So RomneyCare was all Bush’s Fault? The Galen Institute on What Went Wrong

By Gary P Jackson

I ran across this bit of information from the “Galen Institute,” a tax and health care policy think tank. The author is trying hard to make the case that RomneyCare, thanks to factors like a democrat legislature and pressure from the Bush administration, is not much like the original proposal Romney sought to have put into law.

I think we can argue all day long over the merits of this. And yeah, chances are, the Bay State was going to have some form of government run health care no matter who was in office, and maybe Mitt did stop it from being a lot worse than it is. Still, you’d think anyone with a lick of common sense would know you never let a democrat get it’s nose under the tent. Once they are in, it’s all over.

Romney has owned this screw-up from the start. And by owning it, I mean he’s never distanced himself from it, or admitted it was a mistake. Now this may be spin, with Romney figuring it’s better to own it than admit defeat, but who knows.

The article is worth reading because it does set some things straight, and it also reminds us that some of the things Romney [and other candidates ] have promised to do, regarding ObamaCare, simply cannot be done. This leaves us with two solutions: Hope the Supreme Court finds it unconstitutional, and repeal it. It will probably take a combination of both.

Romney’s Best Defense: The Truth About Romneycare

Even though Mitt Romney has had a string of primary wins, support for his presidential bid still is tepid among Republican voters nervous about Romneycare. He could calm them if he were to more fully explain the difference between his vision for reform and the law that ultimately was enacted in Massachusetts.

Gov. Romney gets big applause when he pledges to repeal Obamacare, but he faces silence when he tries to defend Romneycare. He insists, for example, that his individual mandate only impacted the 8 percent of residents who were uninsured (the mandate covers everyone), that he didn’t cut Medicare (states have no authority over Medicare), and that he would issue a waiver to the states to implement Obamacare their way (a president can’t undo an Act of Congress with a waiver).

The voters are not reassured. Gov. Romney can get off the defensive and change the subject by explaining that the Massachusetts law which was passed by the overwhelmingly Democratic legislature diverged significantly from his vision for reform, and then describe what his reform plan would be as president.

During the presidential debate in Jacksonville, Florida, in late January, Romney took a small step in this direction when he acknowledged that his successor, Gov. Deval Patrick, has taken a much more liberal track in implementing Romneycare. “If I were governor,” Romney said, “it would work a heck of a lot better.” Indeed, when it passed the law, the legislature was counting on a Democrat governor to succeed Romney to put the real regulatory thumb screws in place.

The Massachusetts law is different in important ways from the plan that Romney pushed as governor. Few voters know, for example, that Romney strongly opposed the employer mandate and wanted an escape from the individual mandate — allowing people to instead be able to post a bond if they were uninsured and had big medical bills. When Romney signed the law, he believed it contained the escape hatch, but legislators removed it before final passage.

Romney vetoed eight provisions of the Massachusetts bill, and every one of his vetoes was overridden by the legislature. Should Romney have known this was likely? Yes. Should he have known exactly what he was signing? Absolutely. But voters may be more forgiving if he tells them he wanted to give citizens and employers a way out.

Why did he push Romneycare? The state was at risk of losing $385 million in federal Medicaid money, and the Bush administration insisted Massachusetts make changes to get more residents covered and keep the money flowing.

Romney also wanted to find a way to make it easier for small businesses and individuals to get insurance that would be portable from job to job. To get around federal tax law restrictions and to make health insurance portable, he adopted the Heritage Foundation’s proposal to create exchanges that would allow individuals to have portable insurance and pay premiums with pre-tax dollars.
TODAY ROMNEY SAYS, “The market can work to solve our health care needs.” The policy recommendations on his campaign website back up his perspective on patient-centered reform. But primary voters aren’t. He needs to get off the defensive and take charge of this issue.

Here’s a three-step plan:

Step 1: Focus on Repeal of Obamacare.

Gov. Romney needs to get his message straight, or he will be hammered in the general election over false promises. He calls for repeal of Obamacare while saying he would immediately issue an executive order to give flexibility to the states to implement the law their way. That sets the stage to massively confuse the political agenda: He would be sending the states off to begin to implement Obamacare while Congress works in Washington to repeal it.

