Jonathan Cohn has a theory as to why Scott Brown opposes the Democratic reform model at the federal level but continues to back RomneyCare. It’s elaborate and interesting, and suggests that Brown is a very smooth political operator who is largely poll-driven. I do find it fascinating that Cohn doesn’t allow for the possibility that there is another, less cynical interpretation, but we’ll leave that aside.
I have another theory: competitive federalism is a pretty good system, and Brown understands that. Cohn is very familiar with the concept of Tiebout choice, and it is entirely consistent for someone to favor the Massachusetts model in Massachusetts, an affluent state that had a relatively small uninsured population, and recognize that it might not work in a country of 300 million that is dizzyingly diverse.
Cohn addresses the federalism argument in a post-script.
Ben Smith quotes Eric Fehrnstrom, a Brown advisor, with an explanation for why the candidate supports the Massachusetts law but opposes its national analogue:
In Massachusetts, 98% of residents are covered by insurance through our own state reforms. The plan is not perfect, and we need to get costs down, but we have already achieved near-universal coverage. There is nothing for us in a national plan except higher taxes and more spending to finance coverage expansions in other states. It’s a raw deal for Massachusetts,” he said.
The bolding is Smith’s and he’s right to highlight that passage: The intent is to make Massachusetts residents think they’ll be financing insurance expansions in states like Mississippi that haven’t been so forward-thinking on their own. Of course, that’s always been the case: States like Massachusetts are often net contributors and states like Mississippi are often net receivers of federal largesse. That’s one reason it’d be better to handle this all federally.
This strikes me as a non-answer to Fehrnstrom’s point. As I understand it, Fehrnstrom is saying a few different things:
(1) Massachusetts taxpayers won’t fare well under a national plan.
(2) States that have not taken the same steps should bear more responsibility for the problem.
(3) The Massachusetts reform needs further reform, and this iterative process is easier to handle in the more politically homogeneous, less politically-contentious environment that prevails in a single state.
It makes sense to argue that redistribution should happen at the highest level of government, particularly if you fear that competitive federalism will lead to “beggar-thy-neighbor” outcomes rather than valuable institutional diversity that reflects differences of circumstance that ought to be reflected in public policy. This is a pretty deep difference between the U.S. right and the U.S. left.
Cohn’s mental model strikes me as a little puzzling, e.g., he seems to think that because the Massachusetts reform model is relatively popular in Massachusetts, something similar — really, it’s only similar in the broadest outline, but that’s another story — will prove popular nationally. Given the very different circumstances, politically, demographically, etc., under which Massachusetts passed its reform, this is a bit of a leap, in my view.
Also, the individual mandate comes much closer to being a real mandate than the weak mandate proposed in the Senate bill. For individuals with incomes between 150.1 and 300 percent of the Federal Poverty Level, the fine is half the lowest priced premium, depending on age.
These “details” are actually important — so important that I feel a need to italicize. Costs are increasing in Massachusetts. But premiums would likely be increasing at a faster clip under a weaker mandate.
Again, it is much easier to pass a strong mandate in a single state than in Congress. So what? Why is the mandate important? It is the linchpin of this entire complex edifice involving guaranteed issue and community rating. The Massachusetts reformers understood that better than backers of the Democratic reform model, evidently.