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.