By DAVID E. WILLIAMS
Mitt Romney took a big beating on the Wall Street Journal‘s editorial page last week, the same day he laid out his health care plan in the USA Today and defended his position on the topic in a speech in Michigan. I’m not a big Romney fan but had been feeling sympathetic enough toward him on this issue to defend him. After reading what he has to say, though, I’m not prepared to offer a defense. On the other hand, Massachusetts health reform remains defensible, if incomplete.
Here’s what Mitt Romney should have said:
- Health reform in Massachusetts has achieved its main goal: more than 98% of residents now have health insurance including 99.8% of children
- The Massachusetts reform was achieved by bringing together all major stakeholders in the state from both parties, and focusing on addressing a serious problem rather than scoring political points against one another at the expense of the public good
- Gaining consensus enabled health reform not just to get passed, but actually implemented more or less as envisioned, in contrast to earlier failed attempts at universal coverage
- Massachusetts’ long history of substantial public sector investments made this kind of reform feasible. Good schools translate into an educated workforce that attracts high-wage employers who can afford to offer health insurance. That made it possible for the state to offer a safety net that was more generous than other states’ (e.g., in its eligibility criteria for Medicaid) even before the enactment of so-called Romney Care
- Massachusetts, like other states, still has a cost problem. It’s no surprise that Massachusetts health reform didn’t bring costs down. First, that wasn’t its goal. Second, cost problems can’t be addressed in a serious manner without changes in the health care delivery system and reform of Medicare. Tackling the delivery system is very difficult, and states have no power to reform Medicare. That’s why health reform can’t be left purely to the states; it has to be tackled at the national level
- Even a cold-blooded capitalist like me realizes that pure free-market approaches aren’t effective or fair in health care
The Journal team certainly put a lot of effort into its pre-emptive attack on Romney. You’ll find many tough words in there; they even conjure up the ghosts of Ted Kennedy, cast aspersions on the “left-wing media” and tar Romney by association with President Obama. Yet, like most on the right, the Journal doesn’t actually have any solutions to offer other than to let the market do its thing. They used double the normal amount of editorial space, so it seems like they could have at least offered an alternative
Romney’s USA Today piece doesn’t have much to recommend it. Essentially he is trying to position himself in the Republican mainstream on health care, such as it is. That might be a good idea politically but it doesn’t help the cause of intellectual coherence.
- Romney gratuitously uses the word “blessed” in the lead paragraph, just to remind you he’s not a Godless liberal
- He proposes things that don’t make sense, e.g., tax deductions for individuals buying health insurance (which will raise insurance costs and add to the deficit)
- He contradicts himself: e.g., he wants to “empower the states to determine their own health care futures” but also allow people to “purchase insurance across state lines, free from costly state benefit requirements.” That contradiction in particular is really rich!
- He talks about “resources” to care for the poor but is very shy about discussing funding
- He says not a word about changing the delivery system or Medicare
Mitt Romney deserves to be eviscerated for his health care stance in the Republican primaries, and if not there, then in the general election.
David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma, biotech, and medical devices. Formerly with BCG and LEK. He writes regularly at Health Business Blog, where this post first appeared.
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Liberals fear that Romney will be able to make a strong case against re-electing President Obama!
Dr Goel, you are correct, government payers account for 51% of all healthcare spending, but just over 25% of all insureds. And there is no doubt that there has been significant cost shifting to private care as the government has kept the lid on spending and all parties focus on FFS isn’t helping. But consumers view Medical Homes and ACOs as too restrictive and are not interested in migrating to them when they still have other less-restrictive options. If we are to use outcome-based medicine in a meaningful way, then both consumers (and therefore employers) need to be prepared to adopt the those options.
“Just because a lawmaker found something that works for his state, doesn’t mean he would require the same standards on the whole country.”
Are you sugessting a republic or something there Ben? That’s when the end started, when we gave up on the concept of State Right and Equal Protection and started mandating everything from the Federal level. Instead of 50 States operatinmg how their citizens felt best politicians that couldn’t get ideas passed at the level found ways to do it from Washington down. Add the race to 50%+1 and its no where but down from here.
I thought Romney’s ideas on healthcare reform were quite good. I enjoyed his speech in Ann Arbor. Romney offered many commonsense ideas that would have a large affect on the healthcare costs without a radical overhaul of the current system. Americans have shown time and time again that they don’t want radical change to their healthcare systems. Slow and steady change is the order of the day.
I think Romney’s stance that what is good for Massachusetts may not be good for the whole country is perfectly logical and acceptable. I can’t understand why the press would have such a hard time accepting that principle. States are allowed (and in fact encouraged) to craft their own educational programs, tax structures, ethics reforms, and a myriad of other programs that make sense for their state. Just because a lawmaker found something that works for his state, doesn’t mean he would require the same standards on the whole country.
The problem in health care isn’t the lack of government intervention — in the US government payers are estimated at over 50%.
The biggest problem I see is that the government has implemented widespread price fixing (the RVU) and lacked out disruptive innovators with the cost plus FFS reimbursement scheme with no ability to bill for better experience or service (CPT codes…courtesy of the American Medical Association).
Remove price fixing, product innovation limitations, and insurance regulation and, at some point, you might find a free market out there. Haven’t seen one yet.
And please don’t try posting something from the idiots at HCAN, I want real SEC filed data to back that claim up, not some left wing propoganda machine press release
” the 70+ year private enterprise experiment has worked so well that the government has finally HAD to intervene.”
What country are you writting in from Lisa. It would be nice if you foreigners actually learned the US system before criticizing it. Finally intervened, Medicare was passed in 1965, 70 years before that was 1895. What exactly was wring with the US health system between 1895 and 1965 that foced the government it finally intervene. They claimed it was to prevent grandma from losing the shirt off her back, poverty amoungst seniors actually increased, from 13% to 19%.
“Why are insurance companies making record profits?” Anything to back this up? Let me remind you that your talking about health insurance. Don’t post a link showing that some insurance company made more money with Life, P&C, and annuities then claim that shows there is a problem with our health insurance market.
I have to agree with what Lisa says in that ”There is no free market in the health care.”and that ” It is purchased by an employer, it is used by an individual , it is provided by entities that have no incentive to lower costs and the one player that could have played the ‘free market’ role in all of this, the insurance company, became a for-profit industry that focused on insuring the healthy for a profit, vs. providing health insurance coverage to truly manage the risk of bad health.”
“let the market start to correct the numerous and obvious mistakes they have made” … really ?!?!?! the 70+ year private enterprise experiment has worked so well that the government has finally HAD to intervene.
There is NO free market in health care. It is purchased by an employer, it is used by an individual, it is provided by entities that have no incentive to lower costs and the ONE player that could have played the ‘free market’ role in all of this, the insurance company, became a for-profit industry that focused on insuring the healthy for a profit, vs. providing health insurance coverage to truly manage the risk of bad health.
Why are insurance companies making record profits? Because insureds are beginning to pay more of the cost of care (employers are passing on significantly higher deductibles and co-pays) which is causing the insureds to decrease their utilization. In 2010 … that was a windfall profit for insurance companies … in 2011, they will be required to rebate that profit back.
The healthcare/insurance industry had over 70 years to get it right … they failed miserably … it is time for a little government intervention.
“Yet, like most on the right, the Journal doesn’t actually have any solutions to offer other than to let the market do its thing.”
Maybe becuase its the right answer. Get government out of healthcare, end their failed 46 year experiment in reform, and let the market start to correct the numerous and obvious mistakes they have made. We won’t be able to eliminate government all at once but we can start working towards it.
The answer really is that simple and easy.