Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
Much thanks to Peter for playing devil's advocate (that is, my advocate) vis-a-vis Romney on last week's podcast with Mark Levin. But there's one point that Peter, Mark, and most at Ricochet, I believe, are not quite getting.
First, understand that the Republicans' current mantra of "Repeal and Replace" is misguided -- not the "Repeal" part; the "Replace" part. The Republican Party is in desperate need of humility on the subject of non-Medicare healthcare reform. We have precious few immediate or workable solutions to the problems of price, the uninsured, free-loaders, pre-existing conditions, and so on. (There's a reason a smart guy like Gingrich supported the individual mandate until the day before yesterday.)
Yet with this promise of "replace", Republicans are unwisely promoting an expectation that we'll pass some nifty "big ideas" of our own to replace Obama's bad "big ideas". That's a problem, since we've got stinkers, too. For instance, among the House's "conservative" solutions to the pre-existing conditions problem is a federally funded, irresponsibility-subsidizing scheme of "high risk pools" (info here, if you dare), a plan which is as unworkable as it is likely to grow and metastasize. Yep, our current predicament is that even in the event Obamacare is repealed, Mark Levin will still get his convoluted healthcare Leviathan, but it'll come from Republicans -- with a little bipartisanship thrown in to make it stick.
There's only one way out of this fix: Republicans must undo that pathological manner of thinking among Americans that has them looking to Washington for solutions -- particularly on matters as complex and varied and frustrating as healthcare.
Which brings us to Romney, that infuriating rascal I'm tasked with defending. (We all have our roles.) There's a bogus charge around here that "Romneycare gave us Obamacare". No so. In fact, the opposite is true: Romneycare nearly saved us from Obamacare. Recall the Scott Brown election. Brown voted for Romneycare as a state senator, then won the Kennedy seat by promising to vote against Obamacare. So contrary to conservative lore, the near salvation of the Brown election was not a rejection of the individual mandate or some other aspect of Obamacare -- save one: the national aspect of it. That's right. Gov. Romney convinced liberal Massachusetts (!) that it should stop looking to D.C. Cue the Hallelujah Chorus.
This is not to say Romneycare will "work" ("work" being defined differently by the people of Massachusetts than by the people of Texas, which is as it should be). Likely it won't now that Democrats have expanded the mandate way beyond its intended scope of catastrophic-care-only coverage -- which has increased prices, which will increase subsidies, and away they go. And maybe even in a pristine form (as, say, Gingrich supported for a decade or two) Romneycare would fail. In any case, it's a Massachusetts problem, not mine, and such are the pitfalls of state-level experimentation. Ah, federalism.
Further, this is not to say there's nothing useful for Republicans to do in Washington post-repeal. We can pass a few laws to help our states find answers: e.g., block granting Medicaid and eliminating both the subsidy for employer-provided health insurance and the restrictions on interstate insurance markets. Then our 50 states can muddle toward solutions -- in a frustrating, imperfect, trial-and-error sort of way ; i.e., the only way possible. (A suggestion: encourage HSA's.) But such modest federal action will be politically acceptable only if we manage to turn the gaze of Americans away from Washington and toward their state capitals.
That last part is not so easy to do, but we know it's possible: For all his faults, Gov. Romney did it.
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Comments:
Feb '12
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
I would quibble here. Its not up to Republicans or elected officials to convince Americans that big government doesn't have the answers. It must be a grassroots effort, and its the work of at least a generation, if not two. Political parties reflect cultural attitudes and desires, they don't shape them.
Tea partiers claim a grassroots movement which doesn't want politicians imposing their big government ideology using top-down solutions. In listening to why they support certain candidates, one hears them say that Candidate So-and-So will shrink government and stop Washington (and state capitols for that matter) from imposing government on everyone. The thing is, most people like and want government solutions. In promising to shrink government, TP candidates can rightly be seen as imposing a small government ideology using a top-down wrecking ball. That makes electing them difficult, and the ones that do make it have a tough time doing what they promise (cf. Walker, Scott; Kasich, John)
Education and persuasion needs to happen first. In the meantime, you win how you can, biding time and building a mandate for big change.
Jul '11
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
I have one real solution that could dramatically lower costs through competition. Eliminate the state run monopolies of insurance companies. Free market solutions should be instituted first if possible.
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
One reason Ted Kennedy was Mitt's "collaborator" in midwifing RomneyCare through the Massachusetts legislature was the senator's certain knowledge that the act would advance the very government-engineered "market failure" used to justify ever more government intervention in healthcare. Once the market "fails" entirely the government will be "forced" to introduce single-payer national health care.
Apr '11
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
Romney's big accomplishment is that he got liberals to vote for a big government health care program? Sorry, I'm not buying what he's selling. In fact, I'm tired of this whole rotten party. If these are the best arguments the Republicans can make then conservatives should start looking for a new party.
Jan '11
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
I'm not sure national politicians are capable -- for a variety of reasons -- of convincing 300 million Americans that national politics aren't the answer...
Dec '10
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
As late as the 1960's, health care was affordable without health insurance. Physicians had middle to upper middle class incomes, Internists and Surgeons typically had incomes in the mid $50,000 range, and, even extensive hospital stays could be paid from a middle class income. Then the Federal Government got involved with Medicare and the health care cost avalanche was started.
Jan '11
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
So...should we get rid of Medicare?
Mar '11
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
Scott - I suggest you call Dr Levin's radio show and tell him where he is going wrong...
Edited on February 7, 2012 at 11:52pmJul '11
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
I think George Savage hits the exact tactic Obama had in mind when his plan was created. Force a failing system in to a more rapid failure in to which the white knight of single payer rides in with rules and decrees to save us all from ourselves.
