Shots - Health Blog
Wed December 28, 2011
Reversal On Health Mandate Came Late For Gingrich And Romney
Opposition to the administration's overhaul of health care has almost become an article of faith with every Republican running for president.
Candidates promise to repeal the law and its less-than-popular requirement for most Americans to either have health insurance or to pay a penalty starting in 2014.
"It is wrong for health care. It's wrong for the American people. It's unconstitutional. And I'm absolutely adamantly opposed to ObamaCare," former Massachusetts Gov. Mitt Romney said at a debate in Des Moines, Iowa, earlier this month.
"I am for the repeal of Obamacare," former House Speaker Newt Gingrich echoes in a video on his website. "And I'm against any effort to impose a federal mandate on anyone, because it is fundamentally wrong and I believe, unconstitutional."
By now, it's pretty common knowledge that both candidates once supported the so-called individual mandate that's at the heart of the federal health law. That kind of mandate is also at the heart of the law that Romney signed as governor of Massachusetts in 2006.
At the time, a newsletter from Gingrich's former consulting firm, the Center for Health Transformation, praised Romney's state health law, as The Wall Street Journal noted this week. "We agree entirely with Governor Romney and Massachusetts legislators that our goal should be 100% insurance coverage for all Americans," the newsletter said.
And a video from 2008 has surfaced that shows Gingrich explaining why an individual insurance mandate makes sense.
At the Des Moines debate earlier this month, Gingrich agreed that he had supported the idea when he fought President Clinton's health overhaul plan.
"In 1993, in fighting HillaryCare, virtually every conservative saw the mandate as a less dangerous future than what Hillary was trying to do," he said.
That may be the case. But it's also the case that, until quite recently, both Gingrich and Romney still favored the idea of requiring people to have insurance.
"I've said consistently we ought to have some requirement that you either have health insurance or you post a bond ... or in some way you indicate you're going to be held accountable," Gingrich said on NBC's Meet the Press just this past May. When host David Gregory asked if that wasn't simply an individual mandate, Gingrich replied, "it's a variation on it."
Meanwhile, former Governor Romney, who continues to defend his state's individual mandate, has maintained recently that he wouldn't support extending it nationwide. But that's not what he said at the end of March 2010, just days after the federal bill became law, in an interview at Vanderbilt University comparing the two.
"The similarities are that we have an incentive for people to become insured, and the incentive works; we have 98 percent of our citizens in Massachusetts that are insured," he said in the video. "So that's working."
Romney went on to say he actually wouldn't repeal the entire federal law, but, rather, "repeal the bad, and keep the good."
So why the late turnaround?
"You know, it's hard for me to not to be cynical about this, frankly," says Patricia Danzon. She's a professor of health care management at the Wharton School at the University of Pennsylvania.
She's also a co-inventor of the individual mandate back in the late 1980s as one of a quartet of free-market academics. It's the plan that ultimately became the Republican alternative to President Clinton's proposal.
"Our objective was to try to design a health care system that would rely on competitive markets to provide the insurance, but would achieve universal coverage," Danzon said. "And would do it in a way that is as efficient as possible, meaning not cost more in tax revenue than is necessary, but also be reasonably fair and equitable."
Oh, and not have the government run it.
This, was happening at a time when the main Democratic plan was to require employers to provide coverage. Conservative economists frowned on that, because they said it distorted the labor market.
But having everyone covered did remain a key goal. Why? Danzon says it's neither a liberal nor a conservative thing, but purely an economic one.
"The truth is that we're not so mean-spirited that we deny people health care when they truly need it," she explains. "And so people who don't have insurance do get coverage if they desperately need it in an emergency situation, and that ends up being a burden on everybody else."
In other words, making individuals responsible for their own health care is preferable to socializing the health care system.
Or, as Romney put it in an interview on MSNBC just last week, "personal responsibility is more conservative, in my view, than something being given out for free by government."
Romney once again made the case in that interview for why requiring individuals to have health insurance was — and is — a conservative idea. But now that such a mandate has been embraced by President Obama — and proved unpopular with voters — don't expect to see Republican presidential candidates doing much beyond just saying no.