Click here for a guide to following the health care reform story online.
Scott Brown won Republicans a big victory on Jan. 19. But Mitt Romney may have won them an even bigger one.
To credit former Gov. Romney with a role in Senator-elect Brown's Massachusetts upset, and the consequent likely death of the health reform bill, might at first seem ludicrous. Romney played almost no public role in Brown's campaign, mainly because the Michigan-bred Republican is no longer very popular in the Bay State. (During his bid for the 2008 presidential nomination, in which Romney made an abrupt rightward turn, campaign aides actually classified Massachusetts a "bogeyman" to run against—along with France, taxes, Hollywood values, moral relativism, Hillary Clinton, and jihadism.) "There's no added advantage in having Romney with Brown," David Paleologos, director of the Suffolk University Political Research Center in Boston, told Politico's Alex Isenstadt on Jan. 18, "and there's potentially some disadvantage. I don't think there's an upside here at all."
But there is evidence that Romney played a powerful indirect role in Brown's victory by persuading Massachusetts voters that they didn't need the health care reform bill that Brown and his fellow Republicans oppose. How did he achieve that? By giving them a slightly more left-wing version of the same health reform plan four years ago.
According to an election-night poll by Scott Rasmussen (who leans conservative but has a pretty good track record), 56 percent of Massachusetts voters said health care was the most important factor in their voting decisions, compared with only 25 percent who rated the economy the most important factor. A narrow majority of 51 percent said they opposed the health reform bill, compared with 47 percent who favored it. Fifty percent said they'd prefer no health reform bill at all to the one being hatched in Washington. (Brown's position: "I will insist they start over.") That jibes with an exit poll conducted by the Republican firm Fabrizio, McLaughlin, & Associates, which found that 52 percent of voters opposed health care reform. Forty-eight percent said it was the single issue determining their vote. (No independent exit polls are available, apparently because the Boston Globe and the national press decided, early on, that conducting any would not be worth their while.)
Because Massachusetts has had its own version of health care reform since 2006—one that serves as the closest model for Obamacare—it is tempting to conclude that, in voting for Brown, Bay Staters were saying, "We've tried it and it stinks." There's no question that some people in Massachusetts feel this way, most notable among them Dr. Jeffrey S. Flier, dean of Harvard Medical School. (On Jan. 11 Flier hosted a symposium that mostly dumped all over Romneycare.)
But most people in Massachusetts feel differently. A 2008 survey published in Health Affairs found that support for Romneycare, which stood at 61 percent at the time of its enactment, had steadily increased to 69 percent. Support has since fallen (probably because the recession has made voters understandably anxious about the state's sharply rising premiums). But a majority of Bay Staters continues to favor Romneycare. Fifty-nine percent supported it in a Sept. 2009 poll conducted by the Boston Globe and Harvard's School of Public Health, and 54 percent did in a Suffolk University poll released last week. Dr. Flier notwithstanding, physicians favor Romneycare more than their patients do; a November 2009 survey published in the New England Journal of Medicine found doctor support at 70 percent.
Perhaps in deference to these poll numbers (or perhaps because he voted for it as a state senator), Brown ran as a Romneycare fan. "I support the 2006 health care law that was successful in expanding coverage," states his campaign Web page. His only criticism, widely shared, is that it needs to "turn its attention to controlling costs."
Both Brown and Romney have been asked repeatedly to reconcile their support for Romneycare with their opposition to Obamacare. "They're two different programs," Brown told Fox News' Neil Cavuto on Jan. 13. "What we have here is a free-market enterprise where we're providing insurance in various levels to people in Massachusetts. The plans in Washington are a one-size-fits-all plan."
Brown must know that isn't true. Obamacare, like Romneycare, would offer multiple private health insurance plans through one or more exchanges, modeled on Romneycare's "Connector." The exchanges would take a less active role in regulating policies than their Massachusetts counterparts. It's true that Democrats sought to create a "public option" plan to sell government health insurance alongside the private plans in the exchanges. But the public option didn't make it into the Senate bill, and it's common knowledge that battle is lost.
Romney was even more disingenuous than Brown about the supposed difference between Obamacare and Romneycare in a Jan. 11 interview with Greta Van Susteren of Fox News. He began with the same fictitious claim that Obamacare would impose a "one-size fits all plan." He then continued:
No. 2, you don't raise taxes on people to put it in place, which they're intent on doing.
No. 3, you don't put a mandate on businesses. That's not going to create jobs at a critical time like this.
No. 4, you don't cut Medicare. You don't put the cost of this system on the backs of our senior citizens.
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?
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 email@example.com.