Romney’s Federalism Dodge
Romney wants to make a federalism based argument for why his MA health care bill is good, while the PPACA is tyrannical. However, just saying that is not an argument.
As best as I can tell, Mitt Romney’s speech yesterday did not offer any particularly new arguments as to why the health care bill he signed as governor of Massachusetts is really any different from the PPACA signed by President Obama.
His fundamental argument, which he has made before, goes like this:
“Our plan was a state solution to a state problem,” he said while walking his audience through a corporate-style slide presentation, “and his was a power grab by the federal government to put in place a one-size-fits-all plan across the nation” (Source: NYT).
Clearly he wants to make an argument, which he hopes will appeal to the Tea Party faction in particular, that federalism is the core issue here.
However, I think that there are at least two key problems with his approach:
1) If you are going to argue against a “one-size-fits-all” plan, you have to make a case as to why it would be the case that, say, health care in Massachusetts is fundamentally different than health care in New York, Wyoming, or Tennessee.
Indeed, it is problematic to assert that providing health care/the issue of health insurance is a “state problem” as it manifestly is a problem across the country.
Understand: he is not arguing, as some want him to do, that the Massachusetts program is bad. No, he is saying it is good, but just somehow uniquely good for MA and not good for other people. And yet, this is a claim that he does not actually back up with evidence (or even an attempt at a serious argument). On the one hand, it might sound good that different states have unique health care needs, but it is yet another to make the case.
Last time I checked, flu was flu, broken legs were broken legs, and cancer was cancer whether one lives in California, Texas, or Alabama. Likewise the effects of aging tend to be basically constant, with most variations linked to genetics and lifestyle. And while lifestyles do vary, to some degree, state to state, it is unclear to me that they vary in such a way that it would actually dictate health care policy in a major way.
2) If you are going to make the federalism argument, then make it, don’t just pay lip service to it. The following is just so much hand-waving and rhetoric:
If he were president, Romney said, he would on his first day in office issue an executive order paving the way for states to opt out of the new federal law. In its place, he said, he would put forward a variety of measures that would give individual states more resources and flexibility to decide how to cover the uninsured, and to make the health-care market function more efficiently (source: WaPo).
If you really think that there is a variety of options that might be better suited to different states, then give us some examples. Explain your philosophy, don’t dish platitudes like giving states more resources so that they can be flexible. For one thing, scarcity of resources is part of the problem, and second, flexible to do what?
On a side note, I am not sure how a President could issue executive orders to pave “the way for states to opt out of the” PPACA.
The federalism argument here is a dodge, a fig leaf because he doesn’t actually articulate a theory, framework, or policy to go along with it. Rather, he simply hopes that it will be enough to convince the base that he is a True Believer in the Tenth Amendment so that he can move on to other things.
Ultimately, it is a bizarre argument to assert that what you did for Massachusetts was great, but what the PPACA did for the country was a mad power grab. Especially if you can’t make a cogent argument as to what would make MA uniquely suited to that system, but that somehow it doesn’t work for the other 49 states.
I think it is also incumbent upon Romney to explain how it would be an acceptable outcome for some US citizens to have health care coverage as provided by their states while others do not. This is especially tricky if one is running to be president of the whole country. It is easy for a governor to say that I only care about my state, yet another for the president to take that position.
To conclude on the tyranny front: Romney’s position does not address the individual mandate issue (a central part of the MA legislation) in a way that I think most Tea Party folks would like. If it is tyrannical for the federal government to force an uninsured person to buy health insurance, why isn’t it tyrannical for the state government to do the same thing? Indeed, if you listen to his arguments about the individual mandate in MA, they are largely identical to the arguments made by the proponents of the PPACA.
Come on, you’re thinking about it too much. He’s saying all the right things, what’s the problem? *end snark*
Flexible to end that evil, marxist Obamacare, that’s what! (That’s about how deep the thinking is on the right, I’d say.)
Nice post, by the way, but such an honest essay seems wasted on this politician.
Am I missing something? I thought the ACA has the Wyden amendment that allows states to opt out – if they meet federal standards that will prevent a race to the bottom. In addition I though Obama had proposed speeding up the implementation of Tha part of the law. If I’m correct, and I think I am, it would seem to nullify the mittsters argument. This is why Vermont is pursuing single payer.
I don’t necessarily agree with Romney but what’s so bizarre about putting forward the self-evidence argument that there are some things that state governments can do that the Constitution doesn’t allow the Federal Government to do?
Until the insanity of the War On (Some) Drugs, for example, it was a generally understood principle that the Federal Government does not have any general “police powers.” That principle has been generally eroded to the point where the Federal Criminal Code is as complicated as any states Criminal Code. Why should that be the case?
