Cartoon: Gary Varvel
The US spends twice as much per person on health care as other advanced economies, and Medicare is one of the biggest culprits.
Graphic by Rich Clabaugh/The Christian Science Monitor
Today, the Supreme Court justices will take a vote on the fate of President Obama’s healthcare law. We won’t know the outcome until June. But based on how the oral arguments went, the law’s chances of survival seem much slimmer than they did just one week ago.
The administration has been insisting all week that they have no “Plan B” to put in place if the law gets struck down - saying they remain confident that it is constitutional. But rest assured, over the next two months they will be scrambling to come up with both a policy fix and a political strategy to handle what now seems like a very real possibility that it will be overturned.
If the law is found unconstitutional, the Republican line of attack is already clear. It will be framed as both an example of executive overreach and utter incompetence. Just as the president was “in over his head” when it came to the financial crisis, Republicans will argue, he didn’t know what he was doing on healthcare either. As conservative columnist Peggy Noonan puts it in The Wall Street Journal, “The constitutional law professor from the University of Chicago didn’t notice the centerpiece of his agenda was not constitutional? How did that happen?”
For their part, many Democrats have been arguing that an overturn might actually help the president politically - since the whole issue would lose much of its urgency for the GOP base. This week, Senate Majority Leader Harry Reid told reporters, “There’s a significant school of thought that the administration is … in a better position for the election if it’s turned down.”
And Democratic strategist James Carville predicted on CNN that in the wake of an overturn, healthcare costs would skyrocket - and Republicans would then shoulder the blame for the problem. ”The Democrats are going to say, and it is completely justified, ‘We tried, we did something,’” Carville said. “The Republican Party will own the healthcare system for the foreseeable future.”
Still, that public shift in blame - if it happens - would likely be more of a long-term, rather than short-term effect. In the immediate aftermath, the Obama team will rely on a different line of defense, which can be summed up in two words: Mitt Romney.
As White House adviser David Plouffe put it last weekend on NBC’s Meet the Press, the likely Republican nominee is “the godfather of our healthcare plan.” It isn’t just Democrats making this case: Romney opponent Rick Santorum has been arguing throughout the primary fight that the Massachusetts law Romney put into effect as governor - which served as the model for Obamacare - makes Romney “uniquely disqualified” to run against the president on healthcare.
As we’ve already seen, Obama can employ Romney’s own words to defend key elements of Obamacare. Here’s Romney in 2007, talking about the need for an individual mandate (albeit at the state level):
“When [individuals who have chosen not to purchase insurance] show up at the hospital, they get care, they get free care, paid for by you and me. If that’s not a form of socialism, I don’t know what is. So my plan did something quite different. It said, you know what, if people can afford to buy insurance, if they can afford to buy insurance, or if they can pay their own way, then they either buy that insurance or pay their own way, but they no longer look to government to hand out free care. And that, in my opinion, is ultimate conservatism…. [W]e rely on private market dynamics to get people in our state insured and for individuals to finally take responsibility for some portion of their health care rather than expecting government to give them a free ride.”
Romney has said repeatedly that he never believed the Massachusetts model should be employed at the federal level. So far, it’s been a difficult distinction for him to draw.
But if the Supreme Court strikes down Obamacare, Romney will finally be handed one sharp, unequivocal contrast between his law and Obama’s: One was constitutional, while the other was not.
In fact, we can even conceive of Romney using his healthcare experience to then argue that he would be the ideal candidate to go in and clean up the policy mess that the Supreme Court decision may leave in its wake. That, of course, would take a certain amount of political deftness. We’ll see if Romney can rise to the occasion.
— Liz Marlantes
If Mitt Romney wins big today - and the polling going into most Super Tuesday contests suggests the momentum is on Romney’s side - he may have one person to thank: Rush Limbaugh.
The controversy surrounding Limbaugh’s crude remarks about Georgetown Law student Sandra Fluke has dominated political headlines since late last week. It has almost certainly not been helpful to Romney’s main challenger, Rick Santorum, whose personal views on birth control - which he has called harmful to women and society - would seem to put him on Limbaugh’s side of the argument (though Santorum publicly called Limbaugh’s attack on Fluke “absurd”).
But perhaps more important, the brouhaha overshadowed a new vulnerability for Romney that has emerged in recent days and that might otherwise have proved damaging: New evidence that Romney not only approved of the individual mandate in his healthcare law but wanted the federal government to follow suit - and only later tried to make it seem like he didn’t.
Last Friday, Buzzfeed’s Andrew Kaczynski dug up a 2009 op-ed by Mitt Romney in which the former Massachusetts governor clearly seemed to argue in favor of putting an individual mandate in the federal healthcare law.
