Mitt Romney To Talk Healthcare Rip/Replace On Thursday

By Justin Gardner | Related entries in Health Care, health care reform, Republicans, Romney

We all knew this would happen sooner or later, but Romney seems to be finally throwing his Massachusetts healthcare plan under the bus.

ABC takes a look at the upcoming speech:

Former Massachusetts Governor and likely Republican presidential candidate Mitt Romney will outline his approach to health care reform in Michigan Thursday, announcing a plan to “repeal and replace” the law that Democrats enacted last year.

As governor in 2006, Romney signed Massachusetts’ bipartisan health reform law. It required everyone in the state to obtain health insurance and became a model for the controversial law that national Democrats enacted for the entire country in 2010. [...]

A Romney adviser tells ABC News that he will address his own record on health care reform but that it won’t be a major focus of his speech. While Minnesota Governor Tim Pawlenty has apologized for his past support for legislation to enact a “Cap and Trade” system to cut down on carbon emissions, calling it a “clunker”, don’t expect Romney to do the same on health care reform. Look for Romney to continue his federalism defense: the plan he enacted was right for Massachusetts, but not for the entire country.

Sure, he says he’s not doing it, but he is. We all know he is, even if he doesn’t say that the Massachusetts program was wrong. You don’t set up a statewide system that mandates health care coverage without thinking about the implications for that working on a nationwide basis. Romney had presidential aspirations, was seeking to come up with a Republican alternative to single-payer and he found it. So kudos to him. That’s why Obama’s health care plan was originally seen as compromise until Republicans (who had once supported it) started demonizing it as socialist.

Regardless, here are the talking points for his new plan…

• Restore to the states the responsibility and resources to care for their poor, uninsured, and chronically ill.
• Give a tax deduction to those who buy their own health insurance, just like those who buy it through their employers.
• Streamline the federal regulation of healthcare.
• Reduce the influence of lawsuits on medical practice and costs.
• Make healthcare more like a consumer market and less like a government program.

So how are Americans liking Obama/Romney mandated healthcare? A majority favor it according to a recent poll…

The most recent Kaiser Health Tracking poll from April found that 52 percent of Americans wanted to either expand the health care law or leave it as is, while 35 percent said they wanted Congress to repeal it and replace it with a Republican alternative or simply repeal it without an alternative. Overall, just 15 percent preferred the repeal and replace option.

Still, we won’t really know what Americans think of it until 2014 when it really takes effect, but for now Romney is fighting with the GOP on what has become a more popular idea. Can his message translate to the presidential campaign and win swing voters who now favor his old plan?

More as it develops…


This entry was posted on Tuesday, May 10th, 2011 and is filed under Health Care, health care reform, Republicans, Romney. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

16 Responses to “Mitt Romney To Talk Healthcare Rip/Replace On Thursday”

  1. kranky kritter Says:

    You don’t set up a statewide system that mandates health care coverage without thinking about the implications for that working on a nationwide basis.

    What’s that supposed to mean? MA’s HCR program didn’t run afoul of our state constitution. There were plenty of complications and contentious details involved in passing MassHealth, and no reason to worry about whether or not everything in it would scale perfectly to the national level.

    Here’s the thing: MA acted like a state lab and tried something, and has learned a lot. For example, one thing MA learned is that the program didn’t do much of anything to control costs. It cost way more than estimated, drew way more subsidized enrollees than predicted, and is costing the state a fortune compared to what its defenders predicted. As a result, our legislature is trying to come up with some new and very complicated and massive reform of the way that healthcare gets reimbursed. So don’t anyone pretend that MassHeath at this point is anything more than (at best) a good faith work-in-progress effort that has greatly improved access while doing nothing demonstrable about cost growth.

    And that’s the thing none of can run away from. NO ONE has come up with any especially good, plausible, demonstrated ideas for controlling cost growth. At some point, someone with a scintilla of pubes heaves the r-word up onto the table. We’ll discover that we probably don’t want to afford unlimited hip replacements and heart bypasses and heroic whatever-it-takes-end-of-life efforts for everyone.