Further, the Congressional Research Service issued a report that said Obamacare’s major provisions are Acts of Congress, and they simply cannot be changed through an executive order.

His focus should be on repeal. Waivers to the states from Obamacare are not a solution and, in fact, might well detract from the ultimate goal of repealing the law and replacing it with a genuine free market alternative. If Gov. Romney is serious about repealing Obamacare, he will have to devote all of his energies to doing that as soon as possible.

The House of Representatives passed a repeal bill a few weeks after Republicans took control last year. In the Senate, many parts of Obamacare could be repealed through reconciliation with only 51 votes should Republicans take control there, allowing them to enact legislation repealing the spending provisions that are the biggest threat to the economy and to the federal deficit.

He also could calm voters by emphasizing that a federal mandate to purchase health insurance is unconstitutional and detail more reasons why Obamacare’s government-centric approach is wrong.

Step 2: Explain what really happened with passage of Romneycare.

Gov. Romney’s support for states’ rights is important, saying the law worked for Massachusetts but that other states need their own solutions in our diverse and complex country. But conservatives would feel better knowing what he initially proposed in the Bay State. For example:

• Mandate escape. Few voters know that Romney wanted an escape from the individual mandate. Voters may be more forgiving if he were to tell them he wanted to give citizens a way out and that he strongly opposed the employer mandate.

• Real insurance. Romney wanted people to be able to purchase real health insurance that would have covered catastrophic events. Instead, the legislature insisted on including all of the 50-plus health insurance mandates already on the books. The legislature allowed the high-deductible plans only for some young people aged 18-26.

After the Massachusetts law was passed by the legislature, Romney continued to try to reshape it with his line-item veto. For example:

• Employer mandate: Vetoed. The bill called for a mandate on employers with 11 or more workers to provide health coverage or pay an annual fee of $295 per worker. Overridden.

• Covering certain immigrants: Vetoed. The bill included a provision that would allow some non-citizens to qualify for coverage under the new health plan. Overridden.

• New bureaucracy: Vetoed. The bill created a powerful new bureaucracy, called the Public Health Council. Overridden.

• Limiting improvements to Medicaid: Vetoed. The bill restricted changes to Medicaid to make the program more efficient. Overridden.

Gov. Romney must clarify that in working with a Republican Congress on a new health reform agenda, he would start with a very different vision than Romneycare and work much harder to make sure the consumer-friendly structure is what becomes law.

Step 3: Emphasize his vision for market-based health reform, with a much clearer description of what a President Romney’s plan would look like.

He needs to talk about what he would do so he can stop having to defend Romneycare. A handful of specifics would do, many of which are included on his campaign website:

Help states set up functional pools so people with pre-existing conditions are protected.

Provide new subsidies for the uninsured to purchase the coverage of their choice.

Encourage the states to set up marketplaces for people to buy insurance and allow policies to be purchased across state lines.

Boost insurance rules to guarantee that if people have coverage, they can keep it and their premiums won’t skyrocket if they get sick, etc.

Move toward a system of tax credits and deductions to allow individuals to buy and own portable health insurance.

And regarding the “free-rider” problem Romney says that the Massachusetts law was designed to stop: This can be addressed without a mandate and in a way that is likely to be much more effective. For example, if people don’t buy coverage with the credit, then the credit could be used to automatically enroll them in a private plan that would cover their major medical bills. Properly structured incentives would be more effective than a mandate in expanding coverage.

The health reform plan Gov. Romney pushed in Massachusetts was different in key respects from the model that became Obamacare but few people know the truth about Romneycare.

Unless Gov. Romney takes steps to clarify and remedy his position, he will continue to have trouble convincing Republican voters he is serious about repeal and will have an even harder time mapping a clear plan on health reform should he be elected president.

I read all of this and see some good points, but it still comes down to leadership. We see that, as Governor, Romney tried to veto some really bad elements of the health care law, but what exactly did he do in the run up to this monstrosity? No where do I find an effort on Romney’s part to sell his ideas to the people of Massachusetts. No where do I see an effort to get the people on his side of the battle against the legislature. If there were town halls and citizen workshops, I’m not finding them.

