The problem, of course, is that Romney's plan so closely
resembles Obama's (subsidies, exchanges, mandates) that conservatives
who've been conditioned to see Obamacare as the second coming of Stalin
are suddenly treating Romney like Karl Marx.
That reaction, in turn, forces Romney to go all Rambo on the new
national law ("an unconscionable abuse of power"), which prompts the
press to say that Romney is pandering (yet again), which turns off independent voters who think the guy will say anything for vote, and so
But unfortunately, an important fact is being lost in the crossfire here: when Romney says his Massachusetts plan is one thing and Obamacare is another, he does, in fact, have a point. In a new NEWSWEEK interview, the former governor makes his case in greater detail—and with more clarity—than he ever has before. "I think that some Republicans believe that what we did in Massachusetts has to be decried in order to justify their criticism of Obamacare," he says. "But in my view, they're wrong."
Romney's basic argument is that while he believes the plans' shared policy framework is
sound, he disagrees with
Obama's decision to build a national version of Romneycare because he doesn't think it will work—and never has.
Romney points out—rightly—that the Massachusetts plan was designed to function at the state level and becomes something different when scaled up for the nation as a whole. "I can't think of a great metaphor," he says. "Maybe Dr. Jekyll and Mr. Hyde: they both have two arms and two legs, but they're very different creatures ... If you open the door to the federal government, then it leads to all sorts of unattractive elements such as raising taxes and cutting Medicare. What we've gotten into ... is the creation of the Mr. Hyde monster."
Romney's rhetoric here is a little overheated—many experts say that a large national insurance pool is actually preferable to smaller state pools because it creates new efficiencies and eliminates inequalities—but the underlying logic is solid. To pay for its plan, the Bay State simply took $400 million in federal funds meant to bankroll expensive ER care for the uninsured and applied it to new subsidies and exchanges. The White House, on the other hand, now has to raise taxes on the wealthy and reduce Medicare Advantage spending in order to fund Obamacare. Whether you oppose these measures (like Romney) or support them, it's impossible to deny that they really do represent big differences between the two plans—differences that only exist as a result of nationalization.
Romney also makes it clear in the interview that he never wanted to impose his Massachusetts reforms on the rest of America—in fact, much the opposite. "During the campaign, I went through the specific reasoning as to why
our plan was not right for the entire nation," he told me in an unpublished portion of our conservation. "There were two main
points I made. One, insurance costs are very different from state to
state. Massachusetts, for instance, had the highest cost, as I recall,
in America ... No. 2, we only had 8 percent uninsured, whereas states
like Texas, as I recall, were more than twice that amount. So the
solution for Massachusetts would probably be different than the
solution for Texas." His national program, in contrast, would have "give[n] resource
flexibility to states to use money they're already receiving ...
to help the poor buy insurance," then "le[t] states create their own
plans, and ... see how that works." Maybe they would've followed Massachusetts's lead—or maybe not. Either way would've been fine with Romney.
The bottom line, then, is that despite Romney's rhetoric about conservative principles—he told me, for example, that he "oppose[s] a federal plan for purposes of federalism," and that deriving Obamacare from Romneycare is (bizarrely) "like saying a father has spanked his son ... [so] the federal government should be allowed to spank children"—his fundamental objection to Obama's new law is pragmatic: a national version of Romneycare just won't work. "If what was done at the state level they applied at the federal level, they made a mistake," Romney says. "It was not designed for the nation."
You can disagree with Romney's conclusion here—as Igor Volsky explains, " it’s a Darwinian solution that would leave the poorest states with the most pronounced health crisis to fend for themselves" —but you can't say he's being dishonest. In fact, I'm starting to suspect that, policy aside, this sort of Republican message—an informed perspective on why Obamacare won't work rather than a demagogic denunciation of the president's Bolshevik plotting—will only gain more traction as 2012 approaches and passions cool. Ultimately, there may be dozens of reasons why Romney doesn't deserve to win the Republican nomination. But health reform shouldn't be one of them.