    Justin, for the fucl<ing love of christ do something to make the captcha easier.

  2. Mike A. Says:

    “And that’s the thing none of can run away from. NO ONE has come up with any especially good, plausible, demonstrated ideas for controlling cost growth. ”

    Agreed. The effort that Mass is going through should continue and should be continuously assessed as it is modifed. Our political system frowns upon “failures” and does not embrace the process of trial, error, and learning. This is the foundation of continuous improvement. These problems are highly complex with significant interactions and interdependencies across many parts of the government. Until we begin experimenting on a smaller scale to understand what does and does not work, we will struggle to implement an effective solution on the larger, national scale.

  3. gerryf Says:

    “And that’s the thing none of can run away from. NO ONE has come up with any especially good, plausible, demonstrated ideas for controlling cost growth. ”

    Most of the western world has–it’s called single payer. Perfect? No. But it works better at controlling costs than all the Obamacare and RomneyCare plans put together.

  4. Tully Says:

    Most of the western world has–it’s called single payer.

    “Single-payer” being another name for “government rationing,” gerryf. Or “central planning,” if you prefer. It tends to fail completely as a long-run health-care cost containment device in democratic nations, for reasons which should be obvious. People vote for what they want.

    And your statement is simply not true. When it comes to excess health-care cost growth (EHCCG — cost growth exceeding GDP growth, or alternatively, growth in personal income including benefits both government and private) many of those vaunted single-payer systems have higher EHCCG than the US. For example, from 1999 to 2008 health expenditures grew in the United Kingdom at an average rate of 7.2 percent, compared to 5.9 percent for the United States. The differential is even higher when adjusted to reflect the “excess” portion of that cost growth. Canada’s average annual growth from 1999-2008 was 5.9%, same as the US. The US is about in the middle of the pack for EHCCG among OECD nations, BTW.

    RomneyCare was supposed to take pressure off of ER’s and allow broader access to doctors while controlling costs. Instead, Mass ER’s are more crowded than before and wait times for doctor appointments have increased while costs soared. Utterly predictable (and predicted by me back then) as throwing more money or even just more structured payment streams at a limited-supply high-demand market simply stimulates immediate demand while not providing any increase in short-term supply, resulting in either higher prices or increased per capita shortages or some combo thereof.

    The real drivers of EHCCG are limited supply and unlimited demand for relatively price-inelastic medical goods and services. This will occur in ANY developed nation — health care spending comes after basic goods, so after the basic requirements of food and shelter are covered every additional dollar of income will be disproportionally spent on health care.

  5. kranky kritter Says:

    Right. Single-payer doesn’t control costs. Now, there are a few decent reasons to consider undertaking that approach. For one, you get a bit of one-time cost savings as provision becomes streamlined. And the rationing that consumers are subjected to is somewhat less haphazard than under our current patchwork.

    But single-payer will never really control costs to consumers unless the rationing becomes ever more draconian in response to price increases that come from the demand-supply gap. IMO, no one serious about healthcare ought to pretend that this is a problem that Europe or Canada has “solved.” Unless one lacks the ability to do math and analyze real-world data. The numbers Tully cites are cold breeze of truth, folks. Feel the sensation.

    What Tully is saying just can’t be stressed enough. The inherent problem is one of bounded supply against unbounded demand. And before anyone turns all red and gets their panties all atwist, take care to notice that’s no claim that a free market is a panacea. Even a free market can’t, by itself, solve the problem of insufficient resources to provide the quantity and quality of care that we all think we “deserve.” Not unless you call “poor folks are SOL” a solution.

    A freer market might be able to control costs a bit in some places by making consumers motivated to care about the prices the pay and make tough decisions about how much to consume. But that’s only going to help a bit. For one, the extent to which laypeople can act as “informed consumers” in the healthcare market is quite limited. And in the end, too much of a market approach starts to mete out healthcare based primarily on ability to pay, which clearly something that a majority of Americans seems to object to.

    My sense is that a solid American majority does believe that we all deserve medical care regardless of our individual ability to pay for it. But at some point, even if we make this choice collectively, demand eventually outstrips supply to the point where we no longer even have the resources to collectively finance it.

