One advantage the GOP had in the health debate was its total disregard for nuance when it came to messaging. Again and again, Republicans over-simplified provisions in the Democratic plan and convinced a lot of Americans that reform was bad in the process. They said the bill would gut Medicare by slashing half a trillion dollars in funding. That sounded pretty bad to a lot of seniors, especially those who didn’t hear Democrats explain that much of the cuts would come from subsidies to private insurers in Medicare Advantage and wouldn’t have any effect on federally mandated benefits. No, slashing Medicare is a much easier sell. Republicans also said the bill would raise taxes. Yikes – in this economy? That sounded pretty bad too, especially to those who didn’t hear Democrats explain that additional payroll taxes would only affect the rich and taxes on expensive health plans wouldn’t kick in for years and could actually result in higher wages, according to some health care economists. Yeah, higher taxes is a more potent message.
Well, now Mitt Romney – who some believe is the front runner for the Republican nomination in 2012 – finds himself in the same conundrum the Democrats were in throughout the past year. He’s trying to explain the gritty details of how the health reform he implemented as governor of Massachusetts is different than the one President Obama just ushered in on a national scale.
Romney is and will continue to have a hard time with this task. For starters, the Massachusetts plan is structurally the same as the federal plan – the federal plan was, in fact, modeled on the Massachusetts plan. Anyone who says this isn’t true is not being honest. Without wading too far into the policy details, let’s just say that federal health reform is a stool with three legs: subsidies, an individual mandate and an insurance exchange. The Massachusetts stool has the same legs. Jonathan Gruber, the MIT economist who helped design the Massachusetts plan with Romney and who has worked as a consultant for Congress and the White House, said this week that the former governor “is in many ways the intellectual father of national health reform.’’ That wasn’t a dig – it’s true.
But yet out of political necessity, Romney has been stumbling around trying to distance himself from “Obamacare.” His PAC has launched a campaign called “Prescription for Repeal” that will donate to the campaigns of candidates “who will work to repeal the worst aspects of Obamacare and restore commonsense principles to healthcare.” Romney also told the Boston Globe his plan and Obama’s plan are “as different as night and day.”
But they’re not night and day. There are differences sure – the Massachusetts employer mandate is different and the plan didn’t affect Medicare, as Romney eagerly points out – but these differences are nothing compared to the similarities. And if Romney keeps trying to highlight these differences, he’s going to get sucked into the same trap the Democrats fell into with the Medicare cuts and taxes – the nuance will get lost in the shuffle. Romney’s opponents will say he cleared the way for Obamacare. Romney will try to explain wait a minute, actually the Massachusetts plan didn’t raise taxes, at least not directly, and the employer mandate is different and…what’s that, already lost you?
Probably the most effective message for Romney – who’s surely hoping health care will not be the most important issue in the 2012 campaign – is to draw a line between state and federal reform. He’s doing this, saying his approach allowed a single state to implement reforms best for its own unique situation, while federal reform is a “one-size-fits-all plan.” But in practically the next breath, Romney’s saying things like this:
“We passed in Massachusetts a health care bill that makes sure, that if you lose a job or change a job, you won’t lose your insurance. Everybody in Massachusetts is able to keep insurance throughout their life. It’s not taken away from them. So it’s portable.
“No. 2, you can’t be cancelled if you have a pre-existing condition or if you become ill once your insured. So everybody’s insured. Ninety-eight percent of the citizens in our state are insured. So in that respect, it’s very similar.
“We also have an individual responsibility. We have an incentive – a mandate, if you will, to say we need everybody insured. The reason we did that was pretty simple. We had a lot of people showing up at the hospital without insurance – people who had the money or funds to buy insurance, who said, ‘I got no insurance. I’m real sick. Take care of me.’
“And the government was paying for those people. That’s what’s happening here, and in the other states in the country. There are people who — we call them free-riders — who say ‘I’m not going to be insured. I can’t pay my own way. If I have an accident or have a heart-attack, the government will pay for me.’ We say no more. You’ve got [the] responsibility, a personal responsibility, to get insured.”