The campaign desperately needs clarity on this issue. It needs also to shake that worrying tentativeness on Romneycare -- a timidity that suggests to voters that Romney has something to hide.
The answer to the question: "Wasn't Romneycare exactly the same thing as Obamacare?" is, to quote Nancy Pelosi, "Are you serious?" The Massachusetts law contained an individual mandate, which states -- unlike the federal government -- are allowed to impose. But it did not consist of 2,700 pages of new regulations; 159 new boards and commissions; and more than $500 billion in new taxes (and counting); the Independent Payment Advisory Board, a rationing board whose decisions are unreviewable by the courts and practically untouchable by Congress itself; restrictions on religious liberty; Medicare cuts; affirmative action mandates for medical and dental schools; huge new authority over one-seventh of the U.S. economy for the Secretary of Health and Human Services; and open-ended regulations of the way doctors and others perform their jobs.
Beyond that, a glance at the history of Romneycare in Massachusetts shows that Romney's instincts and initiatives were for free-market reforms. An 85 percent Democratic legislature thwarted his best efforts, and a Democratic successor as governor twisted the law's trajectory dramatically.
Before Romney's time, Massachusetts had enacted a number of laws that made its health care system needlessly expensive. All policies offered in the state were required to cover expensive treatments such as substance abuse counseling and infertility. In 1996, the state passed a law requiring "guaranteed issue" and "community rating" -- meaning people could wait until they got sick to purchase health insurance. Naturally, rates skyrocketed. In addition, a 1986 federal law required hospital emergency rooms to treat all patients, regardless of ability to pay.
Romney's idea was to permit Massachusetts insurers to sell catastrophic plans. As Avik Roy explained in Forbes, "Shorn of the costly mandates and restrictions originating in earlier state laws, these plans, called 'Commonwealth Care Basic,' could cost much less. Romney also proposed merging the non-group and small-group markets, so as to give individuals access to the more cost-effective plans available to small businesses." Romney's plan would also have involved a degree of cost sharing so that those receiving subsidies would have an incentive to minimize their consumption.
Romney agreed to the mandate, believing that Massachusetts citizens would get the opportunity to purchase inexpensive, catastrophic plans. But the legislature, together with Romney's successor as governor, Deval Patrick, changed the law to require insurers to offer three tiers of coverage -- all of them far beyond catastrophic care. Perhaps Romney ought to have foreseen what future legislatures and governors would do -- but that's a far cry from the accusation that Romneycare was indistinguishable from Obamacare.
Romney's proposed reforms included fraud prevention measures for Medicaid, requiring the income of both parents to be considered in children's Medicaid eligibility, medical malpractice tort reform, and giving individuals the same treatment as small businesses in the purchase of health plans. He envisioned a system of increased competition and choice.
The bill that passed the legislature contained a number of features Romney couldn't countenance. He opposed the mandate, preferring to permit individuals to post a $10,000 bond in lieu of insurance. The legislature overrode him. He vetoed the employer mandate, coverage for illegal aliens, the creation of a new bureaucracy to be called The Public Health Council, a provision limiting improvements to Medicaid, and one expanding Medicaid coverage to include dental care. His vetoes were overridden.
The health reform law Romney introduced -- as opposed to the one that was implemented by his successor -- stressed competition, reduced regulation and expanded choice for the consumer.
It was a mistake for Romney to sign the bill. As Avik Roy put it, "The individual mandate was a loaded gun that Romney handed to his opponents, who used it to force individuals to buy comprehensive insurance they didn't need." But Romney's bona fides as a free-market advocate and critic of Obamacare are not undermined by Romneycare. He can rightly claim that he foresaw, and attempted to prevent, the consequences of heavy-handed government control of the health care market.