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Paul Ryan to Introduce New Medicare Plan with Democrat Ron Wyden
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The Spectacle Blog
Health Economist John Goodman lays out the speech that Mitt Romney should give to placate his conservative doubters without running from his legacy as governor of Massachusetts:
As governor of Massachusetts, I presided over the most important state-level health reform in our nation’s history. From that experiment I’ve learned a great deal about what works and what doesn’t work in the ongoing effort to lower costs, raise quality and improve access to care.
We accomplished four things that are worth emulating nationwide.
First, we cut the number of uninsured by more than half in my state. If that were replicated nationwide, we would have 25 million newly insured citizens.
Second, we insured the uninsured mainly by using money already in the system (for Medicaid and emergency room care), not by raising taxes or cutting benefits for the elderly and the disabled - as ObamaCare does.
Third, we created tax fairness. Massachusetts is the only state in the union where employees get the same tax relief for health insurance, whether it is provided at work they purchase it on their own. This is in contrast to the arbitrary and unfair way the tax system treats people in other states and the much greater unfairness people will be subjected to under ObamaCare.
Finally, we put partisanship aside and sought everyone’s help in achieving these goals. Left and right, Democrat and Republican - all worked together toward a common end.
On the other hand, there are things we did that I would not recommend to others.
First, there is no need for a mandate. In Massachusetts, as in other states, people pay lower taxes if they insure and higher taxes if they do not. We have added additional subsidies and fines in my state to make being insured even more attractive. These financial incentives alone account for almost all of our success in insuring the uninsured. Once the government starts dictating the content of everyone’s insurance plan, however, the special interests set in, bloating the benefit package and making it prohibitively expensive. By making health insurance expensive and one-size-fits-all, mandates actually defeat the goal of universal coverage.
Second, while increasing the number of people with insurance, we did not create one new doctor or one new nurse. Nor did we deregulate and allow insurers and providers of care to get out from under a mountain of regulations that prevent cost-effective products. As a result, the wait to see a new doctor in Boston is longer than in any other U.S. city. Our emergency room traffic is higher today than before the reform!
I believe the supply side of the market can accommodate a large increase in the number of insured, but only if we give them the freedom to meet the new demand efficiently.
Third, in Massachusetts we adopted the same model of managed competition that is in HillaryCare and in ObamaCare. I like the idea of people choosing among competing health plans. But under managed competition, the premium is the same for everyone, regardless of expected health care costs. That means insurers try to attract the healthy and avoid the sick. After enrollment, the health plans face perverse incentives to overprovide to the healthy (to keep the ones they have and encourage the enrollment of more just like them) and underprovide to the sick (to encourage their departure and discourage enrollment by any more of them).
A better model is the Medicare Advantage program, where seniors also have choice and competition. But in that system, the federal government goes to great lengths to try to ensure that the premium paid for each person matches as closely as possible that person’s expected costs. Because the amount the government pays for each senior can differ by ten-to-one or more, insurers compete just as aggressively to enroll a cancer patient as they do to enroll a healthy patient. I believe we can do something similar for the nonelderly population.
Finally, you cannot allow people to game the system. In Massachusetts, some folks remain uninsured while they are healthy, obtain insurance after they get sick, and then drop their insurance again after they get their medical bills paid. We call these folks “jumpers and dumpers” Under ObamaCare we are about to repeat this mistake nationwide. We do not allow people to game the insurance system with impunity in other federal programs. It’s not allowed in Medicare Part B, in Medigap insurance or in the Medicare drug coverage program.
Were I president of the United States, I would take these lessons to heart. I would replace ObamaCare with a workable health system - copying what works and avoiding what doesn’t work, based on my experience in Massachusetts.
I believe I am the only candidate who actually knows how to do that.
In a way, this would be a very compelling speech. Mitt Romney is better positioned than any other politician to understand both the strengths and pitfalls of Obamacare and other health care “reform” measures.
Yet concerns about Romney’s health care ideas and proposals aren’t limited to the policy details. Ross Douthat nicely summed up one troubling aspect about the political philosophy underlying Romney’s push for the Massachusetts health care overhaul: “Romney’s famous health care bill (with sought access first, and promised cost containment later) is arguably the quintessential example of public policy that looks reasonable in an age of go-go growth, and irresponsible in an age of austerity.”
Romney deserves some compassion for facing conservative criticism for a health care approach that was developed with the help of the Heritage Foundation and thought generally respectable at the time. But Republicans can’t be blamed if the recession and the prolonged debate over Obamacare clarified the problems with fiscally extravagant legislation and the Romneycare/Obamacare approach to health care. Romney may be just the manager needed to navigate the post-Obamacare health care landscape, but Republicans may not be looking for a manager. They may be seeking someone with a philosophical outlook that wouldn’t have accomodated Romneycare and everything it entails.
View all comments (27) | Leave a comment
More Blog Posts by Joseph Lawler
http://spectator.org/blog/2011/05/31/the-healthcare-speech-romney-s
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Chuck| 5.31.11 @ 12:51PM
If Romney is elected he won't abolish Obamacare but he will then claim he can manage the costs better thereby cementing Obamacare into the fabric of American society.
