I enjoyed reading Veronique’s and Douglas’s posts analyzing the costliness of Romneycare. Count me as one of those conservatives who actually like what Mitt Romney did when faced with very real political challenges in Massachusetts. The Democratic alternative to Romneycare — a very high and punitive business tax — was far worse than the state individual mandate, and he did exactly what we want governors to do when faced with political challenges from the left: lead their state in a direction that is more conservative than the alternative, and consequently leave their citizens better off than they would have been under Democratic leadership.
How can we measure the success or failure of Romneycare? Veronique and Douglas emphasize cost, but of course cost is but one measure of success. In fact, cost containment wasn’t the primary goal of Massachusetts health-care reform — universal coverage was. And on that score Romneycare unquestionably succeeded. At a minimum, I’d suggest measuring the success of constitutionally appropriate government reform by asking three key questions: First, did it accomplish its stated goals? Second, does the reform maintain the consent of the governed? Third, is the program affordable and sustainable? (I added the constitutional qualifier because unconstitutional reform should be off the table regardless of its popularity or cost-effectiveness).
It’s undisputed that Massachusetts has the lowest percentage of uninsured citizens in the nation. As rare as it is for government programs to actually accomplish their stated goals, I’m not sure why we continue to glide over this fact as if it’s insignificant. Don’t we want more citizens to have health insurance? Doesn’t that actually help close the gap in uncompensated care created when Ronald Reagan signed into law the Emergency Medical Treatment and Active Labor Act? Reagan’s law effectively ended a free market in health care when it mandated that every federally funded ER (which is virtually every ER in the nation) treat patients without regard for their ability to pay. There’s no such thing as a free market when a vendor has to provide a product without compensation. Romneycare was a logical response to not only the problem of uninsured citizens but also to the problem of uncompensated care.
Additionally, Romneycare has proven popular with Massachusetts citizens – by a 29 percent margin according to the latest polls. Indeed, efforts to repeal the state individual mandate haven’t even garnered enough signatures to get on the ballot. The contrast with Obamacare could not be more stark.
But of course effectiveness and popularity are for naught if the program is unaffordable (no matter how popular Medicare and Social Security may be, we can’t allow them to turn us into Greece). The jury is still out on Massachusetts, but the latest evidence gives good reason for hope. The dramatic cost improvements in 2010 may not last (as Veronique notes), but even earlier studies have calculated the impact on the budget as 1.2 percent per year (in additional expenditures) — hardly ideal but hardly back-breaking.
Does the relative success of Romneycare mean Obamacare is a good thing? Only if all of America were like Massachusetts, and the Constitution were ripped to shreds. Obamacare deals a possibly mortal blow to the concept of enumerated powers — the constitutional idea that the federal government has only those powers given to it by the Constitution — and recreates our national government as something much more like a European-style social democracy. Obamacare is unconstitutional, and that should end the conversation.
But even if the Supreme Court upholds all or part of Obamacare, that hardly ends the argument. Why, for example, would the Obama administration believe that a program that worked in a state that combined high median income and low rates uninsured will work across a nation where wealth and rates of coverage vary dramatically? Arkansas (low income, high rate of uninsured) and California (higher income, even higher rate of uninsured) are not like Massachusetts, and if the jury is still out on the costs of covering Massachusetts’s much lower percentage of uninsured, what will be the budgetary impact of subsidizing percentages two and three times higher?
And of course this discussion of cost and the individual mandate doesn’t even address the enormous bureaucratic scope of Obamacare and its already-unconstituional micromanaging of employee health plans.
Yes, I’m an evangelical for Mitt (disclaimer), but — to be clear — Mitt’s approach to the thorny problem of reforming health care in the face of a veto-proof Democratic majority bent on a destructive alternative was one of the reasons why he won me over. Governors have to govern. They can’t simply strike ideological poses while the Democrats enact an agenda unmolested. Mitt Romney countered the opposition with a better plan, achieved overwhelming bipartisan support, and accomplished reform while still maintaining both a balanced budget and a rainy-day fund. Obama did none of those things.