At the risk of beating a dead horse, there are two other items from Ann Coulter’s pro-Romneycare column that require a response. Coulter contends, “What went wrong with Romneycare wasn’t a problem in the bill, but a problem in Massachusetts: Democrats.” We heard a version of this argument when Congress passed the Medicare prescription drug benefit under George W. Bush — the original Bush proposal was better than the final product. But in both cases, Bush and Romney decided to sign the finished product into law with great fanfare. They both accepted credit for the programs as major legislative accomplishments. You can’t take credit for these bills without accepting the blame too. In the case of Romneycare, while it is true that the Democrats pushed some details to the left, the basic architecture of the plan — mandates, subsidies, government-run exchanges, and expanded Medicaid — were all in the original proposal backed by the governor. The final product didn’t differ in kind from Romney’s proposal, though it did to some extent by degree. And Romney had already decided not to run for reelection, thus leaving the plan’s implementation totally up to Democrats. “Romney, incidentally, has always said his plan would be a bad idea nationally,” Coulter writes. But that’s not entirely clear from his repeated references to the Massachusetts plan as a national model. Romney also predicted , erroneously, that most states in the nation would end up with his mandate-driven approach. Jonathan Gruber, a liberal scholar who helped design both Romneycare and Obamacare, favored federal mandates. The Heritage scholars Coulter cites were originally supporters of the federal mandate. (Many of them have renounced their support; see this op-ed from the oft-Coulter-quoted Bob Moffit who called “operationally ineffective and legally defective.” The point here isn’t to vilify Coulter, a fine columnist, or even Romney. Romney should be defended from attacks from his left. The point is avoid consolidating liberal policy gains by a.) engaging in revisionist history to let our favorite Republican co-conspirators off the hook, b.) making arguments that will make the reversal of those gains much more difficult, and c.) turning serious constitutional and policy differences into partisan squabbling.
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Romneycare is the Democrats’ Fault
Ann Coulter has now written an unqualified defense of Romneycare. What she doesn’t appear to realize is how useful her column will be to defenders of Obamacare. She writes, “It’s not as if we had a beautifully functioning free market in health care until Gov. Mitt Romney came along and wrecked it by requiring that Massachusetts residents purchase their own health insurance.” Coulter points out that many conservatives and libertarians believed “mandatory private health insurance was considered the free-market alternative to the Democrats’ piecemeal socialization of the entire medical industry.” She argues that the Heritage Foundation and the Manhattan Institute were conservative think tanks that backed Romneycare. Every single on one of these arguments could be used for Obamacare. Obamacare is mandatory private health insurance purchased through exchanges with subsidies and expanded Medicaid thrown in. That is also the basic architecture of Romneycare. Obama will argue that his plan wasn’t a government takeover of health care because it’s “not as if we had a beautifully functioning free market in health care until President Barack Obama came along and wrecked it.” He can also point out that many libertarians and conservatives were desperate enough to support his approach when the Democrats were touting policies to its left. Coulter goes on to say that Romneycare passed by overwhelming majorities in both houses of the state legislature, including Scott Brown’s vote. But Brown was only one of a handful of Republicans in the legislature. Those overwhelming majorities were overwhelmingly Democratic. And when you look at the promiment photo of the Romneycare signing ceremony, you will see not the leaders of the Heritage Foundation and the Manhattan Institute beaming with Romney but the Democratic leaders of the state legislature and Teddy Kennedy. Continually dropping Bob Moffit’s name doesn’t alter this reality. Finally, Coulter defends the individual mandate on policy grounds. It’s no worse than other examples of government coercion, she says. The Constitution doesn’t create an unalienable right not to buy health insurance, she argues. The individual mandate is necessary to deal with the free rider problem created in part “the 1946 federal law essentially requiring hospitals to provide free medical services to all comers.” Coulter writes, “The hyperventilating over government-mandated health insurance confuses a legal argument with a policy objection,” even suggesting, messy constitutional issues aside, Obamacare wouldn’t be as big of a deal if all it did was require people to buy health insurance. Leave aside the facts that many of us do oppose the individual mandate on policy grounds as well as legal ones, and that the federal law she blames for the free rider problem passed in 1986, not 1946. Every one of these arguments can and will be used to defend Obamacare. And virtually every one of them is wrong, as concerns both Obamacare and Romneycare. The individual mandate is less about the free rider problem than making the ban on pre-existing conditions sustainable by forcing healthier individuals into the insurance market. The costs of expanding coverage in this fashion have far exceeded the costs of free riders. None of Coulter’s examples of government coercion involve forcing two private entities into a contract with one another. The Constitution doesn’t enumerate the rights of the people, but the powers of the federal government. Coulter’s entire argument hinges on Romneycare being constitutional and Obamacare being unconstitutional. I’ll let pass for a moment the problems with her apparent endorsement of untrammeled state government power and acknowledge, as I have before, that states have police powers that the Constitution doesn’t grant to the federal government. Obamacare raises a constitutional issue that Romneycare doesn’t. The number of people who will find this distinction compelling in a general election is vanishingly small. Worse, the swing vote on the Supreme Court doesn’t evaluate the constitutionality of laws based on the ratifying public’s original understanding of the Constitution (though the court should). A critical mass of justices will look to see whether the president and Congress were acting on a mainstream view of acceptable government power. Coulter has given them a list of examples to bolster this view. Defending Romneycare undermines the arguments against Obamacare by making them looking like partisan point-scoring.
