During
the recent U.S. Senate campaign, I was asked by people in and
outside Massachusetts about "RomneyCare," the name that is sometimes
applied to the Massachusetts health care reform law of 2006.
People
who are usually hostile to or suspicious of big government programs
were surprised to learn that in the first year of the reform law, my
health insurance premiums dropped. Those of us who had been
subsidizing the "free care" pool through our own premiums were
finally getting a break, as many free riders were required to get
their own affordable, basic plans.
Of
course, in the long run, the naysayers were right as usual. In the
second year, I received a notice that my little taxpayer group had
to add prescription drug coverage to its plan — even though none of
our four employees wanted it. I called my legislators to complain,
always an exercise in futility. Mitt Romney and Kerry Healey were
gone, and I didn't know the new people in the executive suite.
Then the
"affordable" premiums shot up again. We dropped an employee to save
money; other small businesses have also laid off, not hired or hired
part time. Meanwhile, legislators and the Patrick administration
remain puzzled by the ongoing unemployment problem.
So was
RomneyCare worth a try? Because the status quo at the time was
unsustainable, something had to be done, and the reform effort
represented an attempt to do it right.
"RomneyCare"
is used in William Eggers and John O'Leary's
new book, "If We Can Put a Man on the Moon: Getting Big Things
Done in Government," as an example of efficacy. (Other examples are
the Marshall Plan, the Cuban Missile Crisis and, naturally, putting
a man on the moon.)
"Romney's team," they wrote, "sought to develop the idea
collaboratively, not collectively."
I
remember the long process. Reform proponents used concepts from both
the conservative Heritage Foundation and the liberal Brookings
Institution and talked with medical centers, insurers and consumers.
There were public hearings, and I attended a panel discussion that
included the North Shore Medical Center at a Salem Chamber of
Commerce breakfast. The public was kept informed through the media
every step of the way. Everyone read the bill!
Romney
was willing to share the process and the stage not only with his
fellow Republicans who shared his belief in the competitive
marketplace, but with Ted Kennedy and the Democratic legislative
leadership. He did veto two sections, including a tax on business,
and though his vetoes were overridden, he signed the final bill.
Eggers
and O'Leary write, "The resulting legislation was not the
ideologically pure vision of any single person, including the
governor, but it did conform to Romney's desire for greater
individual choice and greater individual responsibility."
This is
the bill that state Sen. Scott Brown supported. I almost supported
it myself, right up to the end, when ongoing bad experiences with
the Legislature overcame my hope that it could do anything right.
One
concern that many of us had was that near-universal coverage, some
of it subsidized for low-income people, would encourage new
residents from other states to come here for those benefits. The
Legislature had also not dealt with the issue of illegal immigrants
who use the emergency rooms. And the state refused to repeal an
outrageous tax on self-paying nursing home residents.
When my
premiums went down, I felt I'd been unnecessarily skeptical. Now
that the cost has increased, mandated benefits added, deductibles
eliminated for free-care patients and savings hardly realized, I'm
back to cynicism.
Yet a
recent Washington Post poll about the Massachusetts law shows that
it remains popular, with 68 percent of voters here saying they
support it. And across the nation, voters are saying they want
Democrats and Republicans to work together for reform in Washington,
D.C. — just as Scott Brown has pledged to do.
President Obama and Washington Democrats used a very different
approach than the one used by Mitt Romney and legislative leaders
here. I saw presidential aide David Axelrod discussing ObamaCare
last Sunday on ABC's "This Week," where he said that "people will
never know what's in that bill until we pass it."
So
understandably, "people" want Washington to go back to the drawing
board and start over with a transparent document that is not longer
or more complicated than it has to be to get the job done.
Watching
the C-SPAN debates, I had wondered why, in response to criticism
that they didn't have their own bill, the Republicans didn't bring
out their own complete package and place it — shorter and more
honest — next to the towering pile of partisan political policy poop
that is the Democratic plan.
I now
think I know why. A complete Republican proposal would need to
address all the public's main concerns. Republicans offer more
choice with interstate policies, lower costs from tort reform and
incentives for coverage with tax breaks for health savings accounts.
But they can't address coverage for "pre-existing conditions"
without a mandate for everyone to purchase insurance, and much of
the Republican base hates that mandate.
Until
everyone gets behind Mitt Romney's original point about personal
responsibility, we can't really start over with anything that will
actually work.