Now look, as a Texan, I can’t fathom the sort of Big Government intrusion RomneyCare caused. I can’t understand a people who would allow their state government to take away their Liberty and Freedom, not to mention make their health care far more costly, with fewer services. But then again, this is a state whose voters keep sending radicals to their state house and to Washington. It’s a socialist state, so losing Liberty and Freedom might not concern them.

It might be, as portrayed, that Romney wanted to do the “right thing” but was unable to stop his runaway democrat legislature. But one has to ask, knowing who and what democrats are, why allow the situation that led to RomneyCare’s final product in the first place?

I understand that pressure from both inside the state and the federal government played a huge roll in RomneyCare’s birth, but wasn’t there a far better, market based solution? Wasn’t there a way to reform the process and keep government involvement to a minimum? Wouldn’t a real leader have done more to get his plan enacted over one that is now in place? Wouldn’t a real leader side stepped the legislature and the media, and gone directly to the people?

It’s obvious that Romney isn’t totally to blame for the huge mess in Massachusetts, but it’s just as obvious that he didn’t put forth nearly the effort he should have to get his own vision put in place over the one that now exists.

So here’s the deal. Has Romney learned his lesson? Does he now understand that you can’t give the left an inch, that there really is no dealing in good faith with them? Has he come to realize what a huge mistake he made?

Those are questions that must be answered.



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8 responses to “So RomneyCare was all Bush’s Fault? The Galen Institute on What Went Wrong

  1. Mike

    I’d be curious to hear from the right where does the health care “market” actually work? Is there a major economy anywhere in the world you’d want to live where government mandates in health care don’t play a role? Places where you see either a mandate to buy insurance (like Singapore or Switzerland) or a full government owned and run system (like Scandinavia, or the UK) all have good health outcomes. The US has a patchwork of gold coins and chewing gum and duct tape as a “system” and tends toward the bottom of the rich world in outcomes.

    Do the “free marketeers” have someplace where the main transportation system isn’t either donkies or 1979 land rovers to point to as an example?

    When it comes down to it, anywhere on American soil, you will get subsidized treatment for a serious injury, illness or accident. And you will get health insurance coverage by virtue of age, poverty, military service, etc. Even while saying how awful and oppressive government health care is, you can still suck of the teet of big government. The right loves to privatize profits and subsidize losses (look at the blue state subsidies for the red states for an example.)

    There is a particularly ironic story regarding the Supreme Court case plaintiff fighting the individual mandates (Mary Brown of Florida) who went bankrupt in part because of medical bills. In my personal life, a Republican in-law of mine…… her 20 something year old daughter was struck in a hit-and-run and had no insurance. My Republican in law never questioned or conceded the help of the county to the tune of over $100,000 to save her life and make her as better as she could be post accident.

    Keep criticizing….. just feel the “freedom” that comes from knowing that the government will be there if you really need it.

    • Gary P Jackson

      Here in Texas we have OUTSTANDING health care. I’m not a rich guy by any standard, and had a heart attack earlier this month. I was taken directly to the hospital, and had not one doctor, not two doctors, but a TEAM of highly skilled doctors who looked over me night and day. After a round of tests, I had a stent put in and was out of the hospital, a new man.

      The hospital was CLEAN and I had around the clock service by the nursing staff.

      In countries that have government run, socialized medicine, none of this would have ever happened.

      For one, I would have been placed on a waiting list for the actual surgery. It could have been months. In fact, it could have been hours, not minutes, before I was even attended to in the emergency room.

      In England, one of the nations you mention, they have rules that say a patient must be seen in a certain amount of time, once they enter the ER. They are not equipped to handle those time lines, so they simply leave patients in ambulances for hours at a time, only accepting them, and starting treatment when they can.

      Also, the hospitals are filthy. There is no money to pay for basic things like round-the-clock janitorial services. And there aren’t enough nurses to provide even the most basic of care. Patients have been left to die of thirst, because no one cared.

      Socialized medicine is one of the greatest evils ever placed on humanity. Not only does it provide 3rd world type care, if that, it destroys Liberty and Freedom. It’s pure evil.

      So how did Texas fix things? Tort reform. Texas used to be the malpractice insurance capital of the country. Every degenerate ambulance chaser in the country had set up law offices here. Our legislature passed legislation that limited liability, and stopped nuisance lawsuits.