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Romneycare Becomes Obamacare, Then Coultercare
Jennifer Rubin, the Washington Post ‘s resident Romney campaign mouthpiece, has been joined by another conservative pundit in the “I left my dignity at the altar of Mitt Romney” club. This time, as you may have heard, the offender is Ann Coulter, whose support for the former Massachusetts governor (and lack of publicity to date leading up to her CPAC appearance next week) has led her to offer – in print – a full-throated (albeit screechy) defense of the biggest piece of baggage Romney possesses: the Massachusetts Health Care Reform Act of 2006, or ‘Romneycare.’ Coulter’s column, titled “ THREE CHEERS FOR ROMNEYCARE! ” (yes, the title is all caps in the original), provides a defense of Romneycare that simply and completely ignores both conservative objections and the reasons why it has been a dismal failure as policy. For example, she drops the names of people and organizations that supported it at the time, despite the fact that such supporters were few and far between (opposition was much more commonplace), and that many of those supporters have since publicly changed their minds. An example of this is her declaration that “A leading conservative think tank, The Heritage Foundation, helped design Romneycare, and its health care analyst, Bob Moffit, flew to Boston for the bill signing.” Fine – but what Coulter ignores is the fact that Heritage has since repudiated the idea of an individual mandate at any level, writing in an amicus brief (pdf) filed in a challenge to Obamacare that “since [the passage and implementation of Obamacare], a growing body of research has provided a strong basis to conclude that any government insurance mandate is not only unnecessary, but is a bad policy option .” Where she does acknowledge the obvious issues with Romneycare, Coulter simply throws mud at “Democrats” for ruining Romney’s beautiful program. She writes: What went wrong with Romneycare wasn’t a problem in the bill, but a problem in Massachusetts: Democrats. First, the overwhelmingly Democratic legislature set the threshold for receiving a subsidy so that it included people making just below the median income in the United States, a policy known as “redistribution of income.” For more on this policy, see “Marx, Karl.” Then, liberals destroyed the group-rate, “no frills” private insurance plans allowed under Romneycare (i.e. the only kind of health insurance a normal person would want to buy, but which is banned in most states) by adding dozens of state mandates, including requiring insurers to cover chiropractors and in vitro fertilization — a policy known as “pandering to lobbyists.” Philip Klein has deals with this claim appropriately at the Examiner : This is more silliness. To start, Romney signed the health care law with a smiling Ted Kennedy at his side knowing that Democrats had the votes to override any symbolic line-item vetoes of certain provisions. Furthermore, when he signed the law, he had already announced he wasn’t seeking reelection as governor and knew that it would almost certainly fall on Democrats to implement the law. Part of being a limited government Republican is realizing that once you put the infrastructure in place, successors can always add to it. Regardless, what he actually signed was bad enough. Additionally, Coulter puts her derision for members of the conservative movement on full display by declaring that the only reason opposition to the law exists is because the nickname ‘Romneycare’ sounds like ‘Obamacare.’ Seriously. Of course, that’s not the issue at all – nor is the issue whether or not Romneycare is ‘constitutional’ according to the guiding documents of the United States or of the Commonwealth of Massachusetts, a straw man Coulter spends the remainder of her column arguing against. The problems with Romneycare are plenty without adding straw men to the list. Access to insurance has been increased (as have the penalties for not purchasing it). thanks in no small part to Massachusetts’ ability to stick the federal government and national taxpayers with a hefty portion of the program’s tab, but insurance is not care – a fact many casual participants in the health care debate conveniently ignore. The price of care and treatment has skyrocketed, causing the Office of the Attorney General to declare that government price controls (including the requirement that patients pay the difference out of pocket if they see a provider that charges more than the government-approved rate) must be implemented a quickly as possible to stem the rising tide. The Beacon Hill Institute found that , between Romneycare’s 2006 implementation and 2011: State health care expenditures have risen by $414 million over the period Private health insurance costs have risen by $4.311 billion over the period The federal government has spent an additional $2.418 billion on Medicaid for