A Litmus Test for GOP Success: The Romney Health Care Factor.

mittromney.jpgRamesh Ponnuru has an article about Mitt Romney's presidential ambitions; it looks like the former Massachusetts governor is setting himself just right to put in a very strong campaign in the Republican 2012 primary. But I think the Republican field will remain unhealthy until he can come to turns with what ought to be his most prominent accomplishment: Working with Democrats to create universal health care coverage in Massachusetts. This is what Ponnuru says about that...

The first [obstacle] is the health-care plan he signed as governor of Massachusetts. Republican opinion has hardened against that plan, which can reasonably be described as the national Democrats’ plan minus the public option. Potential rivals for the 2012 nomination such as Pawlenty and Huckabee have taken shots at the plan.

Romney makes three arguments in his defense. The first is that a Democratic legislature and his Democratic successor made the plan worse than his original conception. The second is that he has no intention of pushing the Massachusetts plan on the entire country. Health-care reform, he tells me, “should occur on a state-by-state basis.” The third is that the plan has worked out well for his state. “The plan is well within budget and has accomplished its objectives at a relatively modest cost.”

It’s that third point that could get Romney into trouble. The cost to the state government has indeed been modest. But the plan was designed so that the state picks up only a fifth of the costs the plan generates, with the federal government and the private sector absorbing the rest. Premiums are growing much faster than in the rest of the nation. Waiting times are up, too, which imposes costs on people. The plan is losing popularity in Massachusetts. Ideally, Romney would learn from this experience that a reform centered on state governments’ manipulation of federal dollars is a mistake. At the very least, Romney would be foolish to keep defending the plan.

But Ponnuru's critiques are pretty nebulous on closer inspection. For one, Massachusetts is set to do some pretty revolutionary cost-curve-bending that wouldn't have been possible without the framework that universal coverage efforts put in place, and the Massachusetts Taxpayers Foundation says the plan isn't bankrupting the state. Secondly, the plan isn't losing much popularity in Massachusetts: Last month, 58 percent of residents who had heard of the plan said they supported it. That's pretty popular, although only 35 percent of Republicans support the plan, and that gets to the heart of the GOP conundrum: Massachusetts Health Care Reform isn't a problem for Romney because it's bad policy; it's a problem because it's good policy.

Right now, any kind of serious policy proposal simply won't pass muster among the Republican base, but I remember when the fact that Howard Dean had balanced the budget in Vermont was a selling point for him in the 2003 Democratic primary, not a liability. A governor who has actually enacted a successful state-level health-care reform ought to be promoting it, not hiding from it -- especially when the Mass Reform, like the federal-level plan in Congress now, is a compromise between public and private programs that resulted in more people joining employer-based insurance plans and fewer taking public subsidies. Neither Huckabee nor Palin have a success that begins to compare with Romney's reform. He could be the Bill Clinton of the Republican Party, but Romney can't talk about his biggest achievement as governor!

When Romney isn't acting ashamed of enacting a bipartisan health care reform plan that succeeded, came in under budget, and remains broadly popular years after it was enacted, well, that's when you can take the GOP seriously again.

-- Tim Fernholz

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