The top five failed defenses of RomneyCare 

Mitt Romney announced on Monday that he was forming an exploratory committee to run for president, which raised eyebrows because the news closely coincided with today’s fifth anniversary of the passage of his signature legislation as governor of Massachusetts, the state’s health care law. Given that his signing of the measure promises to dominate the Republican presidential primaries, I thought I’d review the top five failed defenses of the law that have been offered by Romney and his supporters, in no particular order.

The Massachusetts plan was a free market approach, but ObamaCare is a government takeover:

In December 2009, when the so-called “public option” went down in flames in the U.S. Senate, so too did Romney’s ability to distinguish the structure of his plan from President Obama’s in any meaningful way.

Both plans force individuals to purchase insurance under the threat of a penalty, expand Medicaid, and provide subsidies for individuals to purchase government-designed insurance policies on a government run exchange

One of the main architects of the Massachusetts plan, MIT economist Jonathan Gruber, went on to be a paid consultant for Obama and a booster of his health care plan. He recently told the Washington Post’s Jennifer Rubin that Romney’s plan “gave birth” to ObamaCare.

When it comes to the main feature that both plans have in common – the individual mandate – it’s clear that Democrats adopted language during the health care debate that was quite similar to Romney’s.

In an April 2006 Wall Street Journal op-ed, Romney wrote:

Some of my libertarian friends balk at what looks like an individual mandate. But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on government is not libertarian.

During a January 2008 GOP presidential debate on ABC, Romney dug in, explaining:

Here's my view: If somebody -- if somebody can afford insurance and decides not to buy it, and then they get sick, they ought to pay their own way, as opposed to expect the government to pay their way.

And that's an American principle. That's a principle of personal responsibility.

The idea of the mandate being a response to the free rider problem and a matter of personal responsibility has been central to Democratic framing of the individual mandate. In fact, in the law itself, the mandate is called the “individual responsibility requirement.”

It’s the Democrats fault:

The attempt to shift blame to Massachusetts Democrats normally has several iterations. One argument is that Romney used his line-item veto to remove many of the mandates and other objectionable items from the bill, but was overruled by the Democratic legislature. Another is that it fell on Democrats to implement the plan because he left office before the law went into effect, and they messed it up. Neither of these arguments stands up to much scrutiny.

While Romney may have used his line-item veto to reject certain provisions of the law, this was purely symbolic because he knew he was dealing with an overwhelmingly Democratic legislature that would override him. Whatever his frustrations were with the final bill, it didn’t stop Romney from holding a high-profile signing ceremony with Sen. Ted Kennedy at his side five years ago today, or from boasting of his accomplishment in the WSJ op-ed quoted above, entitled, “Health Care For Everyone? We found a way.”

Trying to deflect criticism by pointing to flawed implementation is an even weaker argument. To start, the version of the health care law that he signed had the key features that have drawn the most criticism. Beyond that, Romney announced he wouldn’t seek reelection in December 2005 – months before he signed the health care law. Thus, he signed it knowing full well that he wouldn’t be there to implement it, and that it would almost definitely fall on a Democratic successor. If it was so important to him that the health care law be implemented properly, he should have sought reelection.

It’s the best he could have done in Massachusetts:

This argument, a close relative of the blaming Democrats defense, suggests that given the overwhelmingly liberal legislature, he got as good a deal as could be hoped for. This is a bizarre argument for Romney defenders to advance for several reasons.

To start with, it’s not as if, sometime in the spring of 2006, the Democratic legislature plopped down a health care plan in front of him and Romney had the option of either signing it, or getting what he could in exchange for his support. By Romney’s own account in the WSJ op-ed, he decided to take on health care after the CEO of Staples urged him to do so weeks after he was elected in November 2002, and soon he “assembled a team from business, academia and government.” In other words, this was to be his main legislative ambition in office, something that he spent years developing. Once it was obvious that the end result would be a liberal, government-dominated plan, he could have decided that it was no longer worth doing. But he ploughed ahead anyway.

If the resulting health care law is the best that Romney can do when battling a Democratic legislature, then it certainly doesn’t speak well of his negotiating skills with Democrats -- something that will be a key to getting any sort of conservative reforms passed were he to be elected president.

He didn’t raise taxes to pay for it:

Depending on whether or not you consider the penalty for non-compliance with the mandate a tax, Romney could argue that technically, his health care plan didn’t raise taxes. However, what it did do was lead to massive cost overruns that ended up triggering future tax increases.  As the New York Times reported in 2008, “The legislature and (Gov. Deval) Patrick filled a health care spending gap that approached $200 million for this fiscal year by increasing the tobacco tax by $1 a pack, levying one-time assessments on insurers and hospitals, and raising more money from businesses that do not contribute to their employees' insurance.”

RomneyCare was right for Massachusetts, but ObamaCare is a one-size fits all Washington solution

This is the argument that we’re likely to hear the most. Romney himself has come out and said that he wouldn’t use the Massachusetts plan as a national model for reform and that he would sign a repeal of ObamaCare if elected. Although, it must be said, this wasn’t always so clear. In a February 2007 speech, Romney said, “If Massachusetts succeeds in implementing it, then that will be a model for the nation." And here was the exchange he had with Charlie Gibson in the ABC debate also cited above:

GIBSON: But Government Romney's system has mandates in Massachusetts, although you backed away from mandates on a national basis.

ROMNEY: No, no, I like mandates. The mandates work.

Regardless of what he may have said in the past though, his current position is that he wouldn’t apply his plan nationally. While there’s some element of truth to this, it’s ultimately a problematic argument.

Though the Massachusetts plan was a state-based approach, as Cato’s Michael Cannon has pointed out, the federal government finances 20 percent of the plan through Medicaid.

There’s no doubt that states should have flexibility over their own health care systems and that a state mandate does not raise the same constitutional questions as a federal one. Yet when governors run for office, we evaluate them based on the policies they enacted as state executives. If states are laboratories of democracy, governors should be judged by the experiments that they initiate. If Romney passed ambitious state tax or education reforms, he’d be running ads touting them. Similarly, he’ll no doubt be criticizing his primary opponents for their own governing records. If Romney were to get away with the federalism dodge in this instance, it would render the process of vetting presidential candidates who served as governor virtually meaningless, because they could respond to any unpopular aspect of their records simply by disavowing the same policies at the national level.

The bottom line: Political analysts keep saying that Romney will have to find a way to address the health care issue. But the reality is, he has no coherent defense to offer and it’s too late to disavow the law. As I’ve written before, Romney’s only hope is to simply survive the issue by attrition, hoping that the primary electorate’s attention is diverted elsewhere and that no viable alternative emerges.

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A daily newspaper covering San Francisco, San Mateo County and serving Alameda, Marin and Santa Clara counties.
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