The Google is a terrible thing

Mitt Romney gave a fine defense of the individual mandate to purchase health insurance – back in 2006.

Mitt Romney, explaining Romneycare to Wall Street Journal readers in 2006 (emphasis added):

I assembled a team from business, academia and government and asked them first to find out who was uninsured, and why. What they found was surprising. Some 20% of the state’s uninsured population qualified for Medicaid but had never signed up. So we built and installed an Internet portal for our hospitals and clinics: When uninsured individuals show up for treatment, we enter their data online. If they qualify for Medicaid, they’re enrolled.

Another 40% of the uninsured were earning enough to buy insurance but had chosen not to do so. Why? Because it is expensive, and because they know that if they become seriously ill, they will get free or subsidized treatment at the hospital. By law, emergency care cannot be withheld. Why pay for something you can get free?

Of course, while it may be free for them, everyone else ends up paying the bill, either in higher insurance premiums or taxes. The solution we came up with was to make private health insurance much more affordable. Insurance reforms now permit policies with higher deductibles, higher copayments, coinsurance, provider networks and fewer mandated benefits like in vitro fertilization – and our insurers have committed to offer products nearly 50% less expensive. With private insurance finally affordable, I proposed that everyone must either purchase a product of their choice or demonstrate that they can pay for their own health care. It’s a personal responsibility principle.

Some of my libertarian friends balk at what looks like an individual mandate. But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on government is not libertarian.

Another group of uninsured citizens in Massachusetts consisted of working people who make too much to qualify for Medicaid, but not enough to afford health-care insurance. Here the answer is to provide a subsidy so they can purchase a private policy. The premium is based on ability to pay: One pays a higher amount, along a sliding scale, as one’s income is higher. The big question we faced, however, was where the money for the subsidy would come from. We didn’t want higher taxes; but we did have about $1 billion already in the system through a long-established uninsured-care fund that partially reimburses hospitals for free care. The fund is raised through an annual assessment on insurance providers and hospitals, plus contributions from the state and federal governments.

To determine if the $1 billion would be enough, Jonathan Gruber of MIT built an econometric model of the population, and with input from insurers, my in-house team crunched the numbers. Again, the result surprised us: We needed far less than the $1 billion for the subsidies. One reason is that this population is healthier than we had imagined. Instead of single parents, most were young single males, educated and in good health. And again, because health insurance will now be affordable and subsidized, we insist that everyone purchase health insurance from one of our private insurance companies.

And so, all Massachusetts citizens will have health insurance. It’s a goal Democrats and Republicans share, and it has been achieved by a bipartisan effort, through market reforms.

You can run, Mitt, but you can’t hide. Anyway, you were far more convincing playing a technocrat than you are playing a pitchfork-wielding ignoramus.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

7 thoughts on “The Google is a terrible thing”

  1. Insurance reforms now permit policies with higher deductibles, higher copayments, coinsurance, provider networks and fewer mandated benefits like in vitro fertilization – and our insurers have committed to offer products nearly 50% less expensive. With private insurance finally affordable…

    Note that this is the opposite direction to the Federal bill, which has increased mandated benefits and reduced permissible deductibles and copays.

    Also note that the Massachusetts reform has cost much more than projected.

  2. And if Romney & other Republicans had brought that up and said "hey, this bill is similar to the Mass. bill and we've seen X, Y and Z problems crop up, so we propose the following changes…" it would have been interesting and potentially useful.

    Instead, we got "Death Panels!" and "Communism!" and such. Well played, GOP, well played indeed. Thanks for nothing.

  3. Mitt's problem is that he's in the wrong party. If he was a Democrat, he could just say "I leave my religion at the door" or some other pro-church-state-separation thing when asked about his faith. If he was a Democrat, the above would be an immense asset for any possible run for President – he could present himself as a moderate Democrat who got things done, including the reform above. He's already shown in the past that he can support abortion rights if it means he'll get office (his 1994 Massachusetts Senate run), and so forth.

    In fact, if Mitt was a Democrat, had accomplished what he did as Governor, and made a run at President in 2008 as a Democrat, he'd probably be Obama's Vice President, and almost certainly would have been offered a position in Obama's cabinet if not the VP position.

  4. Great find. Thanks for this one Mark. Good point made by Rob. I wish we could have a Republican party that argued for fiscal conservatism and a more market oriented approach in a well thought out, intelligent fashion. Instead, all we get are blind tax cuts, mindless deregulation and unjust wars based on phony intel and suspect motives.

  5. Brett–Interesting thought, Romney as moderate Democrat. But do remember that Romney made his bones with Bain Captital doing leveraged buy-outs–amassing fast wealth for shareholders and executives, shipping manufacturing and high tech service jobs out of the country, using offshore tax shelters. Imagining Romney as a Democrat is kinda like imagining Jesus as a Pharisee. Quite hard.

  6. Bill, none of those things are unlike a Democrat. There are lots of corporate Dems. Romney would fit right in.

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