One big happy future family: Romneycare, Obamacare, Ryancare

On a second read of the Medicare reform plan outlined in Paul Ryan's 2013 budget, I was whipsawed by crosscurrents of irony.

I was going to lambaste the plan for its touching faith in the Competition Fairy, believed to shower her low cost/high quality beneficence on private insurance plans competing in a government-run and -financed marketplace. Then it occurred to me that the ode I was reading was virtually identical to the praises sung by Democrats for the prospective healthcare exchanges to be established by the Affordable Care Act. Indeed, the ode may have been composed in large part by a Democrat -- Ron Wyden, who coauthored a proposal with Ryan in December 2011 that Ryan's more recent plan resembles more than it departs from (notwithstanding important differences).  Here's part of the opening movement  of Ryan's Song -- emphasis (and repetition) in the original:

Reset to Massachusetts moderate: Romney fondly recalls Bill Clinton

The GOP may finally be getting a little tired of embracing Ronald Reagan's corpse. This election season, Bill Clinton is becoming their icon.

Throughout the debates, Gingrich bragged repeatedly of balancing budgets and creating jobs "with President Clinton."  You'd have thought Gingrich was Clinton's veep.

Now Mitt Romney's latest chosen trope for painting Obama as an old-line liberal is a faux contrast with that great small-government Democrat...Bill Clinton.  In Lansing, Michigan today, this is how Romney cast Obama as a pre-Reagan Democrat:

President Obama chose to apply liberal ideas of the past to a 21st century America.  Liberal policies didn’t work then, they haven’t worked over the last four years, and they won’t work in the future. New Democrats had abandoned those policies, but President Obama resurrected them, with predictable results.

Hey, Romneycare may get a 'death panel'

Not really. But legislation is afoot to create an IPAB (Independent Payment Advisory Board) on steroids -- Trenbolone to the ACA's Creatine. The WSJ's Jennifer Levitz and Anna Matthews report:

Key state legislative leaders unveiled a bill Friday that proposes setting a target for the rate at which overall health spending should rise—a step that would once again put the state in the forefront of efforts to remake the American health-care system...

Romney keeps hacking at Obamacare's shadow limb

Jonathan Chait has helped me understand Romney's signature lie about Obamacare, repeated throughout the debates. The lie completes a false contrast: while Romneycare is a private, market-based solution, Obamacare is a government takeover. Here's the Jan. 26 iteration:

I didn’t say I’m in favor of top- down government-run health care, 92 percent of the people in my state had insurance before our plan went in place. And nothing changes for them. They own the same private insurance they had before.

And for the 8 percent of people who didn’t have insurance, we said to them, if you can afford insurance, buy it yourself, any one of the plans out there, you can choose any plan. There’s no government plan....


I don’t like the Obama plan... He wasn’t interested in the 8 percent of the people that were uninsured. He was concerned about the 100 percent of the people of the country.  “Obama-care” takes over health care for the American people.

For months I've wondered out of what slender thread of reality Romney spun the lie that the ACA "takes over health care" in a way that the Massachusetts coverage plan does not. The best I could come up with was the Independent Payment  Advisory Board, which can recommend reimbursement reductions in Medicare -- with an overlay of the death panel hysteria that Bachmann, Palin et al imposed on that modest instrument of cost control. He could also be referring to national standards for health plan coverage -- but Romneycare imposes such standards too, and in any case, HHS has largely empowered the states to set them.

Now I know what Romney has been swinging at with this "government takeover" bludgeon. It's the ACA's shadow limb: the public option.

Romney's blueprint for Obamacare, July 2009

Thanks to Andrew Kaczynski for unearthing a Mitt Romney op-ed, dated July 30, 2009, exhorting Obama to follow Romney's Massachusetts blueprint in crafting a national healthcare reform bill.

Kaczynski tweets that in this op-ed Romney urged Obama to adopt the individual mandate (unlike in a 2006 WSJ op-ed, where Romney took federalist cover, urging states to follow his lead) . More or less -- though in characteristic fashion Romney left himself a tortured loophole:

Using tax penalties, as we did, or tax credits, as others have proposed, encourages “free riders” to take responsibility for themselves rather than pass their medical costs on to others.

I can just hear him now: "I did not say that the federal government should impose a mandate." Barely true. Nevertheless, the piece is rife with ironies. Hectoring an implicitly clueless and venal student-executive, Romney urges Obama to

take his time:

Shortly after becoming governor, I worked in a bipartisan fashion with Democrats to insure all our citizens. It took almost two years to find a solution. 

drop the public option:

Massachusetts also proved that you don’t need government insurance. Our citizens purchase private, free-market medical insurance. There is no “public option.” With more than 1,300 health insurance companies, a federal government insurance company isn’t necessary...To find common ground with skeptical Republicans and conservative Democrats, the president will have to jettison left-wing ideology for practicality and dump the public option.

In Mesa, Santorum completes his demolition of Romney's false Romneycare/Obamacare contrast

One GOP debate story has unfolded in installments. Over the course of several debates this year, Santorum has serially picked apart Romney's faux contrast between Romneycare and Obamacare. He hammered home one more key point last night, in Mesa AZ.

