JONATHAN COHN MAY 31, 2011
By now everybody who follows politics knows that Mitt Romney signed a universal health care law in Massachusetts and, in so doing, imposed a requirement that all citizens obtain health insurance. But exactly how involved was he in shaping the law? How did he really feel about the so-called “individual mandate”? Two new articles help answer that question – and probably not in ways that will make conservatives happy.
One article, the first of a series on Romneycare, is by Brian Mooney of the Boston Globe. The other is by Ryan Lizza of the New Yorker (and, formerly, of the New Republic). Both are well worth your time if you care about Romney, the politics of the Republican presidential contest, or the story of health care reform.
The articles treat their topics in predictably different ways. Rooney’s story has more detail on state politics and how Romney managed them; Lizza’s story approaches the story from more of a national angle and includes new reporting about the role Romneycare played in shaping Obamacare. But both articles suggest that Romney was a true believer in the individual mandate, as both a matter of policy and philosophy.
Among other things, Lizza and Mooney each quote Jonathan Gruber, the MIT economist (familiar to readers of this space) who would later advise Obama and his allies just as he advised Romney in Massachusetts, about the deliberations and the way governor’s thinking evolved.
Romney and his aides had a lengthy debate about the merits of the mandate, which evolved into a broader philosophical discussion. Personal responsibility was important, some aides argued, but what about the libertarian view that the government had no business requiring people to buy something? It was one thing to ask drivers to buy car insurance. Owning a car is a choice. But the health-insurance mandate demanded the purchase of a product just for being alive.
Philosophically, Romney sympathized with the personal-responsibility argument and not with the libertarians. The pressure of satisfying the Bush Administration was also acute. Gruber, the M.I.T. economist, may have sealed the case with a model showing that, without a mandate, Romney would insure a third of the people at two-thirds of the cost of doing it with a mandate. “All the sick guys sign up,” Gruber said. “So you’d be silly not to have the mandate.” Gruber says he attended a meeting where the discussion of the mandate turned into a debate between Romney and his political advisers. Romney argued passionately for it; his advisers argued against it.
The stories also talk about the partnership Romney forged with the late Senator Ted Kennedy, who presciently saw an opportunity not only to bring universal (or near universal) coverage to his state but also to create a model that might later become a template for national reform. One of the best anecdotes is of Romney and Kennedy making their case to then-Health and Human Services Secretary, Tommy Thompson, on his last day before leaving the Bush Administration.
As they worked out the details, they could hear the sound from Thompson’s retirement party a floor above.
“People kept coming down, saying everyone’s at your party, waiting for you,’’ recalled Stacey B. Sachs, Kennedy’s counsel on health care matters. “The next thing I knew, we were all heading up to the party.’’
Romney and Kennedy were “kind of a riot, on the stage going on about being the odd couple,’’ Sachs said. It was the first time they had shared a stage since their 1994 debate in the Senate campaign.
Kennedy’s support of the Massachusetts bill would provide fodder for Romney’s conservative critics, most of whom exaggerate his role. But Kennedy was a force in moving Robert E. Travaglini and Salvatore F. DiMasi, the Senate president and House speaker at the time, to resolve a stalemate over competing versions of the bill. Just as important, Kennedy’s exalted status among Democrats, particularly on health care reform, provided Romney with valuable political cover at critical moments.
Sachs said the senator made a “strategic decision’’ to support Romney once he became convinced the governor was serious about extending coverage. … “Everyone expected Kennedy to come out screaming, but he said, ‘This looks pretty good, and if he’s willing to work for this, let’s work with him,’ ’’ she said.
I can’t vouch for the details in either article personally, but they are consistent with everything I’ve ever heard about the Massachusetts reforms -- and how they came together. The articles also offer a portrait of Romney at his most appealing, bringing to public office a problem-solving, managerial approach. Unfortunately, that portrait is almost completely at odds with the persona Romney adopted once he started running for president.
As Lizza notes, this dichotomy was crystal clear a month ago when Romney made a major speech about health care in Michigan. He spent the first half explaining, rather convincingly, why the reform with the mandate made sense for Massachusetts -- and then spent the second half arguing, rather unconvincingly, why taking such a plan national represented an unconscionable “power grab” by the federal government. Of course, Romney has been trying to live down his most impressive accomplishment for a while, as Lizza also notes:
As the Boston Phoenix pointed out, when “No Apology” [Romney's first campaign manifesto] was issued in paperback, in February, Romney made a notable change from the original version. In the hardcover, published in early 2010, Romney, after reviewing the success of health care in Massachusetts, wrote, “We can accomplish the same thing for everyone in the country.” In the paperback, the line had been deleted.
By the way, the next part of Mooney’s series will examine, in detail, how Romneycare has worked out for Massachusetts. For policy wonks like me, that’s the most interesting and, perhaps, most important question of all.