The Health-Care Debate

At the Republican debate in New Hampshire earlier this month, presidential hopeful Mitt Romney gave himself a gentle pat on the back for the health-care system he helped create in Massachusetts. "A lot of people have ideas about health care and improving health care. We took the ideas and actually made them work," he said. At an earlier stop on the campaign trail he called the plan "a good model for other states."

But at a Washington luncheon a few months earlier, addressing supporters, Romney sounded less convinced that his ambitious restructuring of the health-care system in Massachusetts had met its objectives. While he reassured them that his bipartisan plan works "in a Republican way," he added that he wanted to make it "work more like a market and less like a regulated utility."

Whether or not Massachusetts's new system, which requires all residents to have insurance, is a success or is authentically "Republican" depends on whom you ask. But to those involved with the plan, Romney's calculated ambivalence toward the program he championed seems as motivated by partisan politics as it is by the plan's effectiveness to date. While he has seemed eager to take credit for its successes, he has glossed over some of the less successful aspects of the plan.

John McDonough, executive director of Health Care for All, an advocacy group, believes Romney's statements about the health plan tend to shift strategically. "When (Romney) is favorably disposed to talk about it, you'd think he did it all by himself. That is absolutely not true," says McDonough. "When he's not feeling good about it he acts like he had very little to do with it. He did. I could show you where his fingerprints are on that bill, and there are many of them."

Jim Mongan, CEO of Partners HealthCare and an influential voice when legislators were drafting the law, sees the former Massachusetts governor as an ideological innovator. The plan centers on an individual mandate, putting the onus on residents—not employers or the state—to insure themselves. "He kind of turned the debate on its head," Mongan says. "He took a conservative approach to a liberal end. This was Romney's innovation: his ability to rethink that debate. It was creative, two-step thinking."

The plan has had mixed results. While there's no doubt that the program has helped to boost the number of insured residents in Massachusetts, some complain that the premiums are too high for those who don't quite qualify for subsidies and that the program favors insurers over individuals.