April 9, 2010
Mitt Romney on Health Care: A Particular Spin
By KEVIN SACK
BEDFORD, N.H. — When it comes to health care, Mitt Romney is hoping to have it both ways, even as he accuses the White House of doing the same.
In the weeks since President Obama and the Democratic Congress enacted their health care overhaul, Mr. Romney, the once and presumably future candidate for the Republican presidential nomination, has confronted an issue that is alternately viewed as a strength and a vulnerability.
As he promotes himself as a problem-solving pragmatist, Mr. Romney can justifiably point to the landmark universal coverage law in Massachusetts that he, as governor, proposed in 2006. But as he appeals to conservative activists and Republican primary voters, he is trying to draw nuanced distinctions between his Massachusetts law and the federal legislation that shares many of its fundamental elements, including a requirement that people have insurance.
The core of his argument is a federalist assertion that the new law usurps powers that properly reside with the states.
“Whether you like what we did or think it stinks to high heaven,” he said of the Massachusetts plan in a speech here on Thursday, “the point is we solved it at our level.”
He then compared the two plans: “I like the things that are similar, I don’t like the things that are different, and that’s why I vehemently oppose Obamacare.”
Whether Mr. Romney can sell that formulation in a black-or-white political culture may become one of the compelling questions of the 2012 campaign.
He is already under assault from conservative writers and potential Republican rivals like Gov. Tim Pawlenty of Minnesota. The Democrats, meanwhile, are working to make the topic as uncomfortable as possible for him.
The Democratic National Committee has posted a video compilation of Mr. Romney’s comments praising the Massachusetts health insurance mandate. Twice last week, Mr. Obama pointedly observed that Mr. Romney seemed to be lambasting a federal plan that was derivative of his own Massachusetts model.
“I keep on scratching my head,” Mr. Obama said at a fund-raising reception in Boston. “I say, ‘Boy, this Massachusetts thing, who designed that?’ ”
In response, Mr. Romney is reminding audiences that Mr. Obama has cast the Republicans as the “party of no,” devoid of ideas. “And yet,” Mr. Romney said in Bedford, “he’s saying that I was the guy that came up with the idea for what he did. He can’t have it both ways.”
He added, “If ever again somewhere down the road I would be debating him, I would be happy to take credit for his accomplishment.”
Mr. Romney, 63, is more than halfway through a three-month, 42-stop tour to promote his best-selling manifesto, “No Apology: The Case for American Greatness.” All profits from the book, which calls for renewed muscularity in both domestic and foreign policy, will go to children’s charities, he said in an interview.
Although Mr. Romney said he would not decide whether to run until after the midterm elections, his tour has the trappings of a perpetual campaign. It included a visit to Iowa in late March as well as three stops this week in New Hampshire.
At a bookstore in Manchester on Wednesday, those seeking signed copies were given red-white-and-blue placards proclaiming “Mitt Romney: No Apology.” Volunteers wore T-shirts listing the book tour dates on the back, as if Mr. Romney were Bruce Springsteen. Aides collected contact information for Mr. Romney’s database.
When the House passed the health care bill last month, Mr. Romney came out swinging, calling the process “an unconscionable abuse of power.” On book tour stops, he has endorsed Republican Congressional candidates who support repealing the law, providing them with checks from his political action committee.
In his book, Mr. Romney cites the Massachusetts experience in identifying three necessary components for universal coverage. They are tax incentives for people to buy health insurance, sliding-scale premiums for those with low incomes, and exchanges that encourage competition in the insurance marketplace. All three are significant pieces of the new federal law.
He gives short shrift to the state’s insurance mandate, which like the federal law requires most residents to purchase coverage or pay a tax penalty. In the interview, he stressed that his initial proposal would have allowed residents to opt out of the requirement if they signed a bond demonstrating that they could cover their health costs. The Democratic-controlled Legislature did away with that provision, but Mr. Romney signed the measure anyway.
“The bill was a step forward,” he explained in the interview, noting that he vetoed some provisions that were then overridden. “It’s a far cry from perfect.”
At his appearances, Mr. Romney is almost always asked to compare the two laws. Aware that conservatives detest the federal legislation, he minces few words.
“It’s worse than New Coke or the Edsel,” he said Wednesday at Saint Anselm College, near Manchester. “Had they brought the federal bill to my desk when I was governor, I would have vetoed.”
One difference, he said, is that Massachusetts, unlike Washington, did not finance its plan with a tax increase. But Massachusetts officials acknowledge that they were able to make the numbers work only by gaining federal permission to redirect Medicaid dollars that compensated hospitals for treating the uninsured. Since Mr. Romney left office in 2007, the state has raised taxes to keep the program afloat during the recession.
Mr. Romney also pointed out that the national law would make heavy cuts in Medicare, although that is a purely federal program. He said it imposed price controls on insurance premiums, although it in fact only allows the government to review rate increases, not to reject them.
Another distinction is that the Massachusetts law made little effort to slow the growth of health costs. Those costs have escalated, Mr. Romney said, because state regulators have required residents to purchase policies that are far more generous than the catastrophic coverage he envisioned.
In his book, Mr. Romney writes that costs could be controlled by eliminating financial incentives for unnecessary treatment and instead paying doctors and hospitals an annual fee for caring for patients. That is also the approach being embraced by Mr. Romney’s successor, Gov. Deval L. Patrick, a Democrat.
At the book signing in Manchester, many Romney fans said they were satisfied with the distinctions he drew between the two plans. But David J. Citarelli, a financial consultant who voted for Mr. Romney in the 2008 Republican primary, said passage of the national law had focused his concerns about the insurance mandate.
“This time,” he said, “I’ll have to listen to what he has to say about why he wanted that to be part of the Massachusetts health care law. If you say it’s not O.K. for the federal government to do it, how can you say it’s O.K. for the states?”