Two months before that USA Today op-ed, Romney had written an article for Newsweek that’s also worth a look.
The right answer for health care is to apply more market force, not less. Here’s how:
1. Get everyone insured. Help low-income households retain or purchase private insurance with a tax credit, voucher or coinsurance. Use the tens of billions we now give hospitals for free care to instead help people buy and keep their own private insurance. For the uninsured who can afford insurance but expect to be given free care at the hospital, require them to either pay for their own care or buy insurance; if they do neither, they would forgo the tax credit or lose a deduction. No more “free riders.” This is the basic plan I proposed in Massachusetts. It has worked. . . .
My take: What Romney was trying to do in 2009 was not to argue in favor of a federal mandate to buy health insurance, exactly. His view was that a federal mandate to buy health insurance is indistinguishable in principle from a federal tax credit to buy health insurance. He made a more extended version of this argument in an on-the-record interview with me in September 2009. Under a mandate, if you fail to buy insurance you have to pay a penalty. Under a tax credit, if you fail to buy insurance you have to pay more taxes. So, his argument went, there’s no difference between the two cases. Note that in the Newsweek passage above, he treats the withdrawal of a tax credit from people who do not purchase insurance as equivalent to a requirement that people buy insurance. Conservatives have had no objection to tax deduction or tax credit plans from President George W. Bush, presidential candidate John McCain, Sen. Tom Coburn, or Rep. Paul Ryan. So–and this part of his argument was implied rather than stated explicitly–they should have no trouble with what he did either.
It’s a beguiling argument although, as I’ve said before, I think it’s a mistaken one. But that’s where I think Romney was coming from in many of his 2009 remarks.