    In other words, even if we decide to stick together and make sure that everyone is guaranteed medical care, we can still only get as much healthcare as we have the resources to provide. There’s no escape from the orbit of that dynamic, no escape velocity that is not a fiction. The gravity of that reality is a bitch.

    This is going to become way more obvious to everyone over the next decade or two. First, smoke this: at 6% annual growth, the price of something doubles in 12 years. Now throw the following into the bowl: the US has a population bubble of baby boomers rapidly graying into their high-consumption years for healthcare. Everyone who needs it is not going to get multiple joint replacement and bypass surgeries, and so on. Not on the dime of a younger and smaller and more debt-burdened workforce. Th equations won’t add up.

  6. Nick Benjamin Says:

    You guys are forgetting one of the best bits of government rationing. Since there’s no profit you’ve just cut costs 3%. Since it’s the government pay for everyone is capped in the low six figures (even Obama only makes $400k). There is no marketing budget. OTOH a private insurance company is gonna have a CEO who makes CEO money, a marketing department, etc. Heck the government doesn’t need an accounts receivable department. It already has the IRS, and adding another payroll tax or a bump in the income tax to the IRS duties is trivial. Add it all up and you’ve gotten rid of $0.10 of your health care dollar minimum. Depending on the insurance company you may have just abolished $0.30-$0.40.

    As for the boomers, their costs are gonna be born by Medicare. We’ve done some planning. The budget deficits account for aging boomers, there’s a $400 Billion trust fund, etc., but right now the numbers look really bad. It’ll only get worse if ObamaCare is eliminated because it includes test runs of basically every idea there is to cut costs beyond single-payer (the public option got left out) and tort reform (was never put in because it’s been tried and failed).

    Ryan’s plan fixes moves the problem from the federal budget to seniors, who would be on the hook for pretty much all growth in health costs. They’d also have to use a private insurance company, which means part of their premiums would go to things like marketing, commission, and CEO salary.

  7. gerryf Says:

    Ahh, Tully. Tully, tully, tully. Breaking out the old “government rationing” screed. Scared any senior citizens with that one lately?

  8. kranky kritter Says:

    To whatever extent those savings truly do materialize Nick, they are one-time savings. They will conceivably lower current prices by some amount, but they will not effect cost GROWTH in any meaningful way. And cost growth is the problem.

    It’s the problem that some folks prefer to ignore when they don’t have a decent answer, Such folks often resort to insulting what other folks have said, like Gerry here. He has no answer for the cost growth issue, so like an infant he poops his diaper and screams when anyone uses the “r” word, rationing.

    When supply is seriously bounded and demand is not bounded at all, controlling supply ()rationing) is the only viable alternative to uncontrolled cost growth. Not my rule, not Tully’s, not the right’s. It’s basic math.

  9. Gerryf Says:

    It’s the problem that some folks prefer to ignore when they don’t have a decent answer, Such folks often resort to insulting what other folks have said, like Gerry here. He has no tanswer for the cost growth issue, so like an infant he poops his diaper and screams when anyone uses the “r” word, rationing.

    As usual KK, your hypocrisy know no bounds. To critics people for having no answers and insulting, and then offering no answers and casting insulting someone…do you even both to read what you write before hitting the submit button?

    I give tully’s ideas all the due they merit (nothing) because it is urge same trite crap the right always brings to the table.

    I have problem with rationing, but the demand for healthcare is not the problem.

    The cost of healthcare is driven by profit.

    Socialized medicine is not the sole answer, but it is a start.

  10. Tully Says:

    LOL & QED.

  11. kranky kritter Says:

    As usual KK, your hypocrisy know no bounds. To critics people for having no answers and insulting, and then offering no answers and casting insulting someone…do you even both to read what you write before hitting the submit button?

    To repeat for those who missed it, I identified the only available “solution”:

    When supply is seriously bounded and demand is not bounded at all, controlling supply (rationing) is the only viable alternative to uncontrolled cost growth. Not my rule, not Tully’s, not the right’s. It’s basic math.

