WASHINGTON -- The immediate reaction to Mitt Romney's 2009 USA Today op-ed on health care reform has zeroed in on his suggestion that President Barack Obama pursue an individual mandate. But that focus misses a broader problem the op-ed creates for the former Massachusetts governor.
Romney has consistently defended his health care reform effort in Massachusetts on 10th Amendment grounds, insisting that it was merely "a state solution to a state problem." The trouble with the president's plan, Romney has argued, is not that its policy particulars -- the individual mandate to buy health insurance, the coverage subsidies, the Medicaid expansion -- were based on the Massachusetts plan, but rather that it "was a power grab by the federal government to put in place a one-size-fits-all plan across the nation."
But Romney's op-ed, published during the heat of the health care debate and recently unearthed by BuzzFeed, is squarely on the side of health care reform being driven by the federal government. In fact, the national plan that Romney sketched out as acceptable to conservatives closely resembles the one that Obama ultimately signed into law.
Romney, after touting the success of the Massachusetts plan in the op-ed, noted that the main problem facing health care generally is soaring inflation and that only the federal government can rein it in. "Here is where the federal government can do something we could not: Take steps to stop or slow medical inflation," he wrote.
Simply believing that the federal government could take action to slow medical cost inflation is not evidence of hypocrisy, of course. Rep. Paul Ryan (R-WI), for instance, has put forth a plan that is nothing like Obama's and that he believes would ultimately lower health care costs. Romney has since embraced the basic contours of the Ryan plan. But Romney's Massachusetts law and Ryan's proposal are as divorced from each other as possible, and there's no indication that Romney was referring to a Ryan-type system in his 2009 op-ed.
After all, MIT economics professor Jonathan Gruber, a key policy architect behind both the federal and Massachusetts plans, famously compared them by saying "they're the same f***ing bill."
Indeed, Romney said in 2009 that Republicans would back the federal reform effort -- under a few conditions.
"Republicans will join with the Democrats if the president abandons his government insurance plan, if he endeavors to craft a plan that does not burden the nation with greater debt, if he broadens his scope to reduce health costs for all Americans, and if he is willing to devote the rigorous effort, requisite time and bipartisan process that health care reform deserves," he wrote in the final paragraph of his op-ed.
Nobody could accuse the president of not spending the "requisite time," with 14 months devoted to the process.
As for that "bipartisan process," the White House and Sen. Max Baucus (D-MT) worked endlessly with the bipartisan Gang of Six, threatening to drag down the entire bill as they negotiated for months. Ultimately, the only Republican who voted for the bill was Sen. Olympia Snowe (R-ME), and she did so only in the Finance Committee, opposing it on final passage.
As for the "government insurance plan," also known as the public option, Obama discarded that. The final bill did not increase the debt according to the Congressional Budget Office. And it will reduce "health care costs for all Americans" not just by providing subsidies but also by rewarding doctors and hospitals for healthy outcomes in general, rather than for a total number of procedures, just as Romney has repeatedly advocated.
The problem for Romney is that the federal-state distinction was the only real way he had of differentiating what he did from what the president has done. His own op-ed suggesting a bipartisan federal health care approach undermines any attempt to make that distinction between now and November.