Now that Mitt Romney is well and truly inevitable, it is becoming imperative for conservatives to begin the arduous work of explaining why his Massachusetts health care plan is in no way similar to the evil, bureaucratic, freedom-destroying Obamacare monstrosity. Ann Coulter gives it a go, as do Yuval Levin and Ramesh Ponnuru in National Review.
The latter brush aside any purported similarities by quickly noting that “policy experts of various political stripes have claimed that Obamacare is essentially Romneycare taken national.” Right, one of those policy experts is Jonathan Gruber, the guy who designed Romney’s health care plan and then designed Obama’s. Let’s see what he has to say:
He credited Mitt Romney for not totally disavowing the Massachusetts bill during his presidential campaign, but said Romney's attempt to distinguish between Obama's bill and his own is disingenuous.
"The problem is there is no way to say that," Gruber said. "Because they're the same fucking bill. He just can't have his cake and eat it too. Basically, you know, it's the same bill. He can try to draw distinctions and stuff, but he's just lying.
Any attempt to explain why Romneycare is so vastly different than Obamacare really ought to explain why the economist who designed both plans thinks they’re the same fucking bill.
Coulter, Levin, and Ponnuru all defend Romney by arguing that he was operating within the constraints of a distorted federal system. “There's not much governors can do about the collectivist mess Congress has made of health care in this country,” writes Coulter. But of course Obama was also operating within the confines of a distorted system, including many interest groups and voters deeply resistant to change.
Levin and Ponnuru urge Romney to vigorously press the argument that his plan has no resemblance to Obama’s. Their advice centers on the one area of difference:
So what, then, should Governor Romney say, if he is the nominee and President Obama suggests that his health-care plan is modeled on the one the Republican enacted? Something, we suggest, like the following:
“Nice try. Your health-care plan, Mr. President, spends a trillion dollars on yet another uncontrollable federal entitlement program and on a massive expansion of a failing Medicaid system. It has an unconstitutional rationing board cut hundreds of billions from Medicare without being answerable to the public, without giving seniors more options, and without using the money to shore up the program or reduce the deficit. It raises hundreds of billions in taxes on employment, investment, and medical research; and after all of that, it wouldn’t even reduce the growth of health-care costs, which is the heart of the problem. And your defense of all that is that it was based on a state program that doesn’t actually do any of those things?
But that is what Romney is already saying, right down to the "nice try." And what it’s saying, basically, is that Obama was fiscally responsible. Romney, owing to a quirk of federal funding, was able to finance his plan with a windfall grant from Washington, meaning he didn’t need to come up with any painful cuts to cover his insurance expansions. Obama raised taxes and found inefficient spending within the Medicare system to finance covering the uninsured. And one of the biggest elements of his tax increase was a reduction in the tax deduction for expensive private plans – basically, the strongest version Obama could get through Congress of a staple idea urged by conservatives, which is to eliminate the tax code’s favoritism for employer-sponsored insurance.
Now, you could argue that this should go even further, and I’d agree. If you had Republicans willing to continue advocating the health care principles they used to advocate before Obama tried to implement them, you could form a stronger political coalition for tearing up the status quo and combining market pressure with universal coverage. But rational reform is pretty hard when the opposition party is able to convince itself that anything you do, including things they favored just the other day, are the death of freedom.