      We’ve had over 9000 doctors migrate to Texas. No longer are doctors forced to order meaningless, and costly tests, just to cover their butts in case there is a problem. In Texas doctors only need worry about treating their patients.

      You’ve obviously never met anyone who has actually been forced to use socialized medicine. They will tell you it sucks.

      The free markets works. The problem is, too many fools try to meddle with it.

      • Mike

        Gary P Jackson wrote: “In countries that have government run, socialized medicine, none of this would have ever happened.”

        Gary, I’m assuming you refer to “everybody else” as having “socialized medicine?” You know that the US consistently ranks poorly on all sorts of measures regarding health outcomes right? The US scores poorly (by first world standards) from infant mortality to life expectancy. And we manage to spend far more than most anybody else for such poor results.

        You wrote: “You’ve obviously never met anyone who has actually been forced to use socialized medicine.” Again I’m assuming you like many on the right just throw out the term socialism at anything any government touches in any way. But if you mean countries like central and northern Europe, you’d be hard pressed to find anybody there that wants what you have in Texas. My only personal experience is with Germany, and what little I’d seen seemed favorable compared to what I’ve seen here in the US. At about half the cost. We happened to stay with some doctor students in Germany at one point, and it was funny to hear them kvetsch about having to make house calls! I was surprised to learn that under some circumstances doctors in Germany were required to make house calls, try getting service like that here.

        Correct me if I’m wrong, but can you point to any study or poll that shows a rich democratic country that wants a “system” modeled after the US? I don’t think such a place exists.

        Even private vrs public in the US isn’t a clearly better one way or the other. My dad gets real “socialized medicine” courtesy of our tax money (Veterans Administration.) My stepmom gets private Kaiser insurance. My dad was telling me how much better he liked the VA. My mom and my stepdad had Kaiser, and used to have to drive about an hour for non emergency care, even though there were a number of hospitals minutes away, just not in the network. They now get “socialized medicine” in the form of Medicare. Last time my mom had to stay in hospital under medicare, I was really impressed with how much nicer their local hospital seemed than Kaiser.

        I am glad to hear that you fared well after your heart attack!

      • Gary P Jackson

        Are you serious? Veterans benefits are no more “socialized medicine” than is a trip to the local diner. Veteran’s benefits are no different than any other employer-retiree plan. The only difference is the federal government is the employer.

        It’s obvious you are completely and totally clueless.

        We have a minimum standard of intelligence that we require of commenters, and you have failed to meet this standard.

        I detest seminar and cut and paste posters. Tire old communist talking points just don’t fly in the real world.

        Canada is another nation with socialized medicine. Because of their useless system, there is a booming health “vacation” business, where Canadians come to America for treatment they either can’t get, or must wait too long for, in Canada. Of course, only those with disposable income can do this. Those without a lot of money become statistics instead.

        America has the best, most available health care in the world. Is it perfect, no. But it’s better than the system the left is trying to shove down our throats now.

        Maybe instead of wasting our readers time, you take a trip to England or Canada, and check out their “health care” system.

      • Mike

        I assume that you realize I’m right, and will just keep my posts hidden but here’s another thought for you:

        you wrote: Socialized medicine is one of the greatest evils ever placed on humanity. Not only does it provide 3rd world type care, if that, it destroys Liberty and Freedom. It’s pure evil.

        Why are our closest allies all living under the tyranny of “socialized medicine”? Canada, UK, Germany, Japan, Australia, Israel, all have universal health care systems of one sort or another. Maybe we should get rid of our first world friends and get some African friends: not much socialized medicine there 😉

        And why should our veterans be getting socialized medicine? Shouldn’t we let them fend for themselves in the private sector and not interfere? From your perspective, veterans should not be forced into shabby government buildings and forced to see bureaucrat doctors assigned by the federal government. They can use Kaiser, or Blue Cross, or any other private insurer.

        Same goes for politicians. Ronald Reagan should have gone to a private practice instead of Bethesda Naval Hospital for surgery. Nancy had surgery there too. But oddly enough, I don’t recall any controversy about getting care from a government run tax funded institution. But the right has more than its fair share of hypocrisy!

        If you’re afraid of facts, don’t answer 😉

      • Gary P Jackson

        You really are as ignorant as it comes.

