Phil’s post yesterday on Romneycare and the current Senate healthcare bill struck me as, if not necessarily unfair to Romney, then perhaps incomplete in its critique. Phil writes:
So now, if Obamacare passes, Romney will be left telling angry primary voters that the only real difference between the two plans is that he implemented his policies at the state level, while Obama did it through the federal government. Sure, it’s clearly worse if the federal government is implementing bad policies, but it’s hard to see how such an argument would pass muster with anybody but those who are already ardent Romney supporters. It’s sort of like saying, “As governor, I raised state income taxes, but the thought of raising federal income taxes — that’s an outrage!”
The case for federalism, though, goes beyond the argument that it’s “worse if the federal government is implementing bad policies.” There are, in fact, policies that are defensible or even necessary at the state level that would be pernicious at the federal level. Now, it would be a gross understatement to say that Phil knows more about healthcare policy than I do, so it may well be that a Massachusetts-style healthcare bill is analogous to raising income taxes, and would have similar policy implications at both the state and federal level. But it isn’t immediately obvious to me that it isn’t instead analogous to levying a sales tax, which is prudent under some circumstances at the state level but would be fairly radical at the federal level.
All that said, if Mitt Romney runs for president next cycle, the burden will be on him to draw the distinction between a state and federal healthcare program, and he will have to do a bit better than the line from his spokesman, quoted in the update to Phil’s post, about “a ‘one-size-fits-all’ solution.”