In it, Romney wrote that “the lessons we learned in Massachusetts could help Washington.” Among those lessons:
“First, we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages ‘free riders’ to take responsibility for themselves rather than pass their medical costs on to others. This doesn’t cost the government a single dollar.”
A number of news outlets seized on the op-ed as evidence that Romney was not only originally on the same side as President Obama on the one issue that has arguably most inflamed the GOP’s conservative base - but had also been lying about his earlier position with impunity, as he later repeatedly claimed on the trail that he never thought the Massachusetts model should be implemented on a national scale. New York Magazine’s Jonathan Chait wrote:
“Romney is now on the verge of escaping with the party nomination having embraced a program his party considers inimical to freedom itself and blatantly lied about having done so without any major opponents pointing this out. It’s pretty incredible.”
On MSNBC’s “Morning Joe,” conservative host Joe Scarborough called Romney a “liar” repeatedly, asking:
“What does it say about a candidate, though, who wrote an op-ed in 2009 saying that, please apply what we did in Massachusetts nationally on an individual mandate, and then goes on the campaign trail yesterday and just lies?”
Not surprisingly, the Santorum campaign has been trying hard to make this a bigger story. Yesterday, the campaign held a conference call with reporters in which Santorum called Romney “an advocate for the individual mandate … not just for Massachusetts but for the federal government.”
The issue could have been particularly potent for Santorum in Ohio - where voters last year rejected the individual mandate by two-to-one on a largely symbolic ballot question.
But, thanks to Limbaugh sucking up all the oxygen, the amount of media attention paid to this story was almost certainly been less than it otherwise would have been.
— Liz Marlantes
It took 16 debates, but on the 17th night Rick Santorum finally put the conservative case against Mitt Romney (and, to a lesser extent, Newt Gingrich’s) healthcare histories into a complete package.
This argument has two prongs, which Santorum laid out neatly:
Prong 1, on the politics: “And [Romney]’s going to have to run against a president — he’s going to have to run against a president who’s going to say, ‘well, look, look at what you did for Massachusetts, and you’re the one criticizing me for what I’ve done? I used your model for it.’”
Prong 2, on what’s right: “You’re arguing for a plan; you’re defending a plan that is top-down. It is not a free-market health care system. It is not bottom-up. It is prescriptive and government. It was the basis for Obamacare.”
The full transcript is below, with Governor Romney and Speaker Gingrich’s remarks appended after the jump.
KING: Senator Santorum, you heard Governor Romney and you heard Speaker Gingrich. Do you trust them if one of them is the Republican party’s nominee and potentially the next president of the United States to repeal this?
FORMER SEN. RICK SANTORUM (R-PA.), PRESIDENTIAL CANDIDATE: The biggest — the biggest thing we have to do is elect a president. I think Newt’s right. The problem is that two of the people up here would be very difficult to elect on, I think, the most important issue that this country is dealing with right now, which is the robbing of our freedom because of Obamacare.
Governor Romney tells a very nice story about what his plan is now. It wasn’t his plan when he was in a position to do a plan. When he was governor of Massachusetts, he put forth Romneycare, which was not a bottom-up free market system. It was a government-run health care system that was the basis of Obamacare, and it has been an abject failure. And he has stood by it. He’s stood by the fact that it’s $8 billion more expensive…
… than under the current law. He stood by the fact that Massachusetts has the highest health insurance premiums of any state in the country. It is 27 percent more expensive than the average state in the country.
Doctors — if you’re in the Massachusetts health care system, over 50 percent of the doctors now are not seeing new patients — primary care doctors are not seeing new patients. Those who do get to see a patient are waiting 44 days on average for the care. It is an abject disaster. He’s standing by it. And he’s going to have to run against a president — he’s going to have to run against a president who’s going to say, well, look, look at what you did for Massachusetts, and you’re the one criticizing me for what I’ve done? I used your model for it. And then…
… then we have Speaker Gingrich, who has been — who has been for an individual mandate, not back when the time that just was — Heritage was floating around in the ’90s, but as late as comments since 2008, just a few years ago.
He stood up and said that you should have an individual mandate or post $150,000 bond. How many $150,000 bond holders do we have here who can post a bond for their health insurance?
These are two folks who don’t present the clear contrast that I do, who was the author of health savings accounts, which is the primary basis of every single conservative reform of health care.
I was the author of it back in 1991 and ‘92, 20 years ago. I’ve been fighting for health reform, private sector, bottom up, the way America works best, for 20 years, while these two guys were playing footise with the left.