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President Barack Obama just gave a speech. Mitt Romney, his likeliest 2012 challenger, just published a book. The speech was about health care reform. So was a chapter in Romney's book. As Massachusetts governor, Romney led a 2006 reform of the state's health care system that provided the blueprint for President Obama's own health-reform plan. That's a source of tremendous discomfort to Romney, who, to judge from his unsuccessful 2008 nomination bid, intends to run not just as a Republican but as a conservative Republican. Nowadays, even moderate Republicans dare not whisper a kind word about Obamacare. Romney confronts this political difficulty by punctuating his discussion of Massachusetts' health reforms with ritual denunciations of Washington's. He insists that Obamacare is qualitatively different from and vastly inferior to Romneycare. How so? Romney grumbles a bit that the Obama bill doesn't do much about tort reform, and he contends Obama is overselling the benefits of electronic recordkeeping and greater transparency in pricing (both of which Romney favors, too). Mainly, though, his argument comes down to two points:
- Obamacare includes a "public option" government insurance plan, which Romney judges to be "a transitional step toward the president's stated goal of creating a single-payer system." Such claims about the public option may or may not be true, but they are certainly irrelevant. There is no public option in Obama's proposal. Lately, there's been a push inside the Senate to tuck it back into the reconciliation bill, but given already-steep odds against getting health reform through the House (where the obstacle is conservative Democrats), that isn't likely to happen.
- Romney believes every state should pursue its own version of health care reform. "States could follow the Massachusetts model if they choose, or they could develop plans of their own," he writes. "These plans, tested in the state 'laboratories of democracy,' could be evaluated, compared, improved upon, and adopted by others. But the creation of a national plan is the direction in which Washington currently is moving." This disagreement isn't stated with much vehemence; Romney calls a federalist approach "my own preference." Anyway, the Senate bill already allows states to achieve health reform by other means provided they can demonstrate comparable results.
Otherwise, Romney's discussion of health reform is, from a partisan perspective, comically off-message. (How could he know what today's GOP message would be? He probably finished writing the book months ago.) Remove a little anti-Obama boilerplate and Romney's views become indistinguishable from the president's. They even rely on the same MIT economist! At the Massachusetts bill's signing ceremony, Romney relates in his book, the late Sen. Ted Kennedy, D-Mass., quipped, "When Mitt Romney and Ted Kennedy are celebrating the same piece of legislation, it means only one thing: One of us didn't read it." The Washington Post's Ezra Klein has noted that Republicans may have a philosophical difference with the Democrats over health care reform, but in practice their proposed solutions have often been remarkably similar. It follows that nearly all Republican opposition to Obamacare is mere political opportunism.
In Romney's case, the practical policy differences aren't visible to the naked eye. To demonstrate this, Slate has extracted and mixed up the following quotations from Obama's March 3 speech and from Romney's book. We defy you to identify who said what. Answers are below the list.
- "Health insurance is becoming more expensive by the day. Families can't afford it. Businesses can't afford it. The federal government can't afford it. Smaller businesses and individuals who don't get coverage at work are squeezed especially hard."
- "The average employer pays more than $12,000 annually for an employee's family coverage, almost double the cost of a decade ago, even after adjusting for inflation. Prior to its bankruptcy reorganization, General Motors was spending $1,400 per automobile on employee health insurance—more than the cost of steel. Not surprisingly, employers are dropping more and more employees from health-insurance plans in an attempt to stay competitive. And those employees who have been able to keep their insurance face ever higher co-pays, premiums, and deductibles."
- "The basics for creating a workable, affordable system that insures everyone and keeps private insurance and personal choice intact are these: First, create incentives for those who can afford insurance to actually purchase it. … Second, create an exchange to help make buying insurance easier for individual—as opposed to corporate—buyers. The exchange lowers premiums. … Third, help the poor buy their own private insurance with a sliding-scale subsidy."
- "There are some who've suggested scrapping our system of private insurance and replacing it with a government-run health care system. And though many other countries have such a system, in America it would be neither practical nor realistic."
- "In my view, the failures we encounter virtually every day are the result of features imposed on the health-care system that have distorted market incentives. …"
- "If Americans enjoyed better health and longevity than people in other countries, it might be reasonable to argue that our excessive health-care spending is simply a rational consumer choice. But the life span of the average American is less than that of people in nations that spend far less. Japanese men outlive American men by five years; Frenchmen outlive us by three years. To put it bluntly, we spend more and die sooner."
- "Confronted by the sheer magnitude of the health-care cost problem—our overspending compared to the Organization for Economic Cooperation and Development (OECD) average is about $750 billion a year—an increasing number of observers recognize that small measures simply will not get the job done."
- "[U]nless everyone has access to affordable coverage, you can't prevent insurance companies from denying coverage based on preexisting conditions; you can't limit the amount families are forced to pay out of their own pockets. The insurance reforms rest on everybody having access to coverage. And you also don't do anything about the fact that taxpayers currently end up subsidizing the uninsured when they're forced to go to the emergency room for care, to the tune of about a thousand bucks per family. You can't get those savings if those people are still going to the emergency room."
- "It builds on the current system where most Americans get their health insurance from their employer."
- "I quote Dr. [Atul] Gawande's [New Yorker] article at length because it was a balanced portrait from a moment in time before the debate became politicized. …"
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