There's a big disconnect between Mitt Romney and many Republicans over the Massachusetts health plan known as Romneycare. The Romney campaign believes questions about the plan have been asked and answered and there is little left to talk about. Some Republicans -- it's not clear how many, but a significant number -- believe the discussion hasn't even started.
It's a situation some Romney aides find baffling. "When people look back at this race, it will be interesting to see the amount of time the other candidates wasted talking about the Massachusetts health plan," says top Romney strategist Stuart Stevens. On the other side are those who nodded in approval when The Wall Street Journal editorial page, discussing the recent Republican debate in Las Vegas, noted that, "After seven debates and many more missed opportunities, the other GOP candidates finally pressed Mitt Romney on his Massachusetts health care record in a serious way."
Much of the arguing over Romneycare has consisted of Republicans accusing Romney of wanting to impose his Massachusetts plan on the entire nation, a la Obamacare. Less explored is the question of whether Romneycare, which up to now has been popular in Massachusetts, is a recipe for disaster that will inevitably lead to some combination of rationing, price controls and higher taxes. That would be a significant blot on Romney's record on whether he saw it as a national model.
On the first question, Romney did, in 2007, say, "If Massachusetts succeeds in implementing (Romneycare), then that will be a model for the nation." That certainly sounds like he was advocating a federal system. But on many, many other occasions, Romney spoke more carefully and said he believes Romneycare is a model for some states to follow but would not be a model for all states and certainly not for a federal plan.
"I think it's a great plan, but I'm a federalist," Romney said on "Meet the Press" in December 2007. "I don't believe in applying what works in one state to all states if different states have different circumstances."
In that 2007 interview, Romney pointed out that a relatively small number, 7 percent, of the Massachusetts population was uninsured. "Texas has 25 percent," he said. "Given the kind of differences between states, I'm not somebody who is going to say, 'What I did in Massachusetts I'm going to now tell every state they have to do it the same way.'" (Yes, Romney singled out Texas -- prescient for a candidate who would one day face that state's governor.)
But as much as he stressed federalism, Romney also stressed that he would be happy to see many states adopt his plan. "I think it's a good model for other states," he continued. "Maybe not every state, but most." At the federal level, Romney said he would "give every state the same kind of flexibility we got from the federal government." That's the Romney position, then and now.
But what about the different question of Romneycare in Massachusetts? On the day before the Las Vegas debate, The New York Times published a devastating story about the current state of Romneycare. Health costs in Massachusetts have risen steeply in the years since the introduction of Romney's plan. "Those who led the 2006 effort to expand coverage readily acknowledge that they deferred the more daunting task of cost control for another day," the Times reported, adding that Romneycare "did little to slow the growth of health costs that already were among the highest in the nation."
Now, with costs going up, the current Massachusetts governor, Democrat Deval Patrick, is considering a cost-control plan that could lead to the dreaded rationing, price controls and higher taxes.
The story seemed ready-made for one of Romney's Republican opponents, who could look Romney in the eye and charge that he had expanded coverage without regard to rising costs, leading to growing taxpayer subsidies and still more government involvement in health care. Former Sen. Rick Santorum tried to make just that case, but got so caught up in interrupting Romney that he failed to put forth a coherent argument. Other candidates intervened, and the question wasn't fully explored -- again.
If it comes up in future debates, Romney will likely argue that he's not responsible for what his successor does. But instead of fending off accusations about whether or not he intended it as a national model, Romney would be forced to discuss the actual workings of Romneycare. That hasn't happened very often, at least not yet.
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