    Sometimes people say such stupid things that it doesn’t even feel like an insult to call them a nitwit for it. It feels more like trying to help:

    The cost of healthcare is driven by profit.

    It’s driven by a variety of things. IF profit were the sole or primary driver of cost growth, as you suggest, then cost growth would be much lower in the nations employing socialize medicine. As Tully already pointed out. And as you have repeatedly ignored. You’re destined to go to your grave bitterly blaming most evils on corporations and profit-taking. In your mind, it’s always going to be corporations’ fault that you don’t get what you believe you deserve.

    Deserve’s got nothing to do with it. Collectively, Americans will get what we have the resources to provide, based on what we produce. Even if we tax corporations more, even if we enact price controls, we won’t touch the problem of demand outpacing supply.

    At its root, the healthcare problem is one of bounded supply versus unbounded demand, coupled with the problems of a nation that is consuming way more than it produces. These problems are not especially complicated to solve, but they are difficult to undertake because they will be quite painful. That means that most folks prefer to deny that this is an accurate description of the nature of the problem. Whatever else can be blamed will be blamed. Sadly, we run the following serious risk: only after we punish those we chose to blame and that fails to fix the problem will we see the light about unsustainable consumption rates.

    Good luck with simply blaming corporations. The math will get progressively more ruthless for America the longer we deny that we have a problem with consuming more than we produce and with insisting that healthcare can be an unbounded entitlement.

    I don’t say any of this to win an argument with you Gerry. That’s not possible.

    And I don’t say any of this because I yearn to claim some mysterious virtue for corporations which are clearly amoral. Nor to defend the venal practices of self-enriching corporate management.

    I say it because our choice is to find a way to really and truly balance the scales quickly, or brace for impact. I don’t want to waste our time on false options that don’t address underlying causes.

  12. Nick Benjamin Says:

    To whatever extent those savings truly do materialize Nick, they are one-time savings. They will conceivably lower current prices by some amount, but they will not effect cost GROWTH in any meaningful way. And cost growth is the problem.

    I’m hardly the only one on this thread who admits there’s a problem, but offers no solution. I haven’t noticed any great proposal from you, for example. Or Tully.

    Besides you’re ignoring a huge factor:
    Cost growth is a existential threat for the US budget because we spend so much more on health care then anyone else. Yeah the Germans, Canadians, etc. are having cost problems, but since they’re growing from a lower base-line they can manage it effectively. If we eliminate a significant proportion of our health care costs today we’ll be in a lot better shape too.

    The whole argument is a little like the guy whose realized he’s going to die anyway so he might as well not bother to breathe. The facts are obvious, the logic is unimpeachable, but that doesn’t mean the conclusion isn’t insane.

    Yes health costs will grow faster then inflation. Yes we’ll have to pay for them somehow. But this is not impossible. Other countries are doing it as we speak. In fact in most of those countries the problem is worse — Germany’s population, for example, is falling, which means they have fewer workers per retiree. And they still manage it.

    ObamaCare’s pilot programs will help us manage this by showing us which cost controls work. RyanCare’s ridiculous premise that the Federal government can let grandma go bankrupt paying for her medical care.

  13. kranky kritter Says:

    You’re ignoring a huge factor-I’ve never said I oppose Obamacare. I’ve only said that it addresses access without addressing cost.

    Please tell me which “cost controls” Obamacare implements that you think have a chance of working.

    Collecting for a few years before beginning payouts made the plan appear solvent, but it’s not. Cutting medicare payouts would cut costs, if those cuts are actually implemented. Will they be?

    I’m in favor of capturing a number of one-time savings by establishing a single interface of some sort and cutting out middlemen providers and red tape makers. But those are one-time savings.

    I’m also in favor of some mandate by which Americans pay no more for drugs than other western nations.

    After that, we’re going to need some form of rationing, by which I mean methods for controlling supply. That means we need to provide a lot of flexibility within the single interface, so that people can choose from a variety of options based on how much cost risk they want to shoulder and how high a level of covered treatment they want.