Massachusetts Over this period, Medicare expenditures increased by $1.426 billion Problems abound besides just these key points, but to understand them in their proper context, it’s important to address just what Romneycare’s three-pronged approach to dealing with the “problem” of the state’s uninsured population, which was relatively low at the time (about 550,000 according to state figures, and 657,000 according to the U.S. Census Bureau), consisted of. Some of the numbers below reference FY 2008 because a portion of this description comes from an analysis I wrote in 2009, when the program was being used as a blueprint for Obamacare. First, Romneycare expanded subsidies for low-income (below 300% of the federal poverty line) residents to obtain health insurance. While this sounds like a valuable benefit being provided to indigent Massachusetts residents, the funding for those subsidies was primarily pulled from the state’s so-called “free care pool,” which had provided medical and mental health services to poor Bay Staters at locations ranging from community clinics to emergency rooms, regardless of their insurance status. As an ironic result of this program, more poor residents had access to subsidized insurance, but fewer could afford care when faced with a deductible and coinsurance – meaning the amount the patient had to pay up front before insurance kicked in, and the percentage of treatment costs past the deductible that fall on the policyholder. The burden of paying for service the Health Care Reform Act placed on the state’s indigent population, combined with the draining of resources from facilities that had previously cared for the poor free of charge, left a larger number of poor Massachusetts residents without access to care than before the system was ostensibly “reformed” to help them gain more affordable access to care. Second, under the Health Care Reform Act, all businesses with over 11 employees located within Massachusetts were legally required to provide health coverage for their workers or face a fine of $295 per uninsured employee. Besides being a flagrant violation of the federal Employee Retirement Income Security Act (ERISA) – a federal law that, among other things, prevents states from mandating employer benefits – the employer mandate has failed to fulfill its primary purpose in the eyes of those who pushed for its inclusion in the bill: not enough employers opted to pay the fine (rather than offer health insurance to employees) to cover the portion of the program cost ($45 million) that proponents expected. In fact, by Spring of 2008, only $5 million had been collected from businesses that declined to offer coverage to their workers – an amount less than one-half of one percent of the $1.1 billion the program cost state taxpayers that year. The vast majority of the rest of that cost had to be covered by diverting funds from the “free care pool,” which, again, severely limited the indigent population’s access to care. Third, Romneycare included its famous individual mandate, making the failure to carry health insurance a violation of state law which that is punishable by a four-figure fine. That fine, collected along with state income tax, essentially operates as an onerous, regressive tax on the uninsured (despite the fact that those who actually file and pay income taxes are statistically the least at risk of being uninsured). The fine can be avoided if an uninsured individual can prove to the state that “no affordable coverage is available” – something that over 20% of the state’s total uninsured have successfully shown, despite promises that the Health Care Reform Act would bring the cost of insurance down to a level that would be affordable by all of the state’s residents. A new “independent agency,” called the Connector, was established by the state government to oversee the enactment of the employer and individual mandates and the implementation of health insurance subsidies for the indigent population. Along with monitoring compliance with those mandates, the Connector is responsible for determining what insurance policy each resident must enroll in, be they subsidized or paying full price, and for enforcing a rationing of care to those who qualify for subsidized coverage. Benefits for those who are below 300% of the poverty line (thus qualifying for subsidies) are limited by what the indigent individual is able to pay in terms of premium, deductible, and coinsurance, with those at the bottom of the income pyramid often qualifying for such severely restricted coverage that they would have been far better off remaining uninsured and continuing to receive care at facilities funded by the “free care pool.” While the establishment of an agency to study the relationship between the uninsured and high health care costs and to help those who qualify for state-administered health coverage programs choose the best fit for their circumstances is not a bad