Journal's Romneycare Attack Misses the Mark

Written by David Frum on Thursday May 12, 2011

Today's Wall Street Journal savagely criticizes Mitt Romney's health care record. But their argument isn't very convincing.

Today's Wall Street Journal savagely criticizes Mitt Romney's health care record.

Let's try to reverse-engineer the editorial to see what the editors believe Romney should have done instead.

When Mr. Romney took office in 2003, the state was already enforcing public utility-style regulation of insurers for premiums and multiple benefit mandates. The resulting distortions were increasing rates fast, along with the natural increases from good but expensive Massachusetts medicine.

In other words: rate regulation of insurers is bad. Using regulation to hold rates down causes rates to go up instead.

The conceit was that a universal reform would cover everyone and all but pay for itself by reorganizing the state's health-care finances

Universal coverage: bad. Universal coverage will force costs up.

In the name of personal responsibility, Mr. Romney also introduced the individual mandate, first in the nation, requiring everyone to buy coverage or else pay a penalty. Free riders, he said, transferred their own costs to others, either through higher premiums or taxes. This is the same argument the Obama Administration is now using to justify the coercion of the individual mandate in the federal courts.

Individual mandates: bad. The "free rider" argument only conceals state coercion.

The people who don't buy coverage though they can afford it aren't really a major fiscal problem .... People who are priced out of coverage require subsidies—so in practice the logic of the individual mandate is that it is a government mandate too.

Subsidies to cover private health insurance for those who cannot afford it: bad. They cause government to grow.

Entitlements automatically grow and grow, and then the political class begins to make decisions that used to be left to markets and individuals.

Political decisions about health coverage: bad. Instead the decision about who should not be covered should be left to markets: if the market does not assign you enough money for coverage, you should not have coverage.

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.

A decline in the number of the uninsured is good if and only if they receive no public aid. Then it becomes bad.

The assumptions encoded in the Journal editorial make nonsense of the Journal's conclusions.

Once government takes on the direct or implicit liability of paying for health care for everyone, the only way to afford it is through raw political control of all medical decisions.

Mr. Romney's refusal to appreciate this, then and now, reveals a troubling failure of political understanding and principle. The raucous national debate over health care isn't about this or that technocratic detail, but about basic differences over the role of government. In the current debate over Medicare, Paul Ryan wants to reduce costs by encouraging private competition while Mr. Obama wants the cost-cutting done by a body of unelected experts like the one emerging in Massachusetts.

But of course the Paul Ryan plan for Medicare does feature a mandate - which is supposedly bad, according to the WSJ. And the Romney plan for Massachusetts did encourage private competition - and yet somehow failed to control costs, which shouldn't happen according to the WSJ.

The WSJ wants to argue that "it's not so much the money as the principle of the thing." But of course the real evil as diagnosed by the Journal is precisely the money. So long as less money is spent, as Ryan proposes, then mandates cease to be a problem for the WSJ. If more money as spent, as occurred under Romney, then private market competition ceases to be an important benefit for the WSJ.

Put bluntly, it's not a very attractive argument.

And it's an argument that Mitt Romney could decisively refute today if he wished. He would begin: "Unlike the Wall Street Journal, I do not think that leaving millions of people uninsured is a good way to hold healthcare costs down." You could even describe such an argument as "no apologies".