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Friday, November 02, 2007

Mass Healthcare Plan Redux (a balanced article from Time)

The new article "Mitt Romney's Defining Moment" in Time, is worth a read. It revisits Romney's saga of Healthcare reform in MA.

This brings back a bit of nostalgia for me. I recall, in April 2006, when the passage of this plan hit the news. That's when I really started paying attention to Romney. As a physician, I've struggled with the day-to-day problem of "the uninsured" but have always cringed at the "solution", according to liberals, of a single-payer government healthcare system (Heck . . . Medicare and Medicaid are bad enough!) I studied the plan and studied up on Romney over the next couple of weeks. I was so impressed by the plan, his policy stances, his record of accomplishment, and his communication skills that I quickly felt a desire to aid him in his goal of becoming POTUS. To make a long story short, I decided that I could contribute to that cause by creating a blogsite (Iowans for Romney) to satisfy that desire while still keeping my "day job." Many of my first blog entries (here, here, here, and here) dealt with this plan (and that it WAS NOT socialized medicine).

It's a pretty balanced article with quite a few MSM "zingers" (How this plan is like Hillary's, How Romney doesn't stump about the plan much, How he doesn't support such a plan nationally, etc . . .) but I'll give you the "good parts" version.

if you ask him how he did it, as I did during an Iowa campaign swing, Romney becomes effusive. It may be that this tale from Massachusetts reveals what kind of President Romney could be. "He was incredibly impressive, with his intellect, his ability," says MIT economics professor Jonathan Gruber, a Democrat who advised Romney and who has since had a hand in the Massachusetts-style health-care plans put forward this year by Clinton, Barack Obama and John Edwards. "If there is anything that qualifies him to be President of the United States, it is his leadership on this issue."

Not bad praise from a Democrat advising other campaigns, eh?

The more the Governor thought about health care, the more intrigued he became by the idea of making it work better.

That whiff of a challenge was reinforced by the stories Romney heard as he traveled the state. After talking to a jeweler in North Andover, a man about his age, Romney remembers thinking, "Gosh, he's 55. He could have a heart attack. He could get cancer. He's got his own business, but he doesn't have health insurance? How can this be?"

So Romney started asking for ideas from his aides, many of whom--especially his political advisers--thought he should just drop it. "It was pooh-poohed by everybody," he says. "I am obstinate. I kept on drawing these squares: Well, if you have this number of people, you take that money, you move it there, couldn't that work? Let's do the math." State HHS secretary Ron Preston kept coming back to the one alternative Romney said he wouldn't accept: Dukakis' approach of requiring employers to either cover their workers or pay a hefty fee. "We didn't make as much progress as I wanted to," Romney says now. So the former management consultant did what he might have recommended to any CEO: he got a new team, showing Preston the door and giving the job to his policy director, former investment banker Tim Murphy. "The thing about Mitt," says Murphy, "is he wants to focus on the analysis."

When they considered the situation as if it were a business-school case study, some simple steps became clear, like getting the word out to the 106,000 Massachusetts citizens who were eligible for Medicaid but didn't seem to know it. Yet they also found something surprising when Romney began looking at who, precisely, the uninsured were in Massachusetts. Everyone expected the typical profile to be that of a single mother just scraping by or maybe someone with chronic illness--not exactly ideal customers for insurers. Instead, nearly the opposite was true. "It turned out they were largely single males, and they were working," Romney recalls. "They were eminently insurable. It's funny how data opens up new insight."

That was the bit of analysis that changed everything. Gruber ran the numbers at MIT: universal coverage would be expensive, but so would any half-measure. Romney could simply expand the existing system and, by doing so, cover about one-third more people. Or he could cover everyone by including an "individual mandate," a controversial measure requiring people to buy insurance and offering subsidies to those who couldn't afford it. The price tag would be about one-third higher. "I began by saying, Well, maybe we could help half the people that don't have insurance, maybe we could help a third of the people, and ultimately it became, You know what? We could actually get everybody insured!" Romney recalls.

In November 2004, nearly two years after his meeting with Stemberg, Romney was finally ready to go public with the beginnings of a plan. As it evolved, it became a proposal to achieve an end that liberals had long dreamed of, but through conservative means: creating more competition in the private-insurance marketplace and insisting that Massachusetts citizens take personal responsibility for their own coverage. "From the minute you heard him articulate it, you knew this was a new concept in American health-care policy," says Robert Blendon, a Harvard University professor of health policy. "It was a very different way of talking about coverage, and he was very articulate in framing it."

Everyone repeat after me: "EXECUTIVE COMPETENCE"

"Before long, Romney was in Kennedy's office in Washington, taking his PowerPoint slides with him. "Had Senator Kennedy said, 'This is a lousy idea, and I don't want anything to do with it,' I would have been back at square one," he admits. Kennedy was sold, and both men turned to the question of how to pay for the plan.

The author gives way too much credit to Kennedy in that last sentence . . . because Teddy wasn't a key figure in the crafting of the legislation nor in the "nuts and bolts" of making it economically viable. Kennedy, however, did see the novelty of the plan (and, I'm sure, was sick of all of his and other liberal healthcare plans never making the grade with the American people) . . . and he did have a key role in helping the plan not get stalled out in the legislature.

That outcome was far from certain. Romney and his PowerPoint traveled from one end of Massachusetts to the other. But as a Republican, Romney had very little leverage with the legislature, where the GOP's representation was so small it was less a minority than a cult. What's more, the senate and the house had very different ideas of what they wanted to do. As the two chambers squabbled, the Medicaid money was in danger of slipping away.

On a Sunday morning in February 2006, Romney personally taped handwritten notes to the doors of senate president Robert Travaglini and house speaker Salvatore DiMasi, begging them not to let this opportunity die. The speaker, for one, wasn't impressed. "A cheap publicity stunt," DiMasi says. Recognizing the limits of his own influence, Romney turned to Kennedy once again. "I asked for his help on certain legislators: 'Could you give a call on this one?'" Romney says. On March 22, 2006, Kennedy did more than that. He went to the floor of both the house and the senate on Beacon Hill and spoke in very personal terms about the battles with cancer his son and daughter had faced. "This whole issue in terms of universal and comprehensive care has always burned in my soul," Kennedy said. The Federal Government had failed the country on health care, he told the politicians , but "Massachusetts has a chance to do something about it."

The bill that emerged from the legislature two weeks later was different in many respects from what Romney had initially proposed. It increased reimbursement for hospitals, which Romney liked, but added more people to the Medicaid rolls, which he didn't. There were far too many requirements placed on insurance companies for Romney's tastes, and he used his line-item veto on the bill's stipulation that employers who don't cover their workers pay $295 per employee each year into a fund to subsidize coverage. The lawmakers easily overrode it . . .

Near the end of the article . . .

Everyone around Romney had assumed this achievement would be a centerpiece of his presidential campaign, showcasing the data-driven, goal-oriented, utterly pragmatic side of Romney. But that side of him has emerged only rarely on the 2008 trail. Instead, he rarely discusses the details of his Massachusetts plan and certainly doesn't tout his partnership with Kennedy. As a presidential candidate, he cautiously adheres to by-the-book Republican dogma of giving individual states leeway in the form of tax breaks to design their own reforms.

Rarely emerged? I guess they've been reading the MSM reports more than they've been around campaigning with Mitt. Even in the last debate in FL he was very clear to not distance himself with this plan nor give the Democratic MA Legislature all the credit for it.

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