The New Republic

Overshadowed by the immigration rumble between Mitt Romney and Rick Perry in the Las Vegas debate was a string of statements that sounded awfully heretical -- a sign, perhaps, that economic anxiety and even the Occupy Wall Street protests are poking ever the tiniest holes in the bubble of GOP orthodoxy. First, there was Rick Santorum noting for the second straight debate that western Europe now has higher rates of upward mobility than the land of Horatio Alger -- and this time he didn't even blame this on Barack Obama. Then there was the general criticism of Herman Cain's 9-9-9 plan as being too regressive in its impact on the poor and middle class -- not a concern that one hears all that much from Republicans discussing tax policy. Finally, there was Michelle Bachmann's monologue pleading with women under economic duress to hold onto their homes in the face of foreclosure. It was unclear what Bachmann was offering to assist women in such a situation -- was she simply suggesting that they slam the door in the face of sheriff's deputies bringing the eviction order? -- but, hey, it's the thought that counts.

Most striking to me, though, was the moment when Mitt Romney and Newt Gingrich, in a tussle over Romneycare that was so staccato that it reads like something out of a Beckett play, managed to agree on one fact: that the individual mandate to obtain health insurance, the centerpiece of Romneycare and Obamacare, derived from the conservative Heritage Foundation. Let's go to the tape:

MR. ROMNEY: Actually, Newt, we got the idea of an individual mandate from you.

MR. GINGRICH: That's not true. You got it from the Heritage Foundation.

MR. ROMNEY: Well, it was something - yeah, we got it from you and the - you - got it from the Heritage Foundation and from you.

MR. GINGRICH: No, but - well, you - well, you - (inaudible) -

MR. ROMNEY: But let me - but let me just -

MR. GINGRICH: Wait a second. What you just said is not true.

MR. ROMNEY: Well, I thought -

MR. GINGRICH: You did not get that from me.

MR. ROMNEY: I think you -

MR. GINGRICH: You got it from the Heritage Foundation.

MR. ROMNEY: And - and you've never - never supported -

MR. GINGRICH: I was - I agree with them, but I'm just saying what you've said to this audience just now plain wasn't true. That's not where you got it from.

MR. ROMNEY: OK. Let me ask - have you - have you supported in the past an individual mandate?

MR. GINGRICH: I absolutely did, with the Heritage Foundation, against "Hillarycare."

MR. ROMNEY: You did support an individual mandate?

MR. GINGRICH: Yes, sir.

MR. ROMNEY: Oh, OK. That's what I'm saying. We got the idea from you and the Heritage Foundation.

MR. GINGRICH: OK. Little broader. (Laughter.)

MR. ROMNEY: OK.

What only a handful of health care wonks probably realized was that this odd repartee amounted to a cardinal heresy. During the drawn-out battle over the Affordable Care Act, Democrats repeatedly tried to make the case that it was hardly a radical document -- that, in fact, its lineage was Republican. Getting to universal health coverage by requiring people to buy private insurance on a well-regulated "exchange," or marketplace, as opposed to a single-payer, Medicare-for-all approach, can be traced through Richard Nixon's universal health care proposal, the GOP alternative to Hillary-care in the 1990s, proposals by the Heritage Foundation early last decade and, finally, the health care law signed by Mitt Romney in Massachusetts. But Republicans refused to acknowledge the essential moderation of Obamacare, and Heritage denied any paternity. Heritage health care expert Robert Moffitt penned an April 2010 op-ed in the Washington Post titled "Obama’s health reform isn’t modeled after Heritage Foundation ideas," in which he argued that Heritage had long since moved away from its past support of a mandate.

Well, now we have the two Republican candidates best versed in health care policy agreeing before millions of viewers that the mandate was in fact Heritage-inspired. I checked with the think tank for their thoughts on this. "We provided technical assistance to Romney’s staff, focusing on the exchange," said Heritage official Mike Gonzalez in an e-mail. "When Romney proposed a bond to encourage ‘personal responsibility’ so that someone who declined to get coverage could not game taxpayers, we agreed with him that this was a viable option to deal with the free-rider problem that we have in our system. Romney sent that to the legislature but could not get them to go along." In other words, Heritage supported Romney's preferred form of getting people to obtain coverage -- a sort of pre-payment for future uninsured care -- but is silent on what the state ended up with, a tax penalty (now above $1,000 per person) for not obtaining coverage. Left unsaid is that both approaches are rooted in what Heritage, and other conservatives, were talking up for much of the last decade: getting to universal coverage by requiring or pressuring in some form or other people to buy private insurance.

A final thought on this: it's becoming increasingly apparent that one of the reasons that Romney's rivals are having a hard time attacking him over the Massachusetts law's ties to Obamacare is the incrementalism of both laws. When Romney declares in defense of the Massachusetts law that it is based on the private insurance marketplace, not public programs, and that it has little impact on those who are already covered, his rivals are unable to retort that this is precisely what makes it the inspiration of Obamacare, because that would mean admitting that Obamacare is not nearly as extreme as portrayed.

I'll conclude with a reader comment posted by Andrew Sullivan that states this as well as anything I've seen: 

So when Romney talks about how his plan used only private insurance companies, his rivals can't say "But so does Obamacare!" because that would be letting the cat out of the bag. They try to contradict his claim that it's market-based - as in Santorum's description of the plan as a "top-down government-run program" - but they know they can't get too specific, because it would expose their lie that either program is government-run... They'd have to talk about the exchanges, which are clearly not socialized medicine ... The only concrete major component truly shared by both plans that's easy for Romney's rivals to attack openly is the individual mandate, but they don't want to limit their attack to it. So they're in a perilous position, and skewering Romney on this issue is not as easy as it would first seem.

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