It has been a long slog, since those days in the early 1990s when right-wing policy analysts proposed an individual mandate to purchase health coverage as a respectable, market-oriented, responsibility-based alternative to either government-provided health care (the nanny state) or mandated employer-provided health care (the boss state). In November, 2004, Republican Governor Mitt Romney of Massachusetts followed through on that conservative proposal, and in April, 2006 he signed into Massachusetts law a health reform plan based on it.
Having conquered Massachusetts, RomneyCare is now the law of the land. But how did Republican RomneyCare become Democratic ObamaCare?
True, the copy is not exact. David Frum points out all the possible reasons--valid and invalid, important and unimportant--that conservatives might be unhappy with this Obama-Pelosi-Reid version of RomneyCare. He finds six:
- it allows illegal aliens to buy health insurance with their own money;
- the progressive taxes imposed to finance it will only become larger and more progressive as time passes;
- a public option may be added to the bill at some point;
- it imposes too many costs on small businesses;
- it doesn't impose enough cost controls;
- it expands the dysfunctional program that is Medicaid.
But these issues are minor compared to the big nut -- the essence of the reform -- which is that the insurance market has been restructured to remove those adverse-selection and moral-hazard problems that have broken our private insurance-based health-financing system. Americans are now being asked not to shirk their responsibilities but rather to act like adults: to take on the burden, to the extent they are financially able, of making sure that when they wind up at the hospital the cost of paying for their care is not loaded onto somebody else's shoulders.
The conservative DNA of ObamaCare is hardly a secret. "The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan,” Frum wrote. “It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994."
So why are none of the talking heads on your TV screen and none of the op-ed writers in your newspaper talking about how this health plan is a big victory for Mitt Romney and Republican policy analysts? Because there has been a conspiracy of silence among those working for the bill and those working against it.
Republicans working against the bill have been unwilling to say "It's RomneyCare!" because they would then face the awkward question of why they did not support it. And they were never, never, never going to vote for it. The point for the Republican legislators, you see, was to follow the Gingrich strategy: work as hard as you can to block the Democratic president’s initiatives so that the press then portrays him as a wimp. Then, Republicans could pick up seats and regain their congressional majorities -- for Americans do not like wimps and the politicians who support them. This political gambit overwhelmed all policy considerations. The Son of Man himself, coming unto the Ancient of Days and stating that this was his favorite health care financing mechanism, could not have called forth Republican votes for it in Congress.
And the Democrats? Well, the critical votes -- numbers 200-240 in the House and numbers 55-60 in the Senate--would vote for RomneyCare but not for anything more liberal and interventionist. These Democrats would not support any form of government-provided health care -- not even Medicare-for-All or Federal-Employees-Heath-Benefit-Plan-for-All. They were not on board for any plan that required businesses to pool the costs of their workers and bargain in their behalf for affordable health care. They were not even on board for a plan that allowed people to vote-with-their-feet and sign up for Medicare if they thought it was a better deal than their private insurance.
So for the Democrats, it was RomneyCare or nothing. Thus the task for Harry Reid, Nancy Pelosi, and Barack Obama was to hold the Democratic right to RomneyCare while not losing the Democratic left. As long as they could say to the left, "Look, this is what we can pass: it's a lot better than a poke in the eye with a sharp stick (and a poke in the eye with a sharp stick is a lot better than our current health care financing system)," they had a chance of holding the left, especially if they could sweeten it with progressive tax and subsidy policies. But if they pointed out the intellectual origins of the plan -- oh, and by the way the guts of the plan came out of the conservative uber-think tank, the Heritage Foundation, and it was what Mitt Romney thought was good policy back in 2004 -- then the left-wing Democrats' heads would have exploded and their votes would have vanished.
Over in that alternative branch of the quantum-mechanical multiverse in which Mitt Romney was elected President in November 2008, this health care bill--with much smaller subsidies and no tax increases on the rich, and with other tweaks and modifications--passed the House of Representatives 352-83 and passed the Senate 79-20, with near-solid Republican support. Left-wing Democrats whined that it was not real reform. The David Broders and David Brookses of the world trumpeted it as an extraordinary victory for American bipartisanship.
Instead, we are here -- where a nearly identical plan appears very, very different.
We truly live in a weird world.