idea in principle – Pennsylvania’s Health Care Cost Containment Council is a good example of one that functions well – the Connector has simply become another regulator, on top of the existing Massachusetts Department of Insurance, that gums up the health care market with excess regulation and adds to the cost of health insurance through the surcharges added to premia in order to fund its continued operation. As with most government-related oversight boards, the Connector has been beset by requests from special-interest advocates, and it has had a very difficult time saying no to many of them. The result has been the imposition of onerous coverage mandates on the insurance policies state residents are now required by law to purchase. With four dozen coverages that are required to be included on every single policy sold within the state, from coverage for the services of nurse midwives to Mental Health Parity (an innocent-sounding mandate that requires mental health to be covered, dollar-for-dollar, to the same level as physical health), insurance premium and health care costs have skyrocketed under the Health Reform Act. Further, the addition of so many mandates actually caused nearly 200,000 previously insured Bay Staters to lose their coverage status because the prescription drug coverage in their private policies was no longer deemed “up to snuff” by the new gatekeeper of health insurance “quality” in Massachusetts. Massachusetts’s attempt at health care reform has increased the number of insured residents by 443,000 (covering about 66% of those who previously lacked insurance). However, the program has cost far more than predicted ($1.1 billion in FY 2008 and $1.3 billion in FY09), due in part to the fact that over half of those added to the rolls of the insured qualify for some form of subsidy. As the program was hemorrhaging cash in 2008, current Governor Deval Patrick (D) declared that it would be kept afloat at all costs, even though (quite ironically) the only way to continue funding it was to drain money from the public hospitals and community clinics that had already been providing care, under the free care pool, to those who were now appropriating that funding in the form of insurance subsidies. Further, the state’s redirecting of free care pool funding and imposition of caps on reimbursements for care has created an access problem by dramatically reducing the number of providers available to see and treat patients, regardless of whether those patients have insurance or not – a reinforcement of the fact that insurance, even when it is as universally prevalent as a government can make it, does not equal access to care. Far from reducing the cost of health insurance, Massachusetts’s individual mandate has driven costs up at twice the average national rate. This was entirely predictable; after all, what can possibly reduce downward pressure on a price more effectively than a legal requirement to purchase it, whatever the cost? According to the Connector, the least expensive price for an insurance policy for a 50 year old non-smoker in 2008 was $3,599 a year ($299.94 per month), with a $2,000 deductible. Next door in Connecticut, that price was just $1,468 a year ($122.36 per month, with a $2,500 deductible) – and Connecticut hadn’t even spent $1.3 billion on controlling and engineering their state’s health care marketplace! The biggest issue with Romneycare from the conservative perspective, though, is simply the massive expansion of government size, control, and intrusion that it represents. Constitutional or not, similar-sounding to ‘Obamacare’ or not, and effective at expanding insurance or not, the Massachusetts Health Care Reform Act is a law which requires individuals living in the Commonwealth to purchase a good or service, allows the state government to decide what an acceptable form of that good or service is and how it can be used, forces healthy individuals into costly high-risk pools to balance out risk and cost (thereby increasing price and severely limiting choice), and demands that residents of Massachusetts and the other 49 states pay an ever-increasing bill to sustain the ever-growing program. Whether or not you support Mitt Romney, the simple truth is that Romneycare is in no way a conservative program, and is in no way supportable by conservatives. Period. On a personal note, I’ve had little use for Ann Coulter for some time now. It’s been clear to me for years that Coulter’s only interest and commitment is herself and the publicity she can garner, not conservatism, the conservative movement, or the GOP. One of my RedState colleagues went so far a few years ago as to call her a “detestable harpy,” and while that may not be the most accurate choice of words to describe her, this latest “contribution” to the primary election discussion simply reinforces Coulter’s lack of direction, conviction, or compass outside of her personal gluttony for publicity.