On some level if different states want to regulate the health insurance industry differently I don’t see what’s so bad about that.
Will this work politically for Romney? I doubt it for the reasons I state in my own post on the matter.
Romney’s not making the argument that ACA is only a rational choice in some places because health care outcomes are radically different. He’s saying that blue staters want an intrusive nanny state- and, btw, he tends to agree that they’re onto something on this particular issue- but red staters don’t. So the argument he’s carved out is that he’s willing to sacrifice red staters’ health to appease their Big Brother paranoia. Which seems fine to me.
The problem is if you let individual states regulate the market then everyone rushes to the lowest common denominator. The prime example is Delaware and credit card companies. Delaware has the loosest rules so that’s where they all ended up.
I think letting states do their own thing while meeting a federal standard for coverage works. Keep in mind that the states send representatives to Washington (congress persons) and can change the standards.
For some reason there’s a political constituency out there of people who accept quite a bit more tyranny at the state level than they ever would at the federal level. I don’t understand the concept of the tyrant being more legitimate because he’s “closer to home” or more grassroots or whatever, but it’s out there.
So if South Carolina decides to enforce single payer and mandatory broccoli eating and whatever else, then that’s fine because it’s the state government at work. But, dadgummit, if one of those dirty scoundrels in Washington tries to go one third as far, then let’s start talking about nullification.
Andyman,
Your ideology is showing. But it’s not about nanny-states. It about the uninsured accessing health care in the most expensive manner and those costs being passed onto the insured. Certainly you don’t think that is appropriate do you?
The Federalism argument is a decent one in terms of political theory and con law but it’s weak as a public policy argument without supporting evidence.
Aside from different levels of tolerance for government intrusion, there’s presumably different funding baselines in each state. So, it may well be that 1) Massachusetts was already above average in terms of employer-provided care and that 2) the requirement to purchase insurance is less onerous in Massachusetts, either because the risk pool is different and it’s cheaper or because people make above median incomes so the hit is smaller proportionally. But you actually have to put forth the argument.
I think of it as more a matter of “Live and let live”. There’s no scientific determination as to what health care delivery system is “right.” So while Idaho may benefit from the system that Massachusetts deployed as defined by how Massachusetts sees things, the people of Idaho may have different priorities and preferences. It’s not clear whether Massachusetts are right or the people of Idaho.
The people of Vermont have decided that there’s a better way. If that’s the better way, why don’t we just adopt it everywhere? Because not everybody defines better the way Vermont does. If someone recognized this, it makes sense to say that while I support this on a local or statewide level, I don’t on a national level. There are a number of things where I feel this way.
On top of this, I have a greater degree of faith that a policy that doesn’t work out as a constituent citizenry desired, that it will be reversed more easily at the state level. So, for instance, when TennCare proved unsustainable, it was reformed near the point of nullification. Meanwhile, Medicare is toxic to the touch regardless of its longterm sustainability in its current form.
@James,
The policy argument (from the left) is that these hillbillies will only stop raging about Teh Socialists when they start noticing that their blue-state cousins are outliving them and aren’t sweating hospital costs when they’re between jobs or dealing with a long-term illness.
So instead of letting them torpedo the whole thing for everyone, we ought to sacrifice a few of them at the beginning for the sake of “flexibility” and “federalism” or whatever, and in time just about everyone will come around.
@HN,
I think you’re confusing my paraphrase of Romney and my own views. I don’t have an issue with a mandate. Neither does Romney, really, which is why he thought it was a great idea as long as his constituency did.
Regarding the “flexibility” and waivers, it’s worth noting that they are subject to federal approval and thus to Washington’s, and not the state’s. priorities and preferences. At the least, it’s not clear that Texas will be able to follow a free-market model if it doesn’t accomplish what DC, and not Austin, considers important.
That’s somewhat more problematic to me than the City of Whatever not being able to determine its own priorities. This, of course, assumes that one does not connsider the states to be anachronisms and/or arbitrary constructs with little legitimacy. Which I think gets at the root of my disagreement with Taylor.
@Trumwill
I wouldn’t characterize my position in that fashion, but I do think we have differing views of what the states are, yes.