    I am Ok with mandating coverage for all, but if that is a dealbreaker, I think that can be managed with a similar alternative. If everyone accesses insurance through a single interface, that would allow some sort of method as follows: you can choose to opt in to health insurance at any point, but the longer you wait, the higher your premium. You can opt in at a low cost low coverage level and then opt for better coverage later, but you pay a higher premium if you wait.

    So suppose one person opts into the best coverage as soon as they become an adult, and someone else waits. Then they both end up getting married and starting a family at age 28, opting for the best family coverage. The first person pays a lower premium because she’s been paying all along. The other pays a higher premium because he waited. Identical risk at age 28, different premiums.

    For any plan to work, it has to address the simple problem that some large portion of health insurance isn’t really insurance, it’s financing for types of care that you know you’ll need sooner or later. I can pay for auto insurance my whole life, and I might never use it.

    But healthcare? Not so much.

    RyanCare’s ridiculous premise that the Federal government can let grandma go bankrupt paying for her medical care.

    No idea if that’s his premise, but I agree we are unlikely to go that route, But the route that we do have to go WILL involve allowing people to make different choices and end up with different costs. If you choose lower cost insurance without hip replacement coverage, then if you need a hip replacement, you only get it on your own dime. Same with other procedures.

    And if we decide that through the single interface some long and growing list of universally worthwhile procedures are always covered, then we can only do that if we have the resources to provide it.

  14. Nick Benjamin Says:

    Please tell me which “cost controls” Obamacare implements that you think have a chance of working.

    Capitation payment is one. The idea is that right now medical providers get paid for every service they perform, therefore they’d be stupid to not insist a patient needs every service they could conceivably justify. The Brits pay a Doctor for every patient he sees, and he has to pick which tests he wants to run, etc. It seems to work fine for them, by every measure they;re as healthy as us despite their prodigious alcohol consumption, and their total costs are lowest of any rich country. So, in theory, this could solve our problems all by itself. In practice nobody’s ever done this in the USA so there’s a pilot program in the bill.

    The Cadillac-plan tax is another. The only income you can get from your employer that isn’t subject to income tax is an insurance plan. Employers have no reason to keep the cost low becau se they’re taking it out of your raise. You have no reason to care about cost because it’s a “fringe benefit.” So it’s a stupid policy that encourages people to spend more on health care then they otherwise would. The tax doesn’t fix the problem, but it does reduce it. The really brilliant thing about it is that if it works our budget problem is a lot smaller then we think, but if it doesn’t work it’ll have a lot of plans to tax so (again) our budget problem is smaller then we think.

    More anti-fraud enforcement in Medicare is a third.

    I could go on. Accountable Care Organizations, the Medicare payments Advisory Board, electronic medical records, etc. etc.

    None of these is likely to be a silver bullet. Especially since Obama was forced to water most of them down to get the bill through. But that just means there’ll be a second bill in like 2020, and when that bill happens we’ll have a lot more data on whether these ideas actually work.

    Collecting for a few years before beginning payouts made the plan appear solvent, but it’s not. Cutting medicare payouts would cut costs, if those cuts are actually implemented. Will they be?

    Cuts to Medicare payment rates aren’t in the plan. They’re part of a completely different plan Clinton and Gingrich created in the 90s, but Congress has never had the balls to actually implement. They were specifically not dealt with by ObamaCare because certain Senators were too pussy to vote for a bill with $Trillion in it.

    As for the 10 years of taxes for 6 years of benefits argument, it only works if you count all the little taxes in the bill (like the one on indoor-tanning salons), but refuse to count all the little benefits that appear before 2014 (like 24-year-olds staying on their parent’s coverage).

    No idea if that’s his premise, but I agree we are unlikely to go that route, But the route that we do have to go WILL involve allowing people to make different choices and end up with different costs

    It’s possible that isn’t his premise. People are very good at tricking themselves into believing things that are obviously not true.

    In this case it’s obvious that a) the private plans will have higher administrative costs then Medicare proper so the voucher is a benefit cut, and b) even if the initial voucher was sufficient medical inflation will grow faster then the vouchers. Which means that sooner or later somebody’s grandma is gonna have to spend her retirement saving on health care. And it’ll almost certainly be sooner.

