Where Do the Candidates Stand on Health Care? Mitt Romney
Mitt Romney's campaign was worried about his too-perfect, Ken-doll style hair. They fretted about his reputation as "Slick Dancing Mitt," his lack of experience as a "tough war time leader," and the fact that he was governor of Massachusetts, a state where he has lived for almost 40 years.
Massachusetts? What's so bad about Massachusetts, you ask? During Mitt Romney's tenure as governor, Massachusetts enacted a universal health care plan which included that m-word that conservatives don't usually talk about and Clinton and Obama have been arguing about.
Yeah, that's right. MANDATE.
In a 77-slide Powerpoint presentation leaked to the Boston Globe last year, Romney's advisers outlined the perceptions they were worried about (like the hair) and the "bogeymen" of Romney's past (like Massachusetts and Mormonism).
But back to mandates. Romney's advisers decided that it was a good idea for the candidate to distance himself from the capital M-word, because of the lower case m-word, and focus instead on winning another M-word.
Turns out the strategy was somewhat successful. Last Tuesday Romney won Michigan, propelling him back into the forefront of the Republican race. Given his renewed national prominence, I think it's time to take a look at what a Romney presidency would mean for the health care of the current and aspiring middle class.
Romney's website doesn't make it easy to find out much about his health care plan. If you go to the website, click on "Issue Watch," and then "Health Care," you find a paltry selection of information. It begins with this one sentence vague policy summary:
"The health of our nation can be improved by extending health insurance to all Americans, not through a government program or new taxes, but through market reforms."
There are then two short newspaper quotes and three links to video clips on MittTV. And, believe it or not, that's it. Unsurprisingly, the m-word and M-word are nowhere to be seen, although there is a picture of Romney with some pretty nice-looking hair.
Some more digging, however, gave me a slightly more complete picture of what Romney-care might look like. In a policy briefing from August of 2007 (which was buried in the press release section of the website), Romney outlines some basic tenets of a possible health care plan.
As predicted, there's very little of Massachusetts in the plan. Romney's four major health care goals are sound -- he hopes to make private insurance affordable, provide access to insurance for all Americans, enhance insurance portability, and slow inflation in health care spending. However, the way that he proposes to go about these goals is unlikely to create a health care system that works for all Americans.
Basically, Romney's health care plan is all about states' rights. According to the the policy brief, states would have a fair amount of leeway to design their own health care systems. A state like Massachusetts would be free to mandate universal health care, but no state would be forced to make such reforms. "Rather than relying on a one-size-fits-all, government-run system, Governor Romney's plan recognizes the importance of the role of the states in leading reform and the need for innovation in dealing with rising health care costs and the problem of the uninsured," the policy brief reads.
However, Romney does propose some nationwide reforms that he believes would help states to create their own health care plans. He plans to decrease funding to federal programs like Medicaid, and provide more block-grants to states instead. This is consistent with Romney's previous statements on health care. As he said about the State Children's Health Insurance Program (SCHIP),
"I agree with the President that this legislation – while well intentioned – took the wrong approach. The Democrat SCHIP expansion bill would take children out of private insurance and put them into government insurance. It was a flawed approach. The right course is to get all children and all citizens insured with private, market-based health insurance."
Romney must have missed the fact that SCHIP was providing insurance to currently uninsured children, not removing them from private insurance. According to the Congressional Budget Office, the original SCHIP bill would have insured 3.8 million children by 2012 who would otherwise have been uninsured.
To his credit, Romney does offer a way to make insurance more affordable. However, he does this mainly by deregulating the insurance industry, which would, as Ezra Klein says, "allow insurers to offer much cheaper, sparser plans that would be very good for the healthy to buy and very bad for the sick as their plans grew correspondingly more costly." Unlike other candidates -- including Obama, Clinton, and Edwards -- Romney doesn't propose to force insurers to cover everyone regardless of pre-existing conditions. This means that Romney's plan could provide cheap insurance for the young and healthy, but older, sicker people could still face discrimination by insurers and end up paying for medical expenses out-of-pocket. Cheap insurance plans also likely wouldn't cover the preventative care that has been proposed by other candidates, which would make insurance and medical costs rise in the long run.
Romney also proposes to "reform" the medical liability system. His policy brief reads,
"Too many doctors are practicing defensive medicine because of frivolous lawsuits and an out-of-control medical liability system. Governor Romney will implement medical liability reform, including federal caps on non-economic and punitive damage awards in medical malpractice cases."
However, as Kia Franklin writes in DMI's recent report, Election '08: A Pro-Civil Justice Presidential Platform, "malpractice lawsuits and malpractice insurance rates are, at best, tenuously linked." The court system helps to increase patient safety, and putting federal caps on malpractice lawsuits only reduces the incentives that hospitals have to improve quality of patient care. She writes,
"Reducing medical errors is a desirable goal, but hospitals have few incentives to invest in increasing patient safety besides the threat of lawsuits. Litigation against hospitals and doctors for medical errors has led to improvements in 'catheter replacement, drug prescriptions, hospital staffing levels, infection control, nursing home care and trauma care.' Yet unyielding efforts for tort “reform” seek to reduce what little recourse patients have now. In turn, these rigorous measures to reduce compensation to injured patients or keep them out of public courts altogether weaken the impact of lawsuits as an incentive for hospitals to improve patient safety."
Romney does have one reform that is likely to improve patient safety and decrease cost -- bringing "health care into the 21st century by enhancing the use of information technology" -- but the rest of his policy suggestions are mainly ways to decrease regulation and give the states more control. There is also very little mention of budgetary concerns in the proposal, presumably because that too would be in the hands of the states.
Overall, Romney's proposed health care reforms would be way worse for the American middle class than perfectly combed hair, unflattering nicknames, or even M-word type reforms. Romney can distance himself from Massachusetts, but the health care needs of the American middle class may be harder to ignore.