A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

ROMNEY: "No, no, I like mandates. The mandates work."

ROMNEY: "No, no, I like mandates. The mandates work."

January 7, 2008

Who knows how much longer we'll have Mitt for our needed doses of health care humor. So let's give him some air time to confuse further the American public about the MA health reform law (our comments in italics). This is from the transcript of Saturday's ABC News presidential debate:

ROMNEY: A lot of people have ideas about health care and improving health care. We took the ideas and actually made them work in our state, as people in New Hampshire know. We put in place a plan that gets every citizen in our state health insurance, and it didn't cost us new money. Actually, it's costing a lot of new money -- an extra $146 million in FY08 alone. And it didn't require us to raise taxes. What we found was, it was less expensive or no more expensive to help individuals who had been uninsured by their own private policy than it had been for us to give out free care at the hospital. Nonsense -- it's the right thing to do, AND is costs more money, not less, to give people insurance coverage. And since we put our plan in place last April, we've now had 300,000 people who were uninsured sign up for this insurance, private insurance. Actually, 70,000 plus got enrolled in MassHealth, the MA Medicaid program; and 160,00+ are in Commonwealth Care which is a sister cousin to Medicaid if there ever was one. And where the doctor -- good doctor was wrong is that it's true the insurance companies don't want to sell policies to one person at a time. It's expensive. We established what we called a connector, a place where individuals could go to buy policies from any company, and that connector would in turn send their premiums on to those companies. So the economics of scale existed. And as a result of what we did, the premiums for health insurance for an individual buying insurance went from $350 a month to $180 a month, with lower deductibles and now with prescription drugs.

ROMNEY: The answer...

GIBSON: Anybody...

ROMNEY: Let me just -- I just -- I want to underline this. We don't have to have government take over health care to get everybody insured. That's what the Democrats keep on hanging out there. The truth is, we can get everybody insured in a free market way. We don't need Hillary-care or socialized medicine. MA health reform would not be possible without significant government involvement at multiple levels.

GIBSON: But Government Romney's system has mandates in Massachusetts, although you backed away from mandates on a national basis.

ROMNEY: No, no, I like mandates. The mandates work.

THOMPSON: I beg your pardon? I didn't know you were going to admit that. You like mandates.

ROMNEY: Let me -- let me -- oh, absolutely. Let me tell you what kind of mandates I like, Fred, which is this. If it weren't...

THOMPSON: The ones you come up with. Bingo.


ROMNEY: Here's my view: If somebody -- if somebody can afford insurance and decides not to buy it, and then they get sick, they ought to pay their own way, as opposed to expect the government to pay their way. And that's an American principle. That's a principle of personal responsibility. So, I said this: If you can afford to buy insurance, then buy it. You don't have to, if you don't want to buy it, but then you got to put enough money aside that you can pay your own way, because what we're not going to do is say, as we saw more and more people...

GIBSON: Governor, (inaudible) you imposed tax penalties in Massachusetts (inaudible).

ROMNEY: Yes, we said, look, if people can afford to buy it, either buy the insurance or pay your own way; don't be free-riders and pass on the cost to your health care to everybody else, because right now...

THOMPSON: The government is going to make you buy insurance...

ROMNEY: No, the government is going to stop...

THOMPSON: ,.. and make you pay -- I mean, the state -- your state plan, which is, of course, different from your national plan, did require people to make that choice, though. The state required them to do that. What was the penalty if they refused?

ROMNEY: They refused to pay your -- let's go back, Fred. What's your view? If somebody...

THOMPSON: Well, I asked the question first.


ROMNEY: OK. Well, I'll answer your question, you answer mine. If somebody is making, let's say $100,000 a year, and doesn't have health insurance, and they show up at the hospital, and they need a $1,000 repair of some kind for something that's gone wrong. And they say, "Look, I'm not insured, I'm not going to pay." Do you think they should pay or not?

THOMPSON: Did your plan cut people off at $100,000? Was that the level?

ROMNEY: No, actually...

THOMPSON: Did it only apply to people with $100,000 income and over?

ROMNEY: It actually applies to people at three-times federal poverty. They pay for their own policy. At less than three-times federal poverty, we help them buy a policy, so everybody is insured, and everybody is able to buy a policy that is affordable for them. The question is this, again, if someone could afford a policy and they choose not to buy it, should they be responsible for paying for their own care? Or should they be able to go to the hospital and say, "You know what? I'm not insured. You ought to pay for it." What we found was, one-quarter of the uninsured in my state were making $75,000 a year or more. And my view is they should either buy insurance or they should pay their own way with a health savings account or some other savings account.

GIBSON: We have an expression in television: We get in the weeds. We're in the weeds now on this.


GIBSON: Let me just -- one point. Yes or no, in your national plan, would you mandate people to get insurance?

ROMNEY: I think my plan is a good plan that should be adopted by other states. I wouldn't tell every state...

GIBSON: In your plan, would you mandate...

ROMNEY: I would not mandate at the federal level that every state do what we do. But what I would say at the federal level is, "We'll keep giving you these special payments we make if you adopt plans that get everybody insured." I want to get everybody insured.


ROMNEY: In Governor Schwarzenegger's state, he's got a different plan to get people insured. I wouldn't tell him he has to do it my way. But I'd say each state needs to get busy on the job of getting all our citizens insured. It does not cost more money. Only in your mind does it not cost more money.

ROMNEY: OK, don't leave me. Don't send the pharmaceutical companies into the big bad guys.

MCCAIN: Well, they are.

ROMNEY: No, actually they're trying to create products to make us well and make us better, and they're doing the work of the free market. And are there excesses? I'm sure there are, and we should go after excesses. But they're an important industry to this country. But let me note something else, and that is the market will work. And the reason health care isn't working like a market right now is you have 47 million people that are saying, "I'm not going to play. I'm just going to get free care paid for by everybody else." That doesn't work. Number two, the buyer doesn't have information about what the cost or quality is, or different choices they could have. If you take the government out of it to a much greater extent, you'd get it to work like a market and it will rein in cost.