Romney’s Response to ObamaCare

Mitt Romney’s entire career reflects a businesslike approach. On the one hand he has been willing to act boldly to solve problems. On the other hand he has been willing to keep what works and discard what doesn’t. The latest Romney pronouncements on health policy are consistent with that history.

As President Obama has said on many occasions, ObamaCare is based on a health reform Governor Romney spearheaded in Massachusetts. But blindly copying a health reform — while ignoring what’s really worth copying and what’s not — is hardly sensible presidential leadership.

Here is what is good about the Massachusetts health reform: (1) Governor Romney brought both parties together to achieve genuine bipartisan reform (something Barack Obama failed at miserably at the national level); (2) he cut the insurance rate in half by giving substantial tax relief to people who must purchase their own insurance, and (3) he did all this without raising taxes.

Here is what is bad about the Massachusetts health reform and what Mitt Romney now appears ready to jettison: (1) an individual mandate to purchase health insurance, (2) a system under which individuals can wait to buy insurance until after they get sick for the same premium healthy people pay, and (3) a system under which insurers have perverse incentives to over-provide to the healthy and underprovide to the sick.

When government tells people they must buy health insurance, special interests gain an opportunity to bloat the required benefits package with all kinds of unnecessary, costly benefits. Romney is not only rejecting this one-size-fits-all approach, he even endorses being able to buy insurance across state lines, giving people an enormous choice of insurance products.

Romney endorses the idea that people who are continuously insured should not be penalized if they get sick and have to change health plans (say, because they lose their jobs). By implication, the governor is not endorsing the idea of letting people who choose to be uninsured sign up for insurance after they get sick with impunity.

The new Romney approach to health policy is both refreshing and sensible.

John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis. He is also the Kellye Wright Fellow in health care. His Health Policy Blog is considered among the top conservative health care blogs where health care problems are discussed by top health policy experts from all sides of the political spectrum.

24 replies »

  1. Steve’s point makes little sense, but the underlying premise reveals a pathetic aspect of American medical care. Why are doctors selling themsleves to insurance carriers and hospitals? Do they prefer to wash windows for the $$$$ million CEOs or take care of patients?

    Romney is a “NO” candidate, without any ideas of his own that will solve the corruption, fraud, and financially incestuous relations between politicians, HIT vendors, PHARMA vendors, and hospitals, all of which have one thing in common: USING THE PATIENT AS GRIST FOR THE CASH REGISTER.

  2. I could sell health insurance for $10 a month, that part is easy. Now, could I provide the services? No. That insurer in Idaho needs docs in NY or NJ to provide care. What happens when they show up asking the NY doc for a deep rate cut? Not happening. They will not have enough patients to get a discount. They will pay full fare. That is what I do now with tiny insurance carriers. That is what everyone does. Amplify that and make all carriers small. They can compete with each other all they want. They can offer low, low premiums. When they get to the provider, they have no market power. Docs and hospitals will make a mint.


  3. The worst part of PPACA is that they think that it will be paid for, in part, by the benefits of HIT. What benefits?

    All I see now are dramatic increases in hospital costs, deteriorating patient care, increase in med malpractice cases, increasing errors and patient neglect, 6 page progress notes laden with legible gibberish, retaliation against doctors and nurses who complain to hospital admin for buying devices toxic to workflow, and mucho scurrying when the EHR crashes.

    Do not be fooled. Mitt is very much like Obama. Mitt loves IT and it.

  4. Buying insurance across state lines will help any male under 50 who lives in New York, NJ, Mass, or any other state that has community rating, and/or guaranteed issue, and/or mandated maternity coverage.

    Using round numbers, the male who was paying $600 a month in New York could pay $100 a month in Idaho if he had no health history, assuming that the ACA does not go into effect and ‘spoil’ Idaho.

    This demographic group is probably more ljbertarian than most to begin with, so the concept of crossing state lines is attractive both financially and ideologically.

    The state line issue is a real one and the dollars saved are important. But as a solution to the health insurance crisis it is trivial.

    Hospitals are not filled with men under 50 unless they have an accident. They are filled with expectant mothers and older patients with chronic illnesses.The real issue is how will those groups get their insurance.

  5. Sorry John. Romney has very carefully avoided saying what he would do. I know you are trying to speak for him, that is your job after all, but Romney is not offering any ideas. Plus, we all know that selling across state lines will increase costs. What you really mean is doing away with state mandates. I know you want to avoid saying that ahead of the election, but in order to do this you need to use the federal government to eliminate state rules.


  6. There is no federal solution to anyone’s idea of healthcare problems as long as there are Sovereign States in the union. Romney got healthcare in Massachusetts. That does not mean he can get it done federally (thank God).

  7. Politicians have no idea how to manage a gray world.

    The irony is, the blue and red parties just turn the moderates and independents purple with the ongoing extremist bashings.

    The ones screeching EMR/HIT works and critics need to shut up are the ones who overtly profit from it. Duh!!!

  8. What is good for the patietns is not good for big business. This is Romney’s bread and butter. The disparity between the haves and the have nots will increase with a Romney presidency. Austerity is not the answer, but enabling the middle class to exist is. Even the doctors are struggling to tread the financial waters considering the cuts in their payments and the excess waste of time they endure while clicking away on flawed EHRs, while the CEOs and entourage of the vendors manufacturing these devices are making $ millions. It is like the doctors have become window washers for these guys.

