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Assessing Mitt Romney's Healthcare Speech

A few initial reactions to Mitt Romney's healthcare presentation in Ann Arbor, Michigan this afternoon:

(1) I use the term "presentation" rather than "speech" because Romney did not use a prepared text or a teleprompter.  Instead, he delivered off-the-cuff (surely rehearsed) remarks at the beginning, then talked through a
powerpoint presentation outlining his plan to replace Obamacare -- which he said should be repealed.  He also chose a relatively small venue, speaking to an intimate audience of what looked like about 100 people.  He fielded several questions at the end.  To project a sense of informality onto what many pundits have pointed to as a pivotal speech, Romney went tie-free.  Stylistically, he performed very well.  He was smooth, detailed, knowledgeable, and on message.  In general, he presented himself as a sharp guy in full command of facts and details. 

(2) I suspect many conservatives will come away from Romney's presentation acknowledging that he's an impressive guy, but still thoroughly unconvinced by his rationalizations of previous policy positions -- namely, his signature 2006 Massachusetts healthcare law, which features an individual mandate.  Romney defended the policy against conservative critics -- arguing that states, and not the federal government, have the right to experiment in "laboratories of democracy."  This appeal to federalism is fine, but how can it be parlayed into a compelling case against Obamacare?  Romney essentially says, we were right to try this system on a limited scope at the state level, but President Obama is wrong to have implemented a very similar regime nationally.  Is that a distinction that will resonate with voters? 

(3) If, hypothetically, Romney were arguing that his experiment failed in many respects, and therefore shouldn't be repeated at the federal level, that could be quite powerful.  But he's still insisting that Romneycare was and is a success.  "I did what I think was right for the people of my state," he told the audience today.  I'll quote again from today's
Wall Street Journal editorial, which persuasively dissents from Romney's optimistic assessment of the Massachusetts law:

The only good news we can find is that the uninsured rate has dropped to 2% today from 6% in 2006. Yet four out of five of the newly insured receive low- or no-cost coverage from the government. The subsidies will cost at least $830 million in 2011 and are growing, conservatively measured, at 5.1% a year. Total state health-care spending as a share of the budget has grown from about 16% in the 1980s to 30% in 2006 to 40% today. The national state average is about 25%.

The safety-net fund that was supposed to be unwound, well, wasn't. Uncompensated hospital care rose 5% from 2008 to 2009, and 15% from 2009 to 2010, hitting $475 million (though the state only paid out $405 million). "Avoidable" use of emergency rooms—that is, for routine care like a sore throat—increased 9% between 2004 and 2008. Meanwhile, unsubsidized insurance premiums for individuals and small businesses have climbed to among the highest in the nation.

(4) I think the most damning portion of the event was Romney's detailed and unapologetic defense of the individual mandate -- the central pillar of both his and President Obama's respective healthcare policies.  Romney's justification for its implementation was virtually indistinguishable from the arguments advanced by the Obama White House.  The mandate is anathema to conservatives, and could very well be ruled unconstitutional.  How can Romney credibly argue that an outrageous, unworkable federal intrusion into every single American's life is totally unacceptable, but an outrageous, unworkable state-level intrusion into every single Massachusetts resident's life is just fine?  As the WSJ elegantly puts it, "Because the states have police powers under the Constitution, Mr. Romney's plan posed no legal problems. His blunder was his philosophy of government."

(5) After offering his robust defense of the MA healthcare kaw (Philip Klein lists and explains what he calls "failed defenses" HERE), Romney moved on to unveiling the broad strokes of his new healthcare plan for America.  Much of it sounded sensible, but a key question will linger in the minds of many primary voters:  If Mitt Romney got it wrong in Massachusetts with a failed big-government solution, and has refused to admit his mistake -- all while attacking President Obama for making virtually the exact same mistake on a larger scale, why should he be trusted to make sound policy decisions in the Oval Office?  It's a question of trust and judgment.  Based on initial reactions to the speech, it seems many conservatives still consider that at least a very open question.

The aforementioned Philip Klein -- a healthcare policy wonk at the Washington Examiner -- just unloads on the speech:

...We judge candidates based on what they actually did when they were in office, and Romney supported all the key principles of ObamaCare in the law he signed.

Most notably, Romney supported the individual mandate, which he again defended today, arguing that it was put in place to combat free riders. But that's precisely the argument the Obama administration is making, not only publicly, but in federal court to combat challenges to its constitutionality. Romney even described the mandate as a matter of “personal responsibility.” In the actual text of ObamaCare, the official name for the mandate is the “individual responsibility requirement.”


...Because the plans are so similar in structure, every time Romney defends his Massachusetts law, it is a de facto defense of the national health care law.

If Romney really is interested in repealing and replacing ObamaCare, the best thing he could do to help the cause is to stop running for president.

Jennifer Rubin at the Washington Post is similarly unimpressed.

Hugh Hewitt, who's a vocal admirer of Gov. Romney, offers his pre-analysis of the speech:

I will play excerpts of the speech Mitt Romney gives on health care on today's program.  ABC's The Note gives a good summary of the good and bad of Romney's plan in Massachusetts, but what matters much more than how that plan has worked is what Romney proposes be done by the federal government if he is elected president.  I suspect he will say about the Massachusetts plan that "some of it worked, some didn't."  But what he's got to say about Obamacare is that he has a plan to get rid of it and quickly.

Lots of Romney opponents argue that Massachusetts' plan sinks the Romney candidacy.  Take it form someone who was certain that Senator John McCain's amnesty bill, Gang of 14 ploy and campaign finance reform law would doom his candidacy, voters look forward, not backward, and it is about the choice they are offered the week they are voting not what a candidate did legislatively years earlier.

I respectfully disagree with the bolded sentence, for reasons explained in point #5.  I like and respect Mitt Romney, but I have major reservations about his Romneycare baggage.  Today's speech did not assuage those concerns.

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