the debates.
The clear beneficiary of yesterday's tactical mistake by Romney is Tim Pawlenty.
The cost-shifting argument is more than "overblown". It's transparently a red herring. If cost-shifting were the real reason for the mandate, it would only require insurance for--wait for it--uncompensated emergency care. It wouldn't require gold-plated health coverage. It would also feature opt-outs for those who could prove that they have the resources to pay for emergency care out-of-pocket.
As Obamacare/Romneycare supporters admit in moments of intellectual honesty, the only real purpose of the mandate is to make economically viable the bans on exclusion of pre-existing-conditions and on premiums that are truly risk-adjusted by forcing the younger and healthier into the insurance pool where they will subsidize the older and sicker.
Anyone who emphasizes "cost-shifting" as the reason for the mandate, and ignores or minimizes risk-pooling and subsidization, is simply a liar.
The problem with healthcare is cost. We someone like the "rent is too d*** high" guy, saying the cost of health care is too d*** high. It's not the cost of insurance. It's the cost of health care. One can monkey around with the insurance all you want and it only changes who pays. How do we lower the cost?
When we talk about oil we talk about drilling to bringing down the cost. Increase supply. It's harder to increase the supply of doctors and surgeons. Right now the right incentives are not in place because hospitals do not make enough money. Why? Because the Federal government does not pay full price to the hospital for those on Medicare and Medicaid. When the government messes with price all sorts of weird things happen.
Since the price mechanism is broken with regard to supply the only sensible way to bring the cost down for the consumer is to decrease demand by reinstituting price. We need some pressure on demand. Remove state insurance requirements (do I really need to subsidize chiropractors) and make seniors pay a least something for going to the doctor. Yes, the uninsured use the emergency room to get care. However, they do it because the cost is too high. Most will pay for their care if they can - even if they are uninsured. However, if you have to pay $1,500 for a doctor to stich up a wound - you might think twice.
The federal government has screwed up healthcare along with some help from the states. Medicare has made private insurance more expensive, restricted the ability for hospitals to make money, and driven up the price of all healthcare. Deregulate!
The irony is just that RomneyCare (and ObamaCare will) harms the very people it purports to protect. As a MA resident, I know several people who had to pay the penalties (Closer to $1k in thier cases)the first year and then scrambled to get the cheapest possible plan in order to avoid the penalty for the following years. Once ObamaCare’s penalties kick in, I suspect that most of the younger uninsured (i.e, the people you'd want in the risk pool to pay for the older insured) will choose to pay the ~ $695/2.5% penalty rather than elect to get insurance.
Whoever told Romney not to apologize and repudiate RomneyCare made an epic strategic error.
My employer is HQ'd in the Bay State and all I can tell you is upon Mitt Romney's signing of this bill into law, my Blue Cross Blue Shield premiums, deducted every two weeks, jumped from $98 to $290 (employee contribution) and my employer had to fork over even more ($3,500 additional per year) for the health insurance benefit. That's an additional $400 per month or $4,800 per year.
I don't care how Mitt or Obama try to spin it, the increase of $4,800 per year for my health insurance premiums was nothing more than a tax increase to cover the uninsured, otherwise known as deadbeats and illegals.
So, tell me Mitt, how does confiscating dollars out of my wallet to fund the uninsured bring down costs again? I thought so. RomneyCare, ObamaCare or whatever else you want to call it, is simply another government controlled vote buying scheme to create a new entitlement for people not able to comprehend the idea of personal responsibility. It's much easier to reach into the pocket of the producer and hand it over to the moocher and that's exactly what this is, nothing more and nothing less.
Cost shifting is what happens when the govt forces insurers to cover everyone, preexisting condition or not. This would be like forcing auto insurers to cover everyone at the same rate, regardless of driving record. Two DUI'S, no problem, pay the same rate as the person with a clean record. Cancer, no problem, pay the same rate as the person with a clean bill of health.
Quick thought question...who is really getting screwed here?
Quick answer...who do you think.
Interesting thought, why have insurance cost risen so much? Maybe the fact third party payers have become the dominant form of compensation in health care. Would you pay 3 grand for an MRI? No, but if BCBS covers it, no problem.
I wonder, where does BCBS get all that money?
Mitt may have been a successful candidate in '08 a time before the Dems crammed the atrocious HC bill through but today he is not. Even the moderate NR and WSJ realize Mitt is done. Good, let's get busy with some of the better prospects!
“But the enactment of Obamacare has raised the stakes on this issue.”
No, it just means National Review is a fair weather supporter of people; kind of like Huntsman’s love affair with Obama. Fair weather support is a failure of character.
“when to walk away from a failed investment.”
Oh do explain how trying to help make insurance available for everyone is a failed investment. As a conservative, I hate to hear other conservatives reduce real people, with real problems and reduce them into cold financial terms.
“The plan is losing popularity”
Huh? FOX news just sited an 84% approval poll for the plan in the debates last week.
Romney’s healthcare presentation reaffirmed for me, that he is the only Republican who can take the fight to Obama in the general election and win. Like it or not, these two men took bold action and led on this issue, everyone else is just coming from the view of being a Monday morning quarterback critic. And being a critic is easy.
"Romney’s healthcare presentation reaffirmed for me, that he is the only Republican who can take the fight to Obama in the general election and win."
Huh? In order to take the fight to Obama the GOP candidate needs to be able to effectively mount a political assault against ObamaCare. In order for Romney to be able to do that, he needs to distinguish RomneyCare from ObamaCare. No objective analysis of Romney’s presentation from the right, left, center, or anywhere else could possibly conclude that Romney effectively made the case that his plan is substantially different than ObamaCare.
The Government should not be able to force anyone to buy something that they don’t want to buy. This is not just a Conservative position, it’s a so-called “Centrist” position that explains why ObamaCare is so darn unpopular. Budget wonks will quite correctly make the case that ObamaCare will cost trillions of dollars more than projected. More importantly, folks like 5350 below can tell you from personal experience just how much RomneyCare has raised our premiums and it’s not just anecdotal as MA’s premiums are the highest in the nation post RomneyCare. The guy who caused our premiums to go up, longer waits for our care and compelled every citizen in MA to purchase insurance is hardly the person to make the case against Obama doing the same nationally.
How you could believe otherwise is utterly beyond comprehension.
Freebird wrote: I live in MA, the plan is very unpopular. On the radio they had one poor guy on the North Shore who is being fined $2K for not have insurance he couldn't afford."
I live in MA too, don't listen to Howie Carr and I LIKE the insurance. Rather than have no insurance, my daughter pays in about $130 month which is based on her income and the plan she chooses. I LIKE that she has insurance. Maybe Howie Carr needs to do a little research and ask why the guy can't afford it? Is he laid off or in debt up to his eyeballs or maybe he spent the money on a sweet car instead. But mostly I think Carr is just too cheap and doesn't want to pay taxes.
But your argument if one bad apple spoils the basket we should throw out the entire basket? Why not fix what's broken, as Romney suggest, instead of breaking what's working.
This editorial exposes the editors of NR as weak, fair-weather, wannabe conservatives. They are apparently more concerned with appealing to the increasingly unreasonable pundit class than with actually governing in the real world.
Another thing that has changed since 2008 is that the competition has grown more conservative. In 2008 conservatives had major problems with all the main competitors: Giuliani on abortion, McCain on a host of issues, Huckabee on his spending and pardons in Arkansas. This time, we've got Pawlenty and probably Daniels who are across the board conservatives. And really, I'd take almost any of the others from this round over the main contenders from 2008.