  9. Bob and Curly make excellent points.

    Curly is right to slam the HIT industry. They have not done squat in the past 8 years, except feed at the trough after deceiving Congress to fill it with dough.

    Bob is also correct. Romney is evasive as to what it is he is saying, chameleon like . With all of their computers and excellent interoperability, the insurance carriers must stalling to screw the patients. They ain’t friendly.

  10. Dr. Goodman states that Romney is in favor of insurance portability for people who must change jobs.

    That is what I think golfers call a ‘chip shot’, i.e. over-rated by any standard of courage or boldness.

    Let me tell my own story.

    A few years ago I changed jobs. I left a big corporation and went to work at a start up.

    I had been insured with Empire Blue Cross of NY while at the corporation.
    (I am a resident of MN)

    When I got to the new job, I wanted to keep my coverage continuous.

    I spent two months calling and writing Empire Blue Cross and requesting continuation coverage.

    They did nothing and finally referred me to Blue Cross of MN.

    Blue Cross had a policy that cost over $2000 a month for one person. But I had to go several months without coverage in order to quality.

    Eventually I wound up on Minnesota’s High Risk plan, which is one of the best in the nation.

    My point is this — portability does not mean diddly-doo if there is no insurer of last resort. I can understand actuarially why the Blue Cross plans do not really want 60 year old individual insureds.

    I do not say that the ACA is the only solution. Self-employed 60 year olds are perhaps a $5 billion problem, and we may not need a $150 billion ACA solution.

    All I am saying is that Romney must be pressed for specifics on how portability will really work. Romney must not be given a free pass for saying
    ‘trust free markets.’

  11. Well, the vendors keep pounding the same hazardous programs:

    They sure are doing nothing continuously to innovate, assure safety, eliminate deign flaws, assure efficacy, assure usability, record and report the defects of their devices, record and report downtimes and associated delays and adverse events.

    No improvements have been seen in 7 years. Theses devices are dangerous to patients hospitalized for complex illness. They are ok for taking care of things like hangnails or acne.

  12. All I’m sayin’ that you keep pounding that worn-out overblown monotone line that is just not gonna get any traction. Doesn’t matter what I think. Your reflexive anti-HIT hyperbole just tends to discredit you. It adds nothing constructive to any of these debates.

  13. To BobbyG: you seem like the perfect sophisticated gentleman to educate us all.

  14. What is bloated in both candidates ideology and likely to cause, paradoxically, the greatest increase in costs, is the mandate to conduct medical care using ill designed, user unfriendly, error promoting EMRs and CPOEs.

    Romney has yet to comment on the sham of HIT and does not recognize that the devices have not any proof of safety, efficacy, and usability.

    All they got are a bunch of zealots trumpeting how they will transform health care (paradoxically, in the wrong direction).

  15. It’s a smoke screen.

    As a doc in the Southeast, I’m not going to negociate a fee schedule with Greater Indemnity of North Dakota. The one or two people in my state who insure with them will have to pay full fare for everything.

  16. Yeah we are in big problem and in confusion. We don’t know actually whats is going on! But I like some of steps they are taken.

  17. “(1) Governor Romney brought both parties together to achieve genuine bipartisan reform (something Barack Obama failed at miserably at the national level);”

    Takes two to “achieve bipartisan reform”, Republicans, as has been noted, refused to play nice in the sand box.

    ” (2) he cut the insurance rate in half by giving substantial tax relief to people who must purchase their own insurance, and (3) he did all this without raising taxes.”

    Isn’t it conservatives who are saying the country’s broke? Isn’t it conservatives who tout “consumer directed heath care” as a means to lower costs. Why is using tax subsidies all of a sudden good idea – maybe because it’s not Obama’s idea, well it is actually, unless it’s Romney’s.

    There will be no insurance benefit loading if one comprehensive plan is what the mandate – mandates.

  18. I’ve never understood this fascination with buying insurance across state lines. When there are consumer complaints, who watches out for the consumers? Is, say, the North Dakota insurance department going to vigorously go to bat for some New Yorkers covered under a ND-based policy? (And I mean no disrespect to the ND Department — I just picked a hypothetical example) Seems ripe for a race to the regulatory bottom.

    Avoiding needless mandates is one thing, but lessening consumer protection is quite another.

  19. Romney was able to act in Massachusetts because both Massachusetts Republicans and Democrats were ready, willing, and able to act to address this serious public problem and craft a workable solution build on conservative (Heritage Foundation) principles.

    On the other hand, President Obama invited Republicans to participate in crafting health reform legislation but was continually rebuffed as part of a sophisticated political strategy to make American’s unsustainable health sector a useful political scare tool. It’s a brave act to reform 20% of the American economy during our second worst economic downturn in our history.

    Buying health insurance across state lines is not a comprehensive solution for most of the uninsured. Most uninsured live in terror not because they want to but because the health insurance market is rigged against them in providing affordable meaningful coverage especially for those with pre-existing conditions.

    No other industrialized nation depends on private insurance to fund its citizens health care thus leaving millions without.adequate access. Health care is a public good. If you consider it a private good/service then it is an example of massive market failure(s).