A Cautious Mitt Romney Enters the Health Care Arena on His Own Terms

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The 2012 Republican presidential nomination will not be won or lost on newspaper op-ed pages, or in the wood-paneled confines of a university classroom, where Mitt Romney spoke Thursday about health care. But that is where the field’s current front runner has been running his campaign so far. He didn’t show up at the first Republican debate. He rarely goes out on the campaign trail. And he officially says he is not running for president, hoping to avoid early scrutiny, even though running is pretty much all he has been doing for months.

It is a strategy meant to shield Romney from criticism for as long as possible, while allowing him to retain more control over his image. But by attempting to compensate for a perceived weakness–namely a poor record of connecting with voters and engaging with the media–he runs the risk of highlighting his own insecurities. One of the first things Romney advisers will tell you about their guy is that he really is incredibly personable, funny and likable in intimate settings. But they still have not shown any interest in letting their candidate get out there to demonstrate this.

Thursday’s formal speech was held in a classroom at the University of Michigan Cardiology Center, a setting that only fit about 100 people, most of whom appeared to be health care professionals. Romney returned to a campaign device he tried in 2008 with little effect, the PowerPoint-driven policy speech. Almost all of the people who watched the speech, as it was streamed online or via C-SPAN, could not see the PowerPoint slides. That may have been intentional; the main message of the speech did not concern policy details, of which Romney promised more later.

Instead, Romney’s message was that he is a detail man, a candidate of substance and competence, who will be able to demonstrate over the coming months the abilities necessary to lead the country out of its current malaise. He also presented himself as a man of principle, who would not change his views based on political pressure. “A lot of pundits around the nation are saying that I should stand up and say that this whole thing was a mistake,” Romney said, referring to his support for a Massachusetts program that mandated health insurance for almost all residents. “It wouldn’t be honest. I, in fact, did what I think was right for the people of my state.”

The problem for Romney is that President Obama’s support for mandatory insurance has become a major issue among the GOP electorate. As a political and a policy matter, it is a challenge to distinguish RomneyCare from ObamaCare; most believe the second wouldn’t exist without the first, even if the legal basis for state-based mandates differs from federal mandates. A “What About ‘The Mandate’?” slide in Romney’s PowerPoint presentation said “free riders” in Massachusetts needed to take “personal responsibility” for their health care costs. This is another way of saying every Massachusetts resident is required to have health insurance or pay a fine. It’s a line that could have been written by Jon Favreau, President Obama’s lead speechwriter.

In Romney’s PowerPoint, however, the Romney Massachusetts plan was summarized as “Help people get and keep their health insurance,” while Obama’s plan was “A government takeover of health care.” Suffice it to say, there are few, if any, independent observers who would consider these to be accurate descriptions of the differences. These phrases are, instead, political messages, hewing as close to reality as just about any other advertising slogan. The purpose of Obama’s plan, like Romney’s, was to “help people get and keep their health insurance,” and several conservatives consider any mandate to be too much government intrusion. As Romney’s rival for the nomination, Rick Santorum said in a statement after the speech, “Both RomneyCare and ObamaCare infringe upon individual freedom and exponentially increase the government’s health care cost burden.”

In other ways, Romney tried to skate over the fine print of his plan. He said that Massachusetts health care reform didn’t require tax hikes. That may be technically true, but the plan relied on a fairly dramatic inflow of federal subsidies to Massachusetts, which are paid for in effect by government borrowing that is later repaid with federal taxes. To pay for the escalating costs of Romney’s program today, Massachusetts has also increased taxes on cigarettes and levied fees on insurers and hospitals.

In criticizing Obama’s plans, Romney mostly stuck to generalities. The new law “hurts health care quality” and “discourages innovation.” How exactly? He didn’t say. The Obama plan “reduces consumer choice,” but so does the Massachusetts health care plan in a way. In order to satisfy the state’s individual mandate, consumers have to have health insurance that meets minimum standards set by the state. Similarly, the Obama plan would set federal standards for credible coverage. Romney also made the point, which he has been making at least since 2007, that he thinks states should take the lead in crafting health care reform, not the federal government.

As for his own plans going forward, Romney seemed to embrace a few key features of the Obama plan. For instance, he said he supported issuing innovation grants for health courts and other medical malpractice reforms, provisions contained in the Obama bill. Romney also said he would like Consumer Reports or something like it to rate health insurance plans so consumers could compare when they shop. The Obama plan has a provision to do just this. Romney wants to “Promote alternatives to ‘fee for service.’” This is done in the Obama plan, via a series of massive Medicare demonstration projects to, for example, pay doctors and hospitals per patient or per “episode of care,” as opposed to paying for every treatment or appointment.

But again, the details are not the message here. There are relatively few Republican primary voters interested enough in the fine print of health care policy to try to work out the differences and similarities between the two health plans. What mattered for Romney was the politics of the event, pushing talking points that his campaign-in-waiting distributed to allies. He was trying to distinguish himself from President Obama and give a demonstration of his own intellectual heft when it comes to complex policy matters.

In the carefully controlled environment of a classroom at the University of Michigan, Romney appeared to succeed. But he won’t be able to take that PowerPoint to the next Republican debate, and if he keeps resisting engagement with the electorate he wants to woo, all his careful avoidance of scrutiny will only raise the stakes once he does get out on the trail. In American politics, there are no shortcuts to the White House. To win the nomination, Romney will have to engage his detractors and win a public debate. Writing op-eds and distributing PowerPoint slides will not be enough.

With Kate Pickert