Amidst the assorted personal attacks and lunar colonization strategies in last Thursday’s Florida debate, Rick Santorum made an actual substantive argument that had oddly been largely absent from the debates until then: That Mitt Romney would have trouble making the case against Obamacare because the Democrats will point to Obamacare’s resemblance in some important respects to the health-care reform Romney helped enact in Massachusetts while he was governor.
The repeal of Obamacare is among the most pressing domestic priorities for the next president (second only to reviving the economy), and is among the most potent political weapons for Republicans in the coming election. The Democrats will certainly try everything they can to neutralize the advantage, and they have already started making the case that Obamacare was just the same thing as Romneycare. Romney’s answer last week—which focused on the fact that Obamacare was a one-size-fits-all federal law—suggests he is not well prepared to deflect that argument and make a wholehearted case against Obamacare. In fact, more than anything his answer suggests that he has not internalized the real case against Obamacare, and for an actual reform of our system of health-care financing.
In the latest NR, Ramesh and I have a piece (which is now up online here) that tries to suggest what his answer should have been, and should be in the fall should he win the nomination. As we note, the very argument that Obamacare was based on a state solution (let alone the amazing fact that Obamacare’s own champions make that argument) is itself proof that Obamacare was not even intended (let alone well designed) to address the actual problems with our system—problems that are caused by a series of badly misguided federal policies (above all Medicare’s fee-for-service structure, Medicaid’s state-federal structure, and the distorting influence of the tax exemption for employer-provided coverage), and which the states must all live with. Romneycare was one (in our view ill-advised and unsuccessful) attempt to live with those problems. But whatever you think of it as a state solution, surely a federal solution would not simply live with our badly broken federal health-care architecture but would fix it instead.
Obamacare thoroughly fails to do that. It keeps Medicare unreformed and just doubles down on price controls through an unconstitutional rationing board, it keeps Medicaid unreformed and just vastly expands it, and it exacerbates the economic distortions in the employer and individual markets.
Romney (like every other Republican at this point) proposes to actually address each of these problems, a process that would have to begin with the repeal of Obamacare and then continue with reforms of Medicare, Medicaid, and the tax treatment of health insurance—all of which he has proposed. The fact that Obamacare’s champions argue in defense of the law that it was based on a state reform that (being a state law) literally couldn’t do anything about the causes of our health-care crisis is hardly an argument in defense of Obamacare, or much of an argument against Romney.