In the fall debates, Romney's rivals couldn't or wouldn't do this. Pawlenty famously chickened out. Perry tried, but he was apparently too ignorant of the core elements of each plan to drive home the fundamental similarities.   Santorum perhaps didn't have enough air time when there were eight on the stage and he was out on the wings

But since his strong showing in Iowa it's been different. On January 19 in South Carolina, he started in on Romney's insistence that while he created a free private insurance exchange in MA, the ACA imposes government-run healthcare -- never mind that the subsidized exchanges created by the ACA are essentially identical to the Massachusetts system. Santorum insisted on the equation:

92% of people in Massachusetts had health insurance, and Romneycare just expanded that to be full subsidized by the state of Massachusetts. Romneycare did not create a marketplace. It is a very prescriptive program. He is arguing for and defending a plan that is top down. It is prescriptive in government and was the basis of Obamacare.

 On January 26 in Florida, Santorum zeroed in on the individual mandate:

Cook little pot, cook!

Don't wake me...if you'd told me two months ago that the Republican presidential candidates would be tearing Mitt Romney apart like this, I would have dismissed it as wishful thinking. A Rolling Thunder Review of early primary season:

You have to live in a world of Swiss bank accounts and Cayman Island accounts and making $20 million for no work, to have some fantasy [Romney's immigration policy] this far from reality” (Gingrich, 1/25).

When Mitt Romney invented government-run healthcare, Romney advisers helped Barack Obama write the disastrous Obamacare...Romneycare sent premiums spiraling out of control, hiking premiums, squeezing household budgets...Now, desperate to save his failing campaign, Romney promises to repeal Obamacare. How can we trust him? Think you know Mitt? Think again. (Winning Our Future, ad, now running).

Question for Republicans

Okay, so now we know that not only did Romney consider his Massachusetts health insurance plan a national model, Gingrich* enthusiastically embraced it as a plan "tremendous potential to effect major change in the American health system," asserting that 100% of Americans should have health insurance and implying that the individual mandate was a linchpin to reaching that goal (I don't consider his spokesman's plaint that Newt didn't write the "Newt Notes" in question worth bothering about). As Ezra Klein reminds us, Obamacare is essentially a Republican scheme for delivering near-universal coverage: "insofar as the Republican Party had a plan for health-care reform, the individual mandate was it."

A question, then, for Republicans: When Romney's healthcare plan was news -- from, say, April 2006, when Romney signed his plan into law, until February 2007, when John Edwards came out with a national plan embracing the individual mandate -- was there any prominent Republican or conservative who went on record saying that Romneycare was an interesting and promising experiment, but that a similarly structured national plan would be inappropriate or unworkable?  Did any mainstream Republican or conservative suggest that an individual mandate imposed by the federal government would violate the U.S. Constitution?

*I don't consider the plaint by Newt's spokesman that Newt didn't write the "Newt Notes" in question any more exculpatory than Ron Paul's claim that he didn't know what was in the Ron Paul newsletters. If you're name's on it, and you disavow it, you're a self-confessed fraud.

UPDATE: I have found a libertarian critic of the individual mandate, writing in USA Today Magazine on July 1, 2006: Cato's Michael Tanner, a critic of "big government conservatism." Tanner argued that the individual mandate was unenforceable; that subsidized mandated insurance for individuals would be unpriceable; that minimum coverage standards would become a goody bag for providers of various health services; and that the individual mandate would lead to more government control of the healthcare system.  As prelude to his attack, Tanner noted that "proposals for an individual mandate have drawn a surprising degree of support from conservatives."

The best liar in the field

It is a fact universally acknowledged that Romney crushed the opposition in the last debate -- in fact in all the debates so far.  That's because he has facts and data at his fingertips, along with a bottomless willingness to twist them in support of current GOP nostrums. The others don't call him on his distortions, because they support the same policies he's advocating -- no new taxes, no bailouts, repeal Obamacare and Dodd-Frank, gut regulations.  And they don't call him out when he creates false contrasts between his own past actions and Obama's, because doing so would imply that there's some virtue in Obama's policies.

The upshot is that Romney is free to propose impossible unions of his past pragmatism -- compromising with Massachusetts Democrats, supporting the TARP bailouts, designing subsidized health insurance exchanges -- with his current extremist positions. Here's how three of those unions played out in the last debate.

Perry flubs a shot at Romney

In tonight's GOP presidential debate, Romney did a great job nailing Perry to the cross of his ridiculous pronouncements against Social Security -- it's unconstitutional, it's a ponzi scheme etc.-- and his recent attempts to unsay them. Unfortunately, when Perry had a chance to turn the tables, and highlight the disconnect between Romney's defense of Romneycare and denunciations of Obamacare, he flubbed it.

I forget the question, but Romney managed to say  in one extended breath that Romneycare was great because "nothing's changed" for the 92% of Massachusetts people who already had coverage, while the uninsured were given a choice among "market-based private insurance" plans. Of course, the same is true of Obamacare. He then cast Obamacare as an abomination because it "puts someone between you and your doctor." In a clearing stands a boxer...lie lie lie, as Romney did every time he said anything about Obama.  While the ACA empowers an independent board to cut Medicare costs on a national level, it puts absolutely no one between doctor and patient in any plan.  In any case, Perry's opportunity was to point out that everything Romney said in praise of the Massachusetts plan was true of the ACA -- and then rip both.