Health achievements get little campaign talk
WASHINGTON -- Here's a team for the ages: Nixon, Romney, Obama. History joins all three in the cause of universal health care, a goal promoted by Richard Nixon four decades ago and advanced in laws enacted by Mitt Romney and Barack Obama in turn.
The most significant health care law since Medicare gets barely a shout-out from Obama. And when Romney must talk about the law he won in Massachusetts, it's because someone's got him on the defensive in the GOP presidential campaign.
"Big health care reform turns out not to be very popular -- and actually unhealthy for the candidates who did it," said Robert Blendon, a Harvard professor who tracks public opinion on the subject.
The Supreme Court will decide if the federal overhaul or any part of it is unconstitutional after arguments next week. If the law GOP opponents call "Obamacare" survives, "Romneycare" will be a guide for it.
Buried in speeches
The federal and Massachusetts laws share much, including a requirement that individuals carry health insurance, a provision that taxpayers provide help for those who can't afford it and protections against denial of coverage. And ObamaRomneycare shares more with Nixon's never-implemented approach -- an insurance system anchored in the private market with a hefty government safety net -- than with the Clinton initiative that collapsed in the 1990s under the weight of its own complexity and reach.
Obama and Romney are not modest men, but you might think so when it comes to this. Health care got two sentences in Obama's State of the Union. Romney sticks to the Republican line that Obama's law must be repealed, and gives so-so reviews of his own law. "Some things worked, some things didn't, and some things I'd change," he said when pressed.
Stuart Altman has been in the thick of it all as a health policy economist who advised Nixon in the 1970s and four more presidents of both parties since. He also co-chaired a Massachusetts task force on health policy in the prelude to Romney's initiative.
"Poor Romney, he has to run away from it," Altman said, simply because Republicans have made it their refrain that "Obamacare" must go, and Romney's plan can't easily be divorced from it. "While Obama's not running away from it, he's not actively selling it, and … that's unfortunate," said Altman, who supports the law.
Time heals rifts?
Romney argues that states must be free to draw up their own plans to expand health coverage and the feds have no business imposing a national solution, a point at the center of the Supreme Court case. The federal law is designed to be paid for in part by cutting money from Medicare, which creates political opposition that states wouldn't face.
But both penalize people who don't buy insurance and businesses that don't offer it to employees, with exceptions for the smallest companies. They both rely on new health insurance marketplaces, called "exchanges" in the federal law, to give individuals outside the employer-supported insurance system a choice of plans. Both laws subsidize workplace-based insurance and coverage for people well above the poverty level.
Romney acknowledged the similarities in a less politically charged time for him, during his 2010 book tour, and praised the individual insurance mandate.
Surveys in Massachusetts consistently suggest Romney's law is well-regarded. And the state law has an advantage over the federal one in winning public support: the passage of time.
"In Massachusetts, in the sixth year of the program, it would be very hard to envision that we're going to take away insurance coverage from all the people who got coverage and say let's go back to six years ago," Blendon said.