@trumwill…
your comment about what dc feels is important versus what austin feels is important is valid and important. (neglectling for the moment that the ACA is a free-market model) however, keep in mind that texas does have a role in determining what dc feels is important.
health care needs to be regulated at some level, state or federal. health care is interstate commerce and so should federal regulations seem appropriate. the flip side of your concern is that change on the federal level is not nearly as capricious and petty as change at the state level can be. using your example of texas – frankly i do not want rick perry and a legislature that actively supports formula one racing while laying off school teachers to determine the level of health care in connecticut (this in spite of the fact that i’m a huge F1 fan). unfortunately that is what would happen if states regulated – everyone will rush to the loosest set of regulations. at the same time i’m sure you don’t want vermont determining that texas should have single-payer, and you are correct to feel that way.
it’s my belief the ACA as currently structured would satisfy all of this. If it does not then it should and it will need to be tweaked – which is inevitable in any case.
I would call the PPACA a hybrid model. I expect that Rick Perry would come up with something that, while also technically hybrid, more on the market side than the other. Do note that I don’t necessarily think a free-market solution is actually best when it comes to health care specifically. The truth is, I don’t know what’s best. It’s one of the reason I want different states to try different things (across the spectrum, not PPACA-to-Vermont). Despite my federalist leanings, I am actually open to the idea that we need a more national policy for a variety of reasons. But I want to see things tried at the state level first. I support what Vermont is doing. I support what Massachusetts has done. Even Tennessee, though it didn’t work out. Even if I’m kind of glad, in all instances, that they weren’t tried in my state. So, for context, that’s more or less where I stand.
The “race to the bottom” is a good reason to oppose McCain’s proposal to allow insurance sales across state lines. There are aspects of PPACA that I like and do not like. I think the exchange is a good idea (as a compromise between allowing more competition without the credit card conundrum). I’ll be interested to see how it works. But while Vermont has the flexibility to pursue its aims, Texas and Idaho have a lot less flexibility to pursue theirs unless they’re using the same metrics that DC is. Though in the event of a Republican administration, it could turn out to be the other way around, where Vermont is (somewhat arbitrarily) declared a failure while Rick Perry is allowed to pursue whatever policy he sees fit so long as it matches up with the President’s idea of what the goals should be.
None of this changes the fact that there is no perfect solution. Neither in the sense of a nationwide solution that makes everybody happy nor the perfect balance between state and federal control. But that doesn’t make the distinction between a state policy and a similar federal policy a null set. I know that for my part, admiration for Vermont shouldn’t be construed as a desire to see the policy implemented nationwide. Nor this distinction being chalked up to inconsistency or hypocrisy.
A lot of the commentary surrounding Romney seems to suggest that if you don’t like PPACA for America, you should also not like Romneycare for Massachusetts. As far as I am concerned, if the people of Massachusetts like it, I am happy for them. And I think that Romney’s ability to come up with a plan that has garnered the support of his state speaks in his favor. The fact that he would not impose it on my state, also. I consider Romney to be groanworthy in many respects. This really isn’t one of them. {shrug}
Trumwill…
I was born in Vermont, and have lived in Dallas. No one knows better that they are different places and different people. Neither better…just different.
I am not in love with the ACA. Frankly I wish conservatives had contributed rather than simply standing by. But it’s what we have. With work in the long run I think/hope it will be better than the status quo.
Getting back to Romney…he seems to be arguing for what already exists and hoping no one notices.
Frankly I wish conservatives had contributed rather than simply standing by.
Don’t get me started on this. The Republicans deserved far worse than they got, as far as this goes.
Getting back to Romney…he seems to be arguing for what already exists and hoping no one notices.
I’d say there’s a difference between “states can apply for waivers and we may/will grant them if they meet certain goals” and “I will grant a waiver to any state that applies for one.”
Geez, next this guy will be arguing that some states should be able to have their own “interpretation” of marriage and let some guy marry 40 wives or something.
I tend to agree, though I suppose it could be said that at least people have he opportunity to move out of the state so afflicted. Which, I suspect they would do.
That said, let me echo what I said on the 18th of last month:
Romney’s plan clearly ignores the individual for the benefit of the collective. I want him nowhere near the reins of power.
Hmm. Bithead is quoting himself.
You can’t make this stuff up…
It’s looks like I’m too late to get into the discussion. Even so, I’ll take a shot:
Personally, were I Romney, I would make a very different argument (“it’s the best I could do in Massachusetts, *and* allowing states to experiment means that we can see that a program like this won’t work out long before we try it on a national level”). And it’s entirely possible that I’m misunderstanding his current argument. But I read it as saying “Nevadans really don’t like the state government intruding on their lives all that much, and as such they deserve to have a system that doesn’t rely on the long arm of the state; Californians, OTOH, seem to accept more state intrusion on their lives and may prefer a solution that reflects that. Each state’s political climate will dictate what kind of solution will be acceptable to its residents. It’s not so much a search for the One Optimal Solution, but a search for several solutions, each acceptable to the people who must abide by them.”