Robert P. Kirchhoefer, in a 2/15/12 posting on the online American Spectator, differentiates RomneyCare from ObamaCare. This is a comment upon that piece.
Mr. Kirchhoefer has made a fine start toward de-mystifying the term, individual mandate. The public has been manipulated into accepting the myth that the essence of ObamaCare is the individual mandate, that the essence of RomneyCare is the individual mandate, and that the litmus test for determining whether a candidate is a progressive (democrat, liberal, socialist, whatever) or a conservative (republican, free-marketeur, libertarian, fascist, whatever) is, whether he or she favors the IM. As Mr. Kirchhoefer suggests, the IM represented only one element of the multiple purposes and effects of RomneyCare, and that element was one that a great many conservatives, including not just Newt Gingrich and the Heritage Foundation, supported: to address the problem/cost of EMTALA – free emergency-room care for every living human being who has neither money nor insurance – without curbing EMTALA. The solution: people either buy the insurance, or do without the care. As it happened, the final version of RomneyCare, after the political process yielded many amendments, vetoes, etc., was less pristine, and the “libertarians” (Gingrich’s term) who decline the insurance, still get the care but must pay a penalty, although there are various provisions for people who really cannot afford to pay for the insurance.
Romney’s critics, Left and Right, like to argue that RomneyCare is just a state-level version of ObamaCare. Republicans who think Romney is the best of the announced candidates but still too weak or wishy-washy to win, acknowledge that RomneyCare has an IM and throw up their hands, which is a shame. The critical difference is that ObamaCare truly represents socialized medicine: every single element of it points toward the elimination of healthcare insurance issued by private-sector insurance carriers, the control of pricing of healthcare services by the government, and governmental control of the medical practices of healthcare providers. Within less than a decade, ObamaCare would be a completely single-payer system in which every aspect of healthcare would be totally under governmental control, and “market forces” would be a quaint relic of happier times. On the other hand, RomneyCare (though compromised in many respects by the Mass. political process), does NOT represent the elimination of markets or the governmental takeover of the provision and pricing of medical services; if applied to the country as a whole, it would not represent a single payer system or a socialization of medicine.
Romney, in his unfortunate, tone-deaf way, has tried, but failed, to make the case that the IM has become the tail that wags the dog and that it has assumed a symbolic significance way out of proportion to its theoretical or practical importance. The use of an IM, with or without the coercive elements that are likely to be at the center of the Supreme Court test of ObamaCare, is not socialized medicine. Socialized medicine is what the country, courtesy of many prior administrations (including not just those of George I and George II, but R. Reagan, during whose term EMTALA was enacted), was already well on the way toward having, long before ObamaCare – through these unfortunate devices: differential income-tax treatment as between individual policies and group policies; prohibitions of interstate offerings of insurance policies; tort-law statutes and court rulings that encouraged or accommodated unnecessarily defensive medical practices that enormously raised costs and distorted resource-allocations; the failure of EMTALA to address the problem of the financial crisis that it predictably engendered; and governmental control of the pricing of all healthcare products, services, and insurance. (For that matter, Massachusetts healthcare was also highly over-regulated long before RomneyCare was enacted and the IM was imposed.) Moreover, the unwinding of the principal anti-market, statist burdens on American healthcare (via tax reform, tort reform, EMTALA reform, removal of pricing controls, and lifting of bans on interstate insurance) is not something that could have been accomplished by Massachusetts or that could be accomplished by any other other individual state or group of states – it can only be accomplished legally at the federal level.
One is tempted to believe that Romney, despite his obvious inability to make the best case for his own position, is at least being crafty in one important respect: in declining to support the judicial or legislative overturning of the IM component of ObamaCare, he may be anticipating a ruling in which the Supremes fail to invalidate the IM. By having stayed largely mum on the IM component of ObamaCare, he enables himself to stay on the attack on the larger, more important, flaws in the legislation, without skipping a beat, regardless of whether Justice Kennedy awakens on the left or the right side of the bed on the morning when the Supremes take their vote.