How Romneycare killed Obamacare.

How to fix health policy.
Jan. 20 2010 6:21 PM

How Romneycare Killed Obamacare

Massachusetts to Washington: "I got mine."

Click here for a guide to following the health care reform story online.

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But Romneycare did rely on taxes (Romney prefers the term "assessment") on insurers and hospitals, which, of course, got passed through to policyholders. And Romneycare did impose a mandate on business; Massachusetts companies employing 11 or more people that don't provide sufficient health insurance coverage to their employees are compelled to pay a "fair share contribution" and/or a "free rider surcharge." Look for similar whoppers about the Massachusetts health plan in Romney's forthcoming policy tome, No Apology: The Case For American Greatness, whose release will occasion a couple of stops in Iowa.

Romney is correct only in saying that his version of health care reform didn't cut funding for Medicare. That would be impossible because Medicare is funded entirely by the federal government. Romneycare's greatest flaw (as noted above) is that it made virtually no attempt to control health spending, which is what Obamacare's projected cuts in Medicare hospital and doctor fees (and to the Medicare Advantage program, a failed experiment in privatization) aspire to do.

So how do you reconcile support for Romneycare with opposition to Obamacare? After his "one size fits all" gibberish on Fox News, Brown stumbled into a more candid reply. "[W]e don't need it," he said. "Why are we subsidizing, why would we pay more, for something we already have?"

Would Massachusetts gain more from subsidies than it lost through taxes should Obamacare become law? Jonathan Cohn of the New Republic posed that question to Michael Miller, policy director for Community Catalyst, a health care advocacy group based in Boston. He replied, "It's complicated." Miller reviewed various pluses and minuses, and finally concluded:

Massachusetts residents may pay something so that low-income people in other parts of the country can get health care, but so what? To call this a problem with reform is at best extremely parochial. If you're going to insist that every state entirely self-finance the cost of caring for the uninsured who happen to reside within state borders, where do you stop—with secession?

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In the absence of any other logical explanation, I conclude that Massachusetts voters cast their vote for Scott Brown in the parochial spirit that Miller describes. Bay Staters saw no reason to vote for health care reform because they already had health care reform. Without Romney, that calculation wouldn't have been possible.

Whether Romney himself will be able to capitalize on the probable death of Obamacare is less certain. I suspect any presidential candidacy he may launch will be haunted, as it was in 2008, by the paradox that this anti-government conservative midwifed in Massachusetts a health care scheme that quickened the hearts of liberal Democrats. Will his fellow Republicans appreciate that Romneycare's very liberality struck a death blow to Obamacare? Probably not. On the other hand, think how much harder a road Romney would travel were Obama's emulation of Romney's greatest gubernatorial achievement to be enacted.

Update, Feb. 4: Brown may be against Obamacare now, but back in July  he gave every appearance of being in favor of it, and he was quite clear on the point that it was modeled on Romneycare:

Well, it's been interesting looking at what the Senate, the U.S. Senate, is doing. They're really mirroring what we did a couple of years ago through Gov. Romney's leadership. We had a bipartisan plan that was carefully crafted to make sure that everybody's interests were taken into consideration: business, providers, individuals and obviously the Commonwealth. And we have a plan, as I said it's somewhat similar to the Federal plan....

Obamacare has changed a little since July, but virtually all the changes have been in a conservative direction. The change that mattered was that the GOP stiffened its political opposition to the bill. Lee Fang has  more details  on the liberal Think Progress blog.

E-mail Timothy Noah at chatterbox@slate.com.

Timothy Noah is a former Slate staffer. His  book about income inequality is The Great Divergence.

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