Jeff Gelles: Mitt Romney continues his strange health-care dance

Mitt Romney interviewed by NBC's Brian Williams. "Don't forget, I got everybody in my state insured," the Massachusetts ex-governor said.
Mitt Romney interviewed by NBC's Brian Williams. "Don't forget, I got everybody in my state insured," the Massachusetts ex-governor said. (EVAN VUCCI / AP)
Posted: October 01, 2012

I've always known I was lucky to have health insurance - unlike close to 1 in 6 Americans - but last week again made that clear. After Mitt Romney's recent comments on that topic, I'm thinking I may need treatment for vertigo.

Consider the dizzying distance the GOP nominee traveled in three days. On 60 Minutes, he echoed George W. Bush's what-me-worry line that Americans can always go to the emergency room. "If someone has a heart attack, they don't sit in their apartment and die," Romney said. "We pick them up in an ambulance, and take them to the hospital, and give them care."

Romney then acknowledged that Massachusetts provides such care through a plan he helped enact - a mix of mandates and subsidies, also known as Romneycare, that became the model for 2010's Affordable Care Act. "But I wouldn't take what we did in Massachusetts and say to Texas, 'You've got to take the Massachusetts model,' " he added.

Yet three days later, he was touting Romneycare as evidence of his compassion.

"Don't forget, I got everybody in my state insured," he told NBC. "A hundred percent of the kids in our state have health insurance. I don't think there's anything that shows more empathy and care about the people of this country than that kind of record."

This time, Romney apparently was trying to refute the idea that he somehow doesn't care about "the 47 percent" of the country - the ones he cast as unreachable Obama supporters four months ago. On that now-viral video, Romney disparaged them as people "who believe that they are entitled to health care, to food, to housing, to you name it."

There's a connection between all these dots, but it doesn't make for a pretty picture.

The sad truth is that constructive health-care reform could have been Mitt Romney's route to reaching a moderate majority of the electorate - if he hadn't instead taken a ride on the Tea Party Limited. Now, he seems almost schizophrenic on the topic - heralding his Massachusetts health-care reform while promising to repeal Obamacare, its national doppelganger, if he wins.

To prove he was on board, he even picked U.S. Rep. Paul Ryan as his running mate - an Ayn Rand enthusiast whose main claim to fame is his insistence that, to balance the budget, Americans under age 55 will have to accept a partly privatized version of Medicare rather than the guarantee of old-age coverage we've had for nearly 50 years.

And Romney wants to dump Medicaid onto the states through block grants, a proposal that will leave the elderly nowhere to turn if Medicare vouchers prove inadequate, since a large fraction of Medicaid goes to nursing-home care.

At the same time, Romney also is proposing tax deductions for the purchase of private insurance - at least for those who qualify and can afford to buy it.

Whether Romney wants to acknowledge it or not, that's a lot less likely without such key provisions of Obamacare - and Romneycare - as premium subsidies, access for people with pre-existing conditions, and community rating. And without the law's bar on annual and lifetime coverage caps, many policies would offer less protection to those who could buy them.

Ironically, the Republicans' single-minded determination to repeal Obamacare makes November's election crucial to anyone who cares about covering America's uninsured - a group that once included Republicans like Mitt Romney.

Romneycare cut the uninsured population in Massachusetts by two-thirds to a best-in-nation 3.4 percent, according to a new report by Families USA. But elsewhere in the country, that now seems to be a population Romney is determined to see grow rather than shrink.

Romney "is really stuck trying to get out of the box he's in," said Jonathan Gruber, an M.I.T. economist who helped design both the Massachusetts and national health-care plans.

"He wanted to get this problem solved, he was pragmatic about how to solve it, and he was excited to do so," Gruber recalled Friday. Now, Gruber said, Romney is forced to distance himself from something that's a key part of his record, that has popular features, and that Gruber believes Romney "actually is proud of."

Politics aside, Gruber suggested that Romney has forgotten some basic facts that led him to champion the Massachusetts plan as a potential national model: a middle-of-the-road alternative to single-payer proposals that liberals have long preferred, such as "Medicare-for-all."

Three numbers are enough tell the story. Last year's median U.S. household income was $50,045. The average cost of family coverage through an employer-sponsored plan was more than $15,000, according to the Kaiser Family Foundation. And an average employee shouldered more than $4,000 of the premium - before other out-of-pocket costs. In other words, for at least half of American households, quality health insurance is close to unaffordable.

The basic problem is that we have a health-care system that costs more than any other country's while providing uneven care, especially to those whose only access is the ER. And it's not just Medicare that's a problem. Private insurers are no better at controlling costs. Extend the graphs beyond a few years, and the whole sector seems unsustainable.

President Obama's plan represents a start at "bending the cost curve" through features such as pilot projects that seek to shift incentives to providers, rewarding them for providing better care rather than just more care. In the long run, rising costs are a problem we plainly need to solve.

But right now, we have an affordability and access problem for tens of millions of Americans who don't get coverage through work and can't afford the market price, especially without the Obamacare reforms.

The hard truth is that we live in an era when capital is highly mobile - manufacturers can move jobs to low-wage workers in China and investors can shift funds to such tax havens as the Cayman Islands - and labor isn't, so we're mostly stuck with vast disparities in income and wealth. A modestly progressive tax system helps at the margins, but that's about it.

One thing we can do, however, is accept that health care is a necessity of modern life, and help make sure everyone can afford it without relying on the ER or facing bankruptcy in the event of a catastrophic injury or chronic illness.

That's what Obama and the Democrats decided to do, to their credit. And it's what Romney once knew but seems to have strangely forgotten.


Contact Jeff Gelles at 215-854-2776 or jgelles@phillynews.com.

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