    And the American people just won’t let that happen.

  15. kranky kritter Says:

    Capitation payment is one . . . The Brits pay a Doctor for every patient he sees, and he has to pick which tests he wants to run, etc. It seems to work fine for them . . .and their total costs are lowest of any rich country. So, in theory, this could solve our problems all by itself. . . . there’s a pilot program in the bill.

    In general, I agree that it’s a good idea to disincentivize what we can call overtreatment…extra tests and so on. Whether American doctors and entitled patients can adapt is a big question. Who is liable when incentivized “undertreatment” leads to bad outcomes is yet another. This can lead to some savings over a shorter term, but unnecessary tests are not the lion’s share of cost growth.

    The Cadillac-plan tax is another. The only income you can get from your employer that isn’t subject to income tax is an insurance plan. Employers have no reason to keep the cost low becau se they’re taking it out of your raise. You have no reason to care about cost because it’s a “fringe benefit.” So it’s a stupid policy that encourages people to spend more on health care then they otherwise would. The tax doesn’t fix the problem, but it does reduce it. The really brilliant thing about it is that if it works our budget problem is a lot smaller then we think, but if it doesn’t work it’ll have a lot of plans to tax so (again) our budget problem is smaller then we think.

    I am a big proponent of treating employer-provided health benefits as income, because it levels the playing field. I’d greatly prefer that change to be made along with some counteracting tweaks to the tax code, than to attack “cadillac” plans, which is going to be endlessly messy and contentious.

    But I’m in a pretty small majority in thinking that HC benefits should be viewed as income. Most people are horrified by the idea, in an overwhelming majority that crosses party lines.

    Which means that sooner or later somebody’s grandma is gonna have to spend her retirement saving on health care. And it’ll almost certainly be sooner.

    And the American people just won’t let that happen.

    Please explain what are you actually talking about here. Why shouldn’t people with retirement savings be asked to spend some of it on their medical care? In fact, many senior citizens already have substantial out-of-pocket expenses under medicare now. So that’s not a new idea or one that “Americans won’t let happen.”

    I don’t like the idea of vouchers because that’s not going to be a good way to protect people from risk like insurance is supposed to do, not when you factor in real-world human nature. Under a voucher system, the people with the unluckiest health will get croaked if they choose high-deductible bigger co-pay plans with lower initial premiums. In the end, I am convinced that we all end up better off with some sort of “we all pay and everyone gets a guaranteed minimum level of care” approach.

  16. Nick Benjamin Says:

    In general, I agree that it’s a good idea to disincentivize what we can call overtreatment…extra tests and so on. Whether American doctors and entitled patients can adapt is a big question. Who is liable when incentivized “undertreatment” leads to bad outcomes is yet another. This can lead to some savings over a shorter term, but unnecessary tests are not the lion’s share of cost growth.

    Nationally I’d agree with you. But in some areas it’s gotten ridiculous. McAllan, TX is notorious:
    http://news.bbc.co.uk/2/hi/americas/8137085.stm

    If you wanna control cost growth you have to identify problems like this before they become the lion’s share of cost growth.

    As for the Cadillac plan tax, I agree. I think anyone of an even mildly wonkish disposition agrees. The problem is the vast majority of Americans don’t, and the unions absolutely hate the idea.

    Please explain what are you actually talking about here. Why shouldn’t people with retirement savings be asked to spend some of it on their medical care? In fact, many senior citizens already have substantial out-of-pocket expenses under medicare now. So that’s not a new idea or one that “Americans won’t let happen.”

    If RyanCare only insisted people spend a little more on their own care it wouldn’t be an issue. But according to the accountants in a few decades of RyanCare the 2/3 of the health care costs for an average 65-year-old would be paid by the 65-year-old.

    Given that a) 65-year-olds are supposed to be retired, and b) caring for people that old is freaking expensive it is unlikely those 65-year-olds will be content with the system.

    Guess who votes.

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