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‘Three Cheers for Romneycare’
TAMPA — Mitt Romney scored an impressive victory in Tuesday’s Florida primary, winning by such a decisive margin that the networks called the race as soon as the polls closed. And his choice of this city as the site of his celebration was not accidental. ‘When we gather back here seven months from now here in Tampa for our convention, we will be a united party with a winning ticket for America,” the former Massachusetts governor said in his victory speech at the Convention Center downtown. Saying that Democrats believed the tough fight for the GOP nomination would leave Republicans “divided and weak,” Romney said, “A competitive primary does not divide us, it prepares us.” Romney’s appeals to party unity surely rang hollow to supporters of Newt Gingrich, who was on the receiving end of a weeklong barrage of attack ads from Romney’s campaign and the Florida winner’s so-called “super PAC,” Restore Our Future. Between the two entities, Team Romney spent something like $17 million on TV and radio ads in Florida, compared to about $5 million spent by Gingrich and the pro-Gingrich “super PAC,” Winning Our Future. The vast majority of the ads by both camps were of the attack variety, and media analyst Ken Goldstein pronounced it “the most negative campaign ever.” If Romney proved nothing else in Florida, he proved what a 3-to-1 ratio in campaign spending can accomplish in a Republican primary. Gingrich came into the Sunshine State10 days ago fresh from a triumphant victory in South Carolina, leading Romney in Florida by nine points according to a Rasmussen poll . When the votes were counted Tuesday night, however, Romney won Florida by 14 points and, in terms of delegates to the GOP convention, the result was even more lopsided than that: 50 to zero in the winner-take-all primary. And in his victory speech here in Tampa, Romney sounded very confident that he will return to accept the nomination in August, ignoring his Republican rival and focusing his attacks on the incumbent Democrat as if the general election campaign had already begun. ” My leadership will end the Obama era and begin a new era of American prosperity,” Romney told his cheering supporters, promising to “build an America where hope is a new job with a paycheck, not a faded word on an old bumper sticker.” Eighty miles away in Orlando, Gingrich drew applause from his supporters by describing the various executive orders he would enact on the day of his inauguration as president. While supporters behind him held signs saying “46 States to Go,” Gingrich addressed himself to “the elite media,” promising he would ” contest every place and we’re going to win and we’ll be in Tampa as the nominee.” In Tampa, however, Gingrich’s boasting was greeted with derision by Eric Ferhnstrom, a top advisor to Romney. “He’s not even on the ballot in 46 states,” said Ferhnstrom, noting that Gingrich failed to qualify for the ballot in next Tuesday’s primary in Missouri, which will thus be essentially a two-man contest between Romney and former Pennsylvania Sen. Rick Santorum. Ferhnstrom said he expects that Romney’s most formidable opponent in Saturday’s Nevada caucuses will not be Gingrich, but former Texas Rep. Ron Paul. And neither Gingrich nor Santorum qualified for the GOP primary ballot in Virginia, which votes on “Super Tuesday” March 6, which will thus also pit Romney in a head-to-head match against Paul. Gingrich didn’t bother explaining any of that to his supporters in Orlando. “It’s now clear that this will be a two-person race between the conservative leader and the Massachusetts moderate, ” he said, obviously attempting to discount Santorum’s claim to be the “consistent conservative” in the 2012 Republican field. Santorum left Florida early, returning home to get a copy of his income taxes demanded by the media, and also to attend to an illness of his 3-year-old daughter, Bella. Santorum spent Tuesday night with supporters in Las Vegas, where he told CNN that the expensive Florida contest was ” a death match that I didn’t want to get involved in.” Santorum said Gingrich’s lopsided loss might inspire Republican voters “to look at this race now and say if you don’t want Mitt Romney and Newt Gingrich doesn’t have what it takes to win this, let’s give someone else a shot.” Santorum said in a Tuesday interview on CNN that his campaign raised more than $4 million in January, boosted by his victory in the Iowa caucuses, and was now raising money at the pace of $200,000 a day. Romney’s rivals will have to continue their campaigns now without benefit of the free national exposure provided by televised debates. There were six debates in January — two each in New Hampshire, South Carolina and Florida — but three weeks will elapse before the next TV debate, Feb. 22 in Arizona. Furthermore, a glance at the campaign calendar shows a three-week gap between next Tuesday’s contests — the non-binding primary vote in Missouri, plus caucuses in Colorado and Minnesota — and the Feb. 28 primaries in Arizona and Michigan. This hole in the GOP calendar is the result of Florida’s decision to leapfrog its primary from March to January, a decision that scrambled the entire campaign schedule. (See, ” Why Does Florida Hate America?” Sept. 30.) As originally approved by the Republican National Committee, the schedule would have begun Feb. 7 with the Iowa caucuses, with Florida voting on the first Tuesday in March. Instead, by the time January was over, four states had already voted and as February arrived at midnight, Romney was riding high as the winner of the biggest prize so far. There were many conservatives who suspected that Florida’s decision to switch its primary to January was a move orchestrated by the GOP establishment, intended to achieve exactly this result. But there was no talk of sinister conspiracies late last night on the patio of the Marriott Hotel in downtown Tampa, where a young Romney campaign staffer sat relaxing in the warm night air and remarked that his flight was scheduled to depart at 8:30 Wednesday morning. “On to Vegas, baby,” said the Romney staffer. And he was smiling like a winner.
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Florida Picks Mitt
Hello? My friend Quin is indignant over a Newt ad. The problem? As Quin and the gang present their facts — they seem to prove Newt right. And themselves…well…no idea. But the word correct isn’t the word that comes to mind. Here’s Quin’s post .