Hass| 6.1.11 @ 1:00AM
Millions of Hillary Clinton voters voted for Obama because they wanted to vote against Bush and Palin, but they still don’t like Obama. I think many will vote for Romney if he makes it to the general election. Anti-Obama voters will be highly motivated and reliable voters regardless of who the Republican nominee is. We need to think about independents and Clinton voters.
We won’t win with a “party of no” Republican candidate.
Every poll that showed Americans opposed to Obamacare also showed that voters see Republicans as cold and disinterested in the healthcare issue.
I support Romney 100 percent, even if I don’t completely support the Massachusetts reform.
Dai Alanye | 6.1.11 @ 2:12PM
It would be unfortunate if Romney took the advice of Lawler and Goodman, because it definitely would increase his chances of getting the nomination, and we don't want that. The fact is that Romney doesn't have the correct instincts for the job he's seeking, and mistakes like defending Romneycare simply prove my assertion.
So no thanks--no Mitt-the-RINO for me.
Louis Tully| 5.31.11 @ 1:03PM
Oh come on.
that ship sailed a couple years ago.
Rich Berger| 5.31.11 @ 1:11PM
No sale.
George S| 5.31.11 @ 1:25PM
That would only make it worse... the key is government has no business picking what works and what doesn't. Romney should say what I learned is I should have left things alone and, on reflection, should have removed regulations. The key to more access is lower prices and the key to lower prices is less government intervention at the behest of the medical lobby.
Mike| 5.31.11 @ 3:10PM
George:
These are the old arguments that resulted in millions of dollars be spent on the high cost of emergency care. This is PRECISELY what we see nation wide and it's not working. Sharpen your pencil George, this is a tough problem and old "leave it alone" hasn't worked. It won't work for the future either. More and more Americans are totally IRRESPONSIBLE with their diets, and obesity is going to bankrupt the system. Romney has this one right for the next decade or so - personal responsibility is what the message needs to be.
Occam's Tool| 5.31.11 @ 2:19PM
I dunno---how about getting government LESS involved in the providing of medical care? Seems to me the AMA was RIGHT in 1964.
But hey, I like the AAPS.
Mike| 5.31.11 @ 2:22PM
Chuck,
Your post is bullsh*tt. Romney will sign the waivers for Obama care.
I have yet to see the American Spectator address the "free-rider" problem of health care. In fact, has Ron Paul addressed it? No.
In 1986, Ronald Reagan mandated that hospitals treat people without insurance in emergency rooms.
Millions of tax payer dollars are covering the "highest health care costs" for people who fail to take personal responsibility.
Romney is the only Republican leader with the cajones to actually "do" anything about it in Massachusetts.
Has anyone else done anything? Nope.
Where are the libertarian gods with their solution to everything? (silent).
George, the key to the problem is personal responsibility.
There are people who can afford insurance who free-ride the system. Your theory is disproved.
Occam's Tool| 5.31.11 @ 7:20PM
How 'bout:
Don't Treat Illegal Aliens in US ERs? Make an exception in EMTALA for illegals.
That would help, a lot.
Peppermint Tea| 6.1.11 @ 10:09AM
How about letting the market work?
Such as de-regulating the health industry so that there are more nurse practitioners, nurse midwife, and physician assistants to care for over half of the ER patients? A no-frills, bare-bones, medical care.
Mike| 6.1.11 @ 10:21AM
Why don't we just ask all of them to volunteer their time?
PT, c'mon, none of what you have proposed translates into personal responsibility.
More nurse practitioners, nurse midwives, or physicians assistants, doesn't translate into MORE doctors who can care for the sick.
Where will they treat them? Not in ER? The location doesn't matter. It's the "type" of care that is expensive - more bodies doesn't make it less expensive.
And where are the scientific studies that indicate that such a proposal would cause less government and lower costs?
Mike| 5.31.11 @ 2:38PM
Lawler says:
"Romney may be just the manager needed to navigate the post-Obamacare health care landscape, but Republicans may not be looking for a manager. They may be seeking someone with a philosophical outlook that wouldn't have accomodated Romneycare and everything it entails. "
Her forgot the last line of this paragraph. Consistent with his line of reasoning,
"They may be seeking someone with a philosophical outlook that wouldn't have accomodated Romneycare and everything it entails, AND DONE NOTHING INSTEAD."
Those with a DIFFERENT philosophical outlook are those who continue to bury they heads in the sand, and put their hands in their pockets and do nothing.
Why?
Because their "philosophical outlook" and framework is FLAWED.
Notice how Lawler cannot list anyone who could have done a better job at solving these issues?
American Spectator writers are long on criticism but non-existent on solutions.
When will the libertarian dogmatists realize that their bag of tricks is empty?
The libertarian philosophical framework needs adjusting - that is WHY libertarian principles - as is - can't encompass and solve these new problems.
