I have a piece up on the home page today exploring the plight of Mitt Romney. As governor of Massachusetts, Romney signed into law a health-care reform bill that is similar in many important respects to Obamacare. The party he (presumably) seeks to lead uniformly opposes Obamacare and wants to repeal it. The Republican officeholders and conservative intellectuals who once shared Romney’s views on issues such as the individual mandate have since moved toward the free-market/libertarian position on those issues. How did Mitt get stranded to their left? What was he doing over there to begin with?
I was going through the archives here at NR world headquarters, and I think I found the answer. Take a look at this chart:
It comes from an article in the May 24, 1993 issue of National Review on the politics of Clintoncare. Here’s how author Peter Samuel described the field of play at that time:
The President himself [Clinton] and some of his closest associates would definitely fall on the left-hand side of the table. They have a starkly Marxist view of the cost problem in health care. In his campaign manifesto Putting People First, Clinton attributed cost escalation simply to greed. He summed up his solution thus: “What we need are leaders who are willing to take on the insurance companies, the drug companies, and the health-care bureaucracies and bring health-care costs down.” From this perspective, the approach to be taken by the task force is simple: Find a way to “crack down” on the “price gouging.”
The schools of thought represented by the right-hand side of the table, however, see the root of the problem not in greed, but in the way the insurance system has developed in this country since World War II. They agree that there is a systemic flaw in the delivery of health care, but argue that the flaw is third-party payment: the fact that when a patient sees a doctor or goes to the hospital, the money seems to come out of someone else’s pocket — his employer’s, his insurance company’s, or the government’s. The individual patient may in fact have paid more than his fair share of insurance premiums and taxes, and he is surely paid a lower wage than if his employer were not paying for his health insurance. But in terms of any incentive he has to keep costs down, it is as if the money miraculously dropped from the heavens.
When the Clinton task force unveiled its plan a few months later, it had combined a little from column A and a little from column B into a hybrid plan that the public ultimately rejected. But at the time, that outcome was far from certain. In a December 13, 1993 piece titled “Contrasting Conservative Plans” (columns C and D above), John Hood wrote that one advantage of the Heritage plan over the Gramm plan was its political feasibility as an alternative to Clintoncare: “By failing to guarantee universal coverage and by letting insurers charge higher prices in the initial underwriting stage to people with pre-existing illnesses or disorders, Heritage defenders say, the Gramm plan fails the first test of reform: Will it pass a nervous Congress and satisfy the demands of the American people?”
What happened in the intervening period is that the political center of gravity shifted to the right on this issue. Republicans looked to the town halls, the tea parties, and the polling on Obamacare and concluded that they could safely oppose the entire concept of compulsory insurance coverage and offer a different direction on health care — one more closely aligned with column D above and centered on attacking the cost problem first. Compulsory insurance would not be necessary, after all, if insurance were something most people could afford to buy on their own.
Most Republicans and conservatives who once supported the individual mandate moved to the right along with the rest of the public. As Sen. Orrin Hatch explained in a post on Critical Condition:
To be clear, I supported [the individual mandate as an] alternative to President Clinton’s massive federal takeover of the American health-care system, because my number-one priority was the defeat of yet another big-government assault on health care that the people of Utah overwhelmingly opposed. It’s that simple.
In the intervening years, I went back and carefully examined, in close consultation with constitutional experts, the legal problems with many of the bills being supported at the time. This needed to be done, because of the hasty nature of the debate which was thrust upon us in 1994. It is simply a fact that Congress has never imposed this kind of mandate before. We concluded, as would any intelligent scholar of the Constitution, that this federal mandate requiring Americans to either purchase health insurance or face a punitive tax exceeds the authority the Constitution has given to Congress.
The Heritage Foundation has adopted this same position, as Robert Moffit explained in an op-ed for The Washington Post yesterday: “Our research . . . has led us to realize our initial idea was operationally ineffective and legally defective,” Moffit wrote. “Well before Obama was elected, we dropped it.”
But it’s not so easy for Romney to move to the right with the rest of the Right. For one thing, he has already taken shots for inconsistency on the abortion issue. For another, health-care reform was his signature achievement as governor of Massachusetts. It would be terribly difficult for him to renounce it and admit that now, with the benefit of hindsight, it was a bad idea.
There is a way for him to handle this, though. As NR’s editors advise in the latest issue, he could say that his experience with health-care reform at the state level demonstrates that “even states with governors who want to build functioning health-care marketplaces cannot do so within the confines of federal health policy.” It comes back to the third-party payer problem, referenced by Samuel above: The preferential treatment of employer-provided insurance has spread skewed incentives throughout the system and made it difficult if not impossible to control costs without resorting to rationing. Who better to fix this system than someone who witnessed firsthand how it undermines the ability of governors to manage their states’ health budgets and make insurance affordable? Maybe that would fly, and maybe it wouldn’t. But I don’t think his current position — to the left of the party and the movement on one of the country’s top three domestic policy issues — is going to get him where he wants to go.