Taking responsibility for one's own health
key to making reform work
by Barbara Anderson

The Salem News
Saturday, January 30, 2010

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.

The comments made and opinions expressed in her columns are those of Barbara Anderson
and do not necessarily reflect those of Citizens for Limited Taxation.

Barbara Anderson is executive director of Citizens for Limited Taxation. Her column appears weekly in the Salem News and other Eagle Tribune newspapers; bi-weekly in the Tinytown Gazette; and occasionally in the Lowell Sun, Providence (RI) Journal and other newspapers.

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