Dai Alanye | 6.1.11 @ 2:19PM
Ridiculous! Even John McCain had a better idea, with Medical Savings Accounts. Until we let people pay their own money on healthcare--money they could otherwise spend on more desirable goods and services--we won't have the needed market discipline to control costs. No big-government program, however fine-tuned it might be, will operate half as efficiently.
PattyMor| 5.31.11 @ 3:43PM
We need a Presidential candidate with FREEDOM as their main objective; not a big government technocrat who will "fix" the medical system. Romney has failed the test. No thanks; go back to Taxachusettes.
Mike| 5.31.11 @ 4:13PM
Patty,
'Freedom as the main objective" is a "platitude." Please loot it up again if you haven't read the definition as of late.
What "oppression" do you live under? What freedoms do you lack today?
Romney is not a "big government" ANYTHING. He reduced the size in government in "Taxachussets" reduced a huge 3 billion dollar deficit and turned it into a 700 million dollar surplus - and also restored MA's rainy day fund adding a billion dollars.
Romney has failed the test? What test? You mean the "do nothing test" of the dogmatic libertarian taking heads? Praise the Lord.
We don't need "do nothing candidates" who sit on their hands and speak in platitudes while taxpayers foot the bill for free-riding and irresponsible citizens drain our pockets while stuffing themselves with empty carbs and gallons of carbonation.
Hass| 6.1.11 @ 1:00AM
Millions of Hillary Clinton voters voted for Obama because they wanted to vote against Bush and Palin, but they still don’t like Obama. I think many will vote for Romney if he makes it to the general election. Anti-Obama voters will be highly motivated and reliable voters regardless of who the Republican nominee is. We need to think about independents and Clinton voters.
We won’t win with a “party of no” Republican candidate.
Every poll that showed Americans opposed to Obamacare also showed that voters see Republicans as cold and disinterested in the healthcare issue.
I support Romney 100 percent, even if I don’t completely support the Massachusetts reform.
Mike| 6.1.11 @ 10:23AM
I am with you. Romney isn't my "perfect" candidate. But I am willing to tolerate those untidy parts, based upon solid campaign promises.
Romney is the libertarian and conservative hope that Obama be removed from office and replaced with an expert who has had a career at turning around organizations, businesses, and government.
No other candidate has that resume.
Michael L. Hauschild| 5.31.11 @ 3:45PM
Here is the speech Romney should give:
“First off, any of you who are thinking of voting for someone who was elected by the most liberal voters in any state of the Union are imbeciles; Christ, you’re as stupid as they are.
Second, that Romneycare thing, what was I thinking? After that debacle there is nothing that I ever could offer in the political realm that even the most liberal Kool Aid drinker could swallow.
Last, I will retire from all things elective, all things public, and all things requiring comment. The only thing I will offer you is an upgrade on the comment (since tricky Dickey is finally dead), “You don’t have the guy with the dog on the roof of his car to kick around anymore.” “
Mike| 5.31.11 @ 4:15PM
Cute Michael - but where's the real answer? You're like the American Spectator writer who is long on criticism or "funnies" but short on solutions.
Name a better candidate than Romney that actually has a track record of "getting results."
Occam's Tool| 5.31.11 @ 7:18PM
Pawlenty. Better results. I worked for him.
Boy, that was easy.
Mike| 6.1.11 @ 10:24AM
Nice try but no cigar. Pawlenty doesn't have name recognition, and doesn't appeal widely like Mitt Romney.
Worse, Pawlenty is even MORE dull than Romney. C'mon - get serious.
Kingofthenet| 5.31.11 @ 7:11PM
Grandma got run over by a Neocon
walkin' home from our house Christmas eve.
You can say there's no such thing as Death Panels.
But as for me and Grandpa, we believe.
She'd been drinkin' too much egg nog.
And we'd begged her not to go.
But she'd forgot her medication,
and she staggered out the door into the snow.
When we found her Christmas mornin,'
at the scene of the attack.
She had a Bullseye on her forehead,
And incriminatin' knife in her back.
Occam's Tool| 5.31.11 @ 7:24PM
Since my wife was denied back surgery unless she endured a wait of 2 years under a New Zealand NHS, back surgery (over a years' wait actually in NZ) that she easily got at Mayo in 1/10th the time (two months), and since I was a Senior Medical Consultant in that same system and saw a bucketload of care denial because of rationing due to following NICE guidelines, yeah, King, "I believe." But don't take my word for it. Go to the ultra-Lib (by US standards) NZ Herald website and punch in "District Health Boards."
Sorry, King, but I'm actually an expert on this, with first hand knowledge. I don't guess or make assumptions.
AH| 6.1.11 @ 12:56AM
Someone should ascribe the Flip-Flopper label to Obama. He has flip-flopped on the debt ceiling, the individual mandate, and public financing for his presidential campaign. Barack Obama is the most blatant flip-flopper!
heather | 6.1.11 @ 4:24PM
How about we work on living a more healthy life. Being overweight is the norm in this society. Taking lots of meds is the norm. How about let's take a little personal responsibility for the state of our individual health. If you don't use the healthcare system as a way to medicate your lifestyle, health care premiums would come down.
Heather