One irony of this campaign is the fact that Mitt Romney's critics have generally said more nice things about his Massachusetts health care plan than he has. When I saw Romney on the campaign trail, early in the campaign, he'd mention it among his accomplishments but seemed determined to avoid any discussion of the details -- most likely, because it wouldn't play so well with the Republican base.
But the health care discussion in tonight's debate forced Romney to talk about details -- and, to his credit, he finally did, explaining why it was important to have an "individual mandate" requiring people to obtain health insurance. Even more interesting, he seemed to suggest he wanted everybody in America to have health insurance.
His actual plan wouldn't do that, since it merely offers some incentives to the states to reach that goal. But even embracing the goal -- even in this hazy, relatively meaningless fashion -- represents something of a break with the Republican pack. You don't hear Rudy Giuliani saying he wants to insure everybody. In fact, if you press him, he'll probably tell you that there aren't that many uninsured, they're not that badly off, etc.
Naturally, Romney also took his usual swipe at "Hillarycare" -- despite the fact that Clinton's plan for the nation, like the one John Edwards has put forward, would use the same basic design that Romney did in Massachusetts. But, in fairness, the plans are not exactly the same. Clinton and Edwards talk about funding their plans much more generously than Romney did in Massachusetts; they'd also create a public plan into which anybody could enroll. (Barack Obama, for that matter, would do the same -- although he hasn't called for a mandate right away like Clinton and Edwards have.)
The extra funding and the new govenrment programs are very, very important features. Without them, you really do create a situation where some portion of the population won't be able to afford coverage. (That's why Massachusetts has exempted a lot of working class people from the mandate, at least in the early going.) Of course, creating a new government health insurance program is postiviely verboten in Republican circles. So is spending significant sums of new money -- particularly if, as the Democrats would do, you get some of that money by letting the Bush tax cuts expire.
One more thing: I'm guessing we'll get a question about individual mandates in the Democratic debate. I've been thinking about this a lot lately. My preference for mandates as policy is well-known to readers of this space. But I confess I've been a bit taken aback at the hostility it generates even from the left (which, perhaps, Obama anticipated). I'm confident about the policy but the politics of the idea, I confess, are pretty complicated.
You could see Romney squirming up there -- and it wasn't hard to imagine Clinton or Edwards doing the same, under similar cross-examination from the eventual Republican nominee. Anyhow, it occurred to me -- as I was writing the above paragraphs, actually -- that Clinton and Edwards should emphasize the public option more.
At least on the left, the main complaint about mandates is that people are being forced to buy private insurance. But Clinton and Edwards both make a public plan available to anybody who wants it. Not only does open the door to a full-single payer plan down the road, it also guarantees that anbydoy who doesn't trust private insruance can get into a better option.
(Given how recently I thought of this, I'm not sure I'll still think it's all that great an idea days -- or even hours -- from now. But that's the great thing about blogs, right? You can write what you think, then change your mind later...)
P.S. By the way, we all spend a lot of time bashing the broadcast
media, so let me be the first -- or one of the first -- to say that ABC
is running a terrific, substance-driven debate. The health care
question began with a smart, provocative backgrounder by Dr. Timothy
Johnson, ABC's well-known medical editor. I know Johnson a little bit
and I can tell you that he understand health policy as well as he
understands medicine. Tonight, voters in New Hampshire and viewers
across the country benefitted from that expertise.
--Jonathan Cohn