        Again, benefits such as medical care to our troops, is NOT socialized medicine. It’s no different than any employer-employee medical plan. Just because the employer is the federal government doesn’t change this important distinction.

        As for the rest, I stand by my comments. I’ve reported on patients in both the UK and Canada who were left to die because of piss poor care. Ever reported on a couple, the girl was in college, who had their baby taken away from them by the NHS, because some bureaucrat thought the girl too stupid to have a child.

        Worried About Death Panels? How about Marriage Panels!

        When you allow the government to take over health care, you sacrifice far too many essential God given rights. You sacrifice Liberty and Freedom for sub-par health care.

        Past that, IF the mandate is upheld, it means the government has unlimited power and can force you to do anything. It can force you to buy a car, and not just any car, but the one government deems you should have. It could also force you to buy a gun and be trained to use it. It could force you into literally any situation. THAT is what the fight is all about. Personal Liberty and Freedom, what this nation was founded on.

        We can absolutely make health care better, but the European socialist model is a total failure. The Canadian system is even worse. Government has never made anything better.

        I suggest you go back to your handlers at the Obama campaign and ask them for better talking points, because frankly, the ones they gave you don’t pass the laugh test.

      • Mike

        So the government can own and operate hospitals and that’s not “socialized”? How so? Are you just going to repeat no over and over again and offer no proof? Please define “socialism”.

        Why aren’t the UK, France, Canada, NL, Norway, Israel, etc begging to get rid of universal care? Do they not have the internet there and are thus unable to get out their opinions. Is their press so repressive there aren’t news stories showing the picketing sick Dutch begging for a US style “system?” I’ve heard criticisms, but I’ve never heard of ANY democracy that had universal healthcare that had a significant percentage of the population that wanted to go back. Show us a poll.

        And again if care in those countries is sub par, why do they LIVE LONGER on average?! When the right takes on teachers unions, you all want to see results go up on tests. But not with health? Why not? Do results not matter?

        You say that if the mandate is upheld the government can force you to buy a car. But there a number of other countries that have mandates for health care, can you point to one that requires you to buy a car? The mandate idea has been around in practice for over a century now.

        Ironic that you should mention being forced to buy a gun, because that is the only historic example of an individual mandate to purchase a private product (Militia Acts of 1792.) Of course what those of us on the left want is closer to what is really “socialized” medicine. We don’t want an individual mandate (that was a republican/heritage foundation idea.) We want a Veterans Health system expanded for the entire population paid for with income tax dollars. “Obamacare” (or at least the individual mandate) was a compromise that he got from you all.

        If my comments don’t pass the laugh test, please counter them with facts.

      • Gary P Jackson

        Actually the UK is trying to end the NHS because it is a complete and total failure. The quality of health care is dismal.

        Again, your ignorance is showing when you talk about veterans care. Seriously, think out what you are saying and you’ll see just how ignorant it sounds. Remember, the brave men and women who serve in the military are OUR employees, so yeah, we, as their employers contribute to their health care.

        As for that Heritage Foundation talking point, I suspect you’ve never actually read the report, just the talking points handed to you by democrat operatives. I suggest you actually read what Heritage was trying to do.

        You obviously don’t understand the end game of the democrat party, and the totalitarians who populate it. We already have democrats banning certain foods (Bloomberg, NYC) and a nation ban on light bulbs. Democrats want to rule every faction of one’s life. They do not believe in personal Liberty and Freedom. Just the collective.

        Yes, it it conceivable that democrats, if allowed to remain in power, could mandate what kind of automobile you must buy. They may not force you to buy a car at all, but they can set specifications that only allow what they deem fit. In fact, they are already doing that to some extent.

        Since you have nothing but stale democrat talking points, I suggest you find a more suitable venue to share them. May I suggest The Daily Kos or the Huffington Post? You’ll find the sort of mal-adjusted, ill-informed audience that will be receptive to your ramblings.

        In 1961 Ronald Reagan spoke to the dangers of socialized medicine. Everything he said is true. BTW, all of those nations you cite as being so great, none of their citizens enjoy the Liberty and Freedom we do as Americans. The citizens of those nations don’t enjoy the prosperity our citizens do either.

        In fact, many of those nations are on the verge of fiscal collapse because of their entitlements, like “free” health care.

        Wise up.

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