Mitt Romney's University of Michigan Grand Rounds Presentation On Health Reform: The Rest Of The Story

Loathed by Conservatives, Feared by Liberals?

Years ago, as a cherry-cheeked participant in the AHIP's executive leadership program, the Disease Management Care Blog attended a national meeting keynoted by Massachusetts' Governor Mitt Romney.  Having steered bipartisan health reform legislation through the Bay State's notoriously liberal legislature, the Republican Mr. Romney was widely admired as a conservative centrist that could get things done.  The young DMCB liked what it heard and joined in the polite applause at the conclusion of Mr. Romney's speech.

How things have changed.  Massachusetts' insurance mandate and subsidies were co-opted by the Affordable Care Act (ACA), earning the Governor the enmity of  a grumpy Republican party and its Tea Party allies. 2012 Presidential front runner Mr. Romney now finds himself in the ironic position of being openly lauded by Democrats as the inspiration for Obamacare.

Since the road to the White House now  goes through having to defend "mandates," Mr. Romney on May 12 did what all politicians do when they have a problem: he gave a speech.  Curiously, however, he decided to give a PowerPointed Grand Rounds at the University of Michigan.  Initial reaction seems to be ranging from disappointment to skepticism to outright hostility. Absent in all of the mainstream media, however, is any helpful summary description of what Mr. Romney actually said. 

Thousands of smart DMCB readers want to know if it really is that bad.  Maybe not, says the DMCB.  Decide for yourself.

Mr. Romney's 30 minute presentation is readily viewable on YouTube in three parts (1, 2, and 3).  He readily admits that his stance on "replace and repeal" a federal law patterned "Romneycare" is political millstone, but, soldiering on, he points out that Massachusetts....

1. at the time he was Governor had a State fund committed to cover the costs of approximately 500,000 uninsured.  In the meantime, 94% of the population already had insurance.

2. used its "rights and responsibilities" under the 10th Amendment of the U.S. Constitution to address a "State" problem of "free riders." Several studies showed that many of the uninsured had the means to afford health insurance, yet, thanks to the fund's generosity, opted for free health care by refusing to pay their physician and hospital bills.

3)  The resulting law required "personal responsibility" from the free riders, using the threat of fines to force them to buy insurance. For those unable to afford it, the fund mentioned above was retasked to providing premium subsidies.  And, thanks to that fund, Massachusetts Taxpayer Foundation agrees that there have been no new taxes.

While what has been dubbed "Romneycare" worked in his State, he doesn't think its parallel is working at the Federal level. It has new taxes, upends the Federalist system by increasing D.C.'s involvement in health care, limits choice of insurance plans, is too complex, discourages innovation, repels physicians and kills jobs

So, President Romney would issue an ACA "waiver" to all 50 States while seeking a repeal of the law.  Then, he'd work on new legislation that would

1. return to Federalism with flexible State block grants and DISH payments that support charity-based care, exchanges, other subsidies, private coverage arrangements, chronic illness programs, reinsurance, risk adjusted programs and high risk pools,

2. promote responsibility by giving individuals a tax deduction for purchasing health insurance that is on the same level as what given to US businesses,

3. focus Federal regulation on making sure that insurance is portable, chronic illness is covered, that businesses can form purchasing pools and that insurance can be purchased across State lines,

4. establish medical liability reform with caps on non economic damages, health courts and alternative dispute resolution,

5. enable market reforms, such as health savings accounts that can can also be used to pay insurance premiums, co-insurance, value based insurance products, Consumer Reports style transparency, HIT, interoperoperability, capitated rates and bundled payments.

Mr. Romney's smarter critics readily distinguish between Federal vs. State involvement in health insurance. They condemn him for presiding over a mandate at any level, calling it, for example, a "blunder" in the "philosophy of government."  Opposed to anything other than a free market, they point to Massachusetts' rising costs, queues, and continued State governmental meddling.

All well and good, says the DMCB, but today's critics were far less visible when Massachusetts first passed its law, which even its supporters noted was a work in progress.  Thanks to 20/20 hindsight, the Cranky Conservative Class can find plenty to not like, but let's face it: based on what was known at the time, Romneycare sure looked like a good idea.  President Obama and his allies' mistake was not recognizing its lessons and recklessly doubling down with hundreds of billions of dollars worth of new Federal entitlement programs across all 50 States.  The Conservative Class' mistake is failing to discern that and adding insult to injury by making Mr Romney's affable style of bipartisanship an unforgivable sin.

The DMCB thinks there is no better evidence of just how much the Democrats fear Mr. Romney's ideas than the grins in this softball laden interview between MSNBC host Chuck Todd and current Massachusetts Governor Patrick. This one-two punch of 1) embarrassing liberal endorsement of Governor Romney's reforms combined with 2) attacking the candidate is political gamesmanship at it best, ultimately designed to enable a more right-of-center candidate to win the Republican nomination.  There is no way Mr. Duvall would have given that interview unless Mr. Obama's political handlers loathed the prospect of debating a bipartisan-minded Mr. Romney on the merits of State vs. Federal health care reform.