The first thing to say about Mitt Romney’s health care problem is that he’s not alone among the viable Republican field in having to explain past positions. Tim Pawlenty supported cap and trade; Jon Huntsman signed a regional cap and trade deal; Newt Gingrich cut ads with Nancy Pelosi about his support for cap and trade. And it’s not just environmentalism; given the rigidity of the modern Republican Party, every candidate has some policy preference worthy of throwing them off the reservation. I’m not convinced this is as big a problem for Romney as everyone thinks.
UPDATE: Newt Gingrich was a huge mandate fan himself.
That’s not to say it isn’t a problem. The Wall Street Journal told Romney he should go try to become Obama’s running mate, relying on right-wing critiques of the universal reform in Massachusetts, not all of which are valid. And health care, being the signature bill passed by Obama, simply has more prominence than other litmus test issues in the Republican Party.
But Romney is firmly back on the reservation. His op-ed in USA Today, a short version of the speech he will give today in Ann Arbor, has a vision for health care that does not differ much at all from the GOP party line:
1) state experimentation: this is a fancier way of saying that Romney wants to let states opt out of the Affordable Care Act. I don’t think it’s been thought out any more than that. Especially because his second idea is…
2) Letting people buy insurance across state lines. Well, that doesn’t allow states to become “laboratories for democracy.” It links them to the state with the fewest insurance regulations, in a race to the bottom. States trying to design their own insurance plans would not be able to set regulations or standards for insurance. It would be impossible for a state to come up with a comprehensive plan. This is an invitation for profit-gouging for the insurance companies.
3) Allowing individuals to exchange their employer-based health care for a tax deduction to buy their own insurance. This would shrink the risk pool for employer-based health care, degrading coverage for those who keep their insurance. And without standards of any kind for individual insurance, it gives a too-small tax deduction for expensive coverage. This part is incredibly vague, but it appears to fracture the market even more than now.
4) “Individuals who are continuously covered for a specified period of time may not be denied access to insurance because of pre-existing conditions.” This means approximately nothing, because the whole point of pre-existing conditions is to cover people not currently covered by insurance.
5) Medical malpractice reform. Conservative boilerplate.
6) Health savings accounts and high risk pools. More conservative boilerplate.
There’s nothing in here that differs even a little bit from the tiresome set of conservative arguments for health care reform. McCain had the voucher program in his campaign plan, and things like HSAs and medical malpractice have been bouncing around for a while. Everyone will deliver the same plan, and given the experience of the Paul Ryan budget, they’ll all probably avoid talking about Medicare, as Romney does. Without differences, you’re just talking about the past, and in the Republican field, nobody’s hands are clean.
This probably is good enough for Romney to sidestep the issue, but really pretty bad as a prospect for people who need stable health care.