If someone asked you to come up with a good reason that Mitt Romney—the boring one-term governor of a state he left with high debt, poor job-creation and low approval ratings—became a credible national candidate, you might have a hard time doing so. The fact that he is wealthy and could self-finance his way into the top tier of Republican presidential contenders helped, as did the fact that he had won in the bluest of states, Massachusetts.
But the main reason, ironically, is that he was associated with a policy achievement—healthcare reform—that he has completely come to oppose. Back in 2007, Republicans still pretended to care about the crisis of 45 million uninsured Americans and costs that keep spiraling upwards. And so they looked to the one Republican who had tackled that problem at the state level and had done so with a program that harnessed the private sector rather than creating a massive new entitlement program. Conservative organs such as National Review, which would later inveigh against the Affordable Care Act (ACA), cited Romney’s experience with reforming the health insurance system as one of his most valuable credentials.
Throughout this campaign Romney has walked a tiny tightrope on healthcare: he attempts to make amends for passing the state level template for the ACA by issuing over the top denunciations of socialist, unconstitutional “Obamacare.” Meanwhile he has studiously avoided saying anything of substance about how he would address the massive market failure that defined the pre-reform American healthcare system.
On Tuesday in Orlando Romney gave a speech intended to create the false impression that he intends to replace the ACA with something that would provide the same benefits through other means. Here is how the Washington Post summarized the speech: “Romney fleshed out a plan he proposed earlier that would apply free-enterprise principles to the nation’s health-care system rather than operate it like a ‘government-managed utility,’ letting competition drive down prices and increase quality.” The “earlier” they refer to is Romney’s big healthcare speech last May that was meant to make it clear how different he is from Obama on the subject.
That was the main thrust again on Tuesday. Romney repeated the usual right-wing shibboleths: that the ACA has hamstrung the economic recovery by placing “unaffordable” cost burdens and new taxes on families and businesses. He has been at this for a while, using misleading anecdotes, such as his blatant misrepresentation of a passage from Noam Scheiber’s book that he claims shows the White House knew healthcare reform would damage the recovery, when it only shows that it knew more stimulus might have been more valuable to the short-term recovery. Of course, had Obama proposed more stimulus spending instead of healthcare reform in the fall of 2009, Romney and other Republicans would have opposed it.
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In fact, the Romney campaign appears to disagree with the Post that Romney offered much more substance than he did last May. When I asked for details of what he is proposing, the campaign said he laid it out last year and the program is available on the campaign website.
The healthcare page on Romney’s site does not, in fact, tell you much about what Romney would do. Instead it mostly offers vague, inoffensive sounding principles such as “Ensure flexibility to help the uninsured, including public-private partnerships, exchanges, and subsidies” and “Offer innovation grants to explore non-litigation alternatives to dispute resolution.”
Some of the principles are more blatantly ideological and potentially quite troubling, such as “Limit federal standards and requirements on both private insurance and Medicaid coverage.” Those federal standards and requirements are in place to protect citizens from rapacious companies and miserly state governments that would deprive recipients of necessary treatments. Any given federal requirement might be too costly or unnecessary. But Romney doesn’t specify which federal requirements he would eliminate so as to avoid inviting scrutiny of what his policy would do to the vulnerable.
The few specifics Romney offers could reduce, rather than expand, medical coverage. Romney would turn Medicaid into a block-grant program. That way, if poverty increases the federal government would not be on the hook for covering more Medicaid recipients. It would be the state’s problem. And what would the states do? Reduce the quality of coverage, or tighten eligibility rules to reduce the number of people covered.
The only other major change to the health insurance delivery system Romney offers is this: “End tax discrimination against the individual purchase of insurance.” That’s a euphemism for creating an expensive new tax deduction. That’s pretty hypocritical coming from someone who promises to cut tax rates and somehow magically make up for the lost revenue by eliminating tax expenditures.
Currently employer-provided health insurance is not taxed as income. Consequently, we overspend on health insurance by favoring that compensation over money employers pay to workers and the workers spend on anything else. This is actually not a very good policy for anyone. Employers are stuck with escalating healthcare costs, employees see their wage increases get diverted to healthcare, and the individual insurance market offers inferior, expensive coverage that unfairly disadvantages the self-employed and thus discourages risk taking.
These are all good reasons to get rid of our current system and switch to a universal, single-payer approach, such as making everyone eligible for Medicare. The alternative way to eliminate the current market distortion would be to end the tax deductibility of employer-based health insurance. That’s the program John McCain ran on in 2008. Back then, conservatives made sensible arguments in favor of doing so. For example, the Family Research Council complained in 2007 that employer-sponsored health insurance enjoys the single largest subsidy in our tax code.
But Mitt Romney is not John McCain. He is a coward, who lacks an iota of McCain’s political bravery. Consequently, Romney fears the backlash that would ensue if he took the principled position in favor of removing this inefficiency. So instead he proposes to equalize the treatment by making it also tax-deductible for individuals to buy their own insurance. That’s good for them, but it does nothing for the market. (The advantage to the market of McCain’s proposal was that it would move millions of health working-age Americans into the individual insurance market, much as the individual mandate would.) The ACA creates a flat tax credit for buying insurance. Romney would repeal that and offer a tax credit based on how much you spend on health insurance, so it would disproportionately benefit richer people who can afford more expensive tax plans.
In a similar act of falsely telling voters they can have their cake and eat it too, Romney promises to keep the most popular provision of the ACA, the rule preventing insurers from excluding prior conditions, without explaining how he would prevent the insurance market from a death spiral of cost increases. (The current mechanism for preventing that, the individual mandate, is the core of what Romney promises to repeal if the Supreme Court doesn’t do so first.)
As a freelancer who pays for his own insurance, I stand to benefit. But as American citizens, we all stand to lose.
