Romneycare Sure Looks Like Obamacare

Reading Mitt Romney's No Apology it's hard to avoid the suspicion that Obama and Romney have more in common with each other on the issue of healthcare reform than either does with his party's more fervent supporters.

Click here for all of David Frum’s blogposts on Mitt Romney’s “No Apology”.

I have to say I got a big chuckle out of Romney's healthcare chapter. Two years ago, I published a book on conservative reform that urged conservatives to pay more attention to the social costs of obesity. Those lines prompted National Review's book reviewer to ceremonially drum me out of the conservative movement. Two years later, the candidate endorsed by National Review in 2008 has this to say: "One of the biggest behavioral contributors to sickness and death is our big waistlines, and the cascading negative health impact of that excess weight." (191) Romney then proceeds through a very well-informed discussion of the obesity problem, culminating in a suggestion that health insurers be allowed to discount premiums for the non-obese.

Romney sharply distinguishes his healthcare preferences from Barack Obama's. For him, the red line is the public option. He adamantly opposes it. Yet in many other respects, there is common ground. Like Obama, Romney worries about the malign incentives of fee-for-service medicine. Like Obama, Romney regards the status quo as unsustainable. Like Obama, Romney is a big fan of the healthcare journalism of Atul Gawande.

And of course, the public option has now vanished from the Obama plan. Which means that the federal plan bears a closer family resemblance than ever to Romney's idea: regulated health insurance exchanges, mandates to buy insurance for those who can afford it, subsidies for those who cannot. Romney's preference would be to omit the mandate for those who "can demonstrate their ability to pay their own health-care bills." (176) That would be precious few of us. And he wants to allow states ample leeway to innovate without hindrance by the federal government.

Romney frames the distinction between his preferences and President Obama's as "free enterprise and consumer-driven markets or government management and regulation." (193)

It's hard to avoid the suspicion that these two technocrats have more in common with each other on this issue than either does with his party's more fervent supporters. With this one difference: shout outs to CEOs in Ch 7 - 3, including one to the CEO of drugmaker Novartis.