This process will wind up being 20- 25% of our GDP compared to the 8-12% of other countries socialized systems. It will also be inferior for a number of reasons.
Jul '11
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
The medical establishment routinely gave charity to the impoverished and elderly as well.
You are very correct that cost controls escalated costs considerably.
May '11
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
Scott, Question. What makes block grants so appealing? Are they not just a slightly different way for the Federal government to force states to do something they may not want to do? Block grants usually come with a medicine ball size roll of strings attached. Besides, block grants have the effect of forcing wealthier states to subsidize poorer states since they are usually based on population not on the state's tax base.
Think of block grants this way: "To whom much is given; much is expected."
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
Well Scott, since you're on defense, which presumably is where we and the presumptive nominee will reside for the duration, perhaps you can help with a claim that Obama will use ad infinitum, from the guy who helped craft Romneycare. From The Hill:
Dec '10
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
Medicare and third party payers definitely started this snow ball rolling. HSAs are the answer with catastrophic hospitalization policies as back up. Indigents or others who cannot afford coverage should seek care where they will likely find generous institutions and charities where all will feel more compelled to pitch in based on their own magnanimity, not being coerced by a despotic regime.
Then tort reform should also be part of all this.
Prices will come down.
Apr '11
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
Part of the frustrating thing about Levin's comments is that he specifically denied that Romney's plan was to return entitlements, like Medicaid, to the states. Levin said that this was the basis for his opposition (that we need to take steps towards the Constitution, specifically like that, and Romney didn't intend to). I got the impression, though, that this was because he was simply ignorant of Romney's healthcare platform rather than because he thought that Romney's long held desire to see Medicaid block granted was insincere.
He certainly made no arguments to support the claim that Romney did not intend to do precisely what he was saying must be done, at least not in terms of substance. He did say that defending Romneycare was a problem, because he suggested that Romneycare was in violation of the Federal Constitution, although the Constitutional mechanics for this belief were extremely unclear. Mollie noted the following day that no conservatives made this argument, by which I believe she meant that no one took it seriously (this was part of a criticism of Coulter for raising Levin's argument as a straw man).
Oct '10
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
Thanks Dave, you took the point right out of my mind. The Obama administration looked to Romneycare as they crafted Obamacare. I agree with you Scott that the repeal and replace mantra is flawed, but Romney doesn't even seem to be on board with repealing it. What's worse, he wanted the nation to look to Massachusetts as they formulated their own healthcare policies. Yes, the states can mandate it and the fed govt can't but when Romney doesn't even have an objection to the program on its substance then how can we be sure that he doesn't want people looking to Washington for solutions? He could have vetoed the bill as governor if he had philosophical objections to it, i.e., an aversion to big govt, but he has no such aversion.
Dec '11
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
Why cant we just make the case that you cant purchase immortality, and its a moral hazard to try with other people's money?
Apr '11
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
Pilli: Scott, Question. What makes block grants so appealing? Are they not just a slightly different way for the Federal government to force states to do something they may not want to do? Block grants usually come with a medicine ball size roll of strings attached. Besides, block grants have the effect of forcing wealthier states to subsidize poorer states since they are usually based on population not on the state's tax base.
Think of block grants this way: "To whom much is given; much is expected." · 11 minutes ago
It is true that a system of block grants is less good than the absence of a system. Abolishing medicaid would be a better policy, substantively. Since abolishing medicaid is almost certainly impossible, all we can do is maximize states' rights and minimize costs. Block grants achieve this, although the degree of freedom and minimized costs is obviously a question of the details.
Likewise, it will be a redistributive system, but no more so than the current one.
It's the most radical federalist and conservative policy in entitlements since the great Grover Cleveland. It could be yet more radical, but instead prepares those further steps future future reformers.
Jul '10
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
The notion that the Massachusettan rejection of ObamaCare was based on policy differences between their RomneyCare and ObamaCare is not entirely accurate. The mandate, the exchanges, the mix of policy offerings, the burst of controlling governmental panels are all there. The differences Romney cites are incidental to the core program. Even RomneyCare fans are in no way enthusiastic about paying for the reform twice. Or ObamaCare's half trillion cut in Medicare. Or the ham handed way the bill was passed. Or the suddenly glaring fact the Congresscritters no longer even pretend to know what's in the bills they vote for. Romney has to reach back four years to find poll results that shows Massachusettans to be largely satisfied with the law.
I absolutely share your skepticism concerning federal Republican directed health care market "reforms". Maintaining federal involvement through block grants perpetuates the K Street gamesmanship and pose of federal responsibility that landed us here to begin with.
RomneyCare took millions of private policy holders and priced them into Medicaid. Many others pay the fine rather than surrender their rights to the Medicaid trap.
Any solution that fails to reduce the Medicaid rolls is at best suspect.
Apr '11
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
This is sort of like arguing "Communism may not be right for West Germany, but it's a great system for East Germany".
Which is to say, completely wrong and illiberal. Socialism is wrong, even for states like Massachusetts where a majority of the voters are deluded enough to want it.
Apr '11
Re: Romney's Not-So-Modest Accomplishment - or - What Mark Levin Doesn't Get
a: Why do you claim he is not keen on repealing Obamacare? He ran against federal healthcare in 1994, as governor, in his book, in 2008, and endlessly this cycle. He repeatedly tells us how, and why.
b: Important differences Romney fought for include HSAs (unsuccessfully) and conscience (mostly successfully).
c: Romney did veto chunks of it, which vetoes were easily overridden.
d: Supporting one big government program doesn't make you a fan of big government. Reagan, for instance, launched the largest pre-Obamacare expansion of medicare in 1988.