Decision 2012: Battle of the Health Care Contortionists

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Joe Raedle, Olivier Douliery / Getty Images

Mitt Romney and Barack Obama

Both major party candidates running for President, Barack Obama and Mitt Romney, say America faces a clear choice in November. But good luck figuring out all the fine print, especially when it comes to their positions on health care reform.

Here are their stated positions on one topic, the idea of imposing an individual mandate, which requires all citizens to buy health insurance:

Barack Obama, who ran for President in 2008 by promising to oppose an individual mandate, is running in 2012 on his success in passing the individual mandate in to law. He insisted the mandate penalty was not a tax until his lawyer argued before the Supreme Court that it was a tax.

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Mitt Romney, who ran for President in 2008 describing the individual mandate he passed in Massachusetts as a model for the rest of the nation, is running in 2012 by promising to dismantle the individual mandate. He believes Obama’s healthcare reforms will burden American with economy-killing tax increases, though Romney does not believe that the mandate itself constitutes a tax.

Those sentences are confusing. So let’s try again. This time, in the form of a hypothetical Q&A:

What do you think about an individual mandate?

Obama: I opposed it in 2008, but started supporting it in 2009. Now I hope the thing I ran against to get elected will be my historical legacy as president.

Romney: I supported it in Massachusetts, and called the state reforms a model for the nation in 2007 and 2008. But now I hope to dismantle the federal version of my state-level success.

Is the penalty for not following the individual mandate a tax? 

Obama: It is not a tax, unless I am arguing my case before the Supreme Court. Then, it is a tax, and the court agreed with me, and I am happy about this.

Romney: It is not a tax, even though my own party leadership now claims it is a tax. But I still want to dismantle Obama’s health care reforms because it raises taxes.

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Still confused? Let me describe it another way, as a set of talking points:

Obama Talking Points

–Individual mandate was bad in 2008, good in 2009.
–Penalty for not following mandate was not a tax in 2009, but is a tax in 2011.

Romney Talking Points

–Individual mandate was good in 2008, but became bad after 2009.
–Penalty for not following the mandate was not a tax then, even though all my Republican colleagues now call it a tax. I am consistent!
–But there are other parts of ObamaCare that increase taxes, and for this reason even the non-tax parts must be stopped.

If this is still confusing, I can’t really help you. Both candidates have tied themselves in knots standing on principal while bending to political necessity. In the case of Obama, the necessities were beating Hillary Clinton in the 2008 primary, passing an historic health care reform through Congress and winning an argument at the Supreme Court. In the case of Romney, the necessities were solving the problem of the uninsured in Massachusetts, trying to win the 2008 Republican nomination, and recreating himself as the anti-Obama in 2012.*

Though the two men take a similar approach to political expediency, that does not mean that they support similar health care policies at the moment. So let us not let the tactical absurdity cloud the real impacts:

If you elect Barack Obama, there is a solid chance his health care reforms of 2010 will become the accepted law of the land. That means lots of things, including insurance reforms, millions more with insurance, a major expansion of Medicaid in most states, and the possibility that if you refuse to buy insurance you will see your tax refund withheld. It also will likely put some long term pressure on federal budgets, unless health care costs rise slower than expected.

(MORE: Health Care Issue May Fade Fast for Romney)

If you elect Mitt Romney, there is a solid chance that some or all of Barack Obama’s health care reforms will be repealed. That will likely mean relatively less federal spending on Medicaid, which helps provide medical coverage to the poor. It will also probably means less long term pressure on the deficit, and millions more Americans without health insurance. Depending on how the repeal goes, this could also mean a loss of some of the insurance reforms.

But then even these positions are not set in stone. Unless you go third party, you will be pulling the lever for a candidate with a demonstrated ability to shift his rhetoric and policy positions to meet the political moment. And whoever wins is almost certain to face the task of governing with a squabbling Congress in an impatient country. All campaign promises are subject to change.

*Apologies for the asterisk, but there some fine print here. Romney argues that he never argued for a federal one-size-fits-all health care reform plan. In 2007 and 2008, he was a big supporter of using the mandate model on a state-by-state approach, but not as a federal level. But it is also true that in 2009, he appeared on Meet The Press and other shows to offer support for federal solutions that adopted the individual mandate, including the so-called Wyden-Bennett bill. See this video at 6:20.