It's not as if we had a beautifully functioning free market in health care until Gov. Mitt Romney came along and wrecked it by requiring that Massachusetts residents purchase their own health insurance. In 2007, when Romneycare became law, the federal government alone was already picking up the tab for 45.4 percent of all health care expenditures in the country.
Until Obamacare, mandatory private health insurance was considered the free-market alternative to the Democrats' piecemeal socialization of the entire medical industry.
In November 2004, for example, libertarian Ronald Bailey praised mandated private health insurance in Reason magazine, saying that it "could preserve and extend the advantages of a free market with a minimal amount of coercion."
A leading conservative think tank, The Heritage Foundation, helped design Romneycare, and its health care analyst, Bob Moffit, flew to Boston for the bill signing.
Romneycare was also supported by Regina Herzlinger, Harvard Business School professor and health policy analyst for the conservative Manhattan Institute. Herzlinger praised Romneycare for making consumers, not business or government, the primary purchasers of health care.
The bill passed by 154-2 in the Massachusetts House and unanimously, 37-0, in the Massachusetts Senate -- including the vote of Sen. Scott Brown, who won Teddy Kennedy's seat in the U.S. Senate in January 2010 by pledging to be the "41st vote against Obamacare."
But because both Obamacare and Romneycare concern the same general topic area -- health care -- and can be nicknamed (politician's name plus "care"), Romney's health care bill is suddenly perceived as virtually the same thing as the widely detested Obamacare. (How about "Romneycare-gate"?)
As The New York Times put it, "Mr. Romney's bellicose opposition to 'Obamacare' is an almost comical contradiction to his support for the same idea in Massachusetts when he was governor there." This is like saying state school-choice plans are "the same idea" as the Department of Education.
One difference between the health care bills is that Romneycare is constitutional and Obamacare is not. True, Obamacare's unconstitutional provisions are the least of its horrors, but the Constitution still matters to some Americans. (Oh, to be there when someone at the Times discovers this document called "the Constitution"!)
As Rick Santorum has pointed out, states can enact all sorts of laws -- including laws banning contraception -- without violating the Constitution. That document places strict limits on what Congress can do, not what the states can do. Romney, incidentally, has always said his plan would be a bad idea nationally.
The only reason the "individual mandate" has become a malediction is because the legal argument against Obamacare is that Congress has no constitutional authority to force citizens to buy a particular product.
The legal briefs opposing Obamacare argue that someone sitting at home, minding his own business, is not engaged in "commerce ... among the several states," and, therefore, Congress has no authority under the Commerce Clause to force people to buy insurance.
No one is claiming that the Constitution gives each person an unalienable right not to buy insurance.
States have been forcing people to do things from the beginning of the republic: drilling for the militia, taking blood tests before marriage, paying for public schools, registering property titles and waiting in line for six hours at the Department of Motor Vehicles in order to drive.
There's no obvious constitutional difference between a state forcing militia-age males to equip themselves with guns and a state forcing adults in today's world to equip themselves with health insurance.
The hyperventilating over government-mandated health insurance confuses a legal argument with a policy objection.
If Obamacare were a one-page bill that did nothing but mandate that every American buy health insurance, it would still be unconstitutional, but it wouldn't be the godawful train wreck that it is. It wouldn't even be the godawful train wreck that high-speed rail is.
It would not be a 2,000-page, trillion-dollar federal program micromanaging every aspect of health care in America with enormous, unresponsive federal bureaucracies manned by no-show public-sector union members enforcing a mountain of regulations that will bankrupt the country and destroy medical care, as liberals scratch their heads and wonder why Obamacare is costing 20 times more than they expected and doctors are leaving the profession in droves for more lucrative careers, such as video store clerk.
Nothing good has ever come of a 2,000-page bill.
There's not much governors can do about the collectivist mess Congress has made of health care in this country. They are mere functionaries in the federal government's health care Leviathan.
A governor can't repeal or expand the federal tax break given to companies that pay their employees' health insurance premiums -- a tax break denied the self-employed and self-insured.
A governor can't order the IRS to start recognizing tax deductions for individual health savings accounts.
A governor can't repeal the 1946 federal law essentially requiring hospitals to provide free medical services to all comers, thus dumping a free-rider problem on the states.
It was precisely this free-rider problem that Romneycare was designed to address in the only way a governor can. In addition to mandating that everyone purchase health insurance, Romneycare used the $1.2 billion that the state was already spending on medical care for the uninsured to subsidize the purchase of private health insurance for those who couldn't afford it.
What went wrong with Romneycare wasn't a problem in the bill, but a problem in Massachusetts: Democrats.
First, the overwhelmingly Democratic legislature set the threshold for receiving a subsidy so that it included people making just below the median income in the United States, a policy known as "redistribution of income." For more on this policy, see "Marx, Karl."
Then, liberals destroyed the group-rate, "no frills" private insurance plans allowed under Romneycare (i.e. the only kind of health insurance a normal person would want to buy, but which is banned in most states) by adding dozens of state mandates, including requiring insurers to cover chiropractors and in vitro fertilization -- a policy known as "pandering to lobbyists."
For more on "pandering" and "lobbyists," see "Gingrich, Newt." (Yes, that's an actual person's name.)
Romney's critics, such as Rick Santorum, charge that the governor should have known that Democrats would wreck whatever reforms he attempted.
They have, but no more than they would have wrecked health care in Massachusetts without Romneycare. Democrats could use a sunny day as an excuse to destroy the free market, redistribute income and pander to lobbyists. Does that mean Republicans should never try to reform anything and start denouncing sunny days?
Santorum has boasted of his role in passing welfare reform in the 1990s. You know what the Democrats' 2009 stimulus bill dismantled? That's right: the welfare reform that passed in the 1990s.
The problem isn't health insurance mandates. The problem isn't Romneycare. The problem isn't welfare reform. The problem is Democrats.
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