The folks at this AEI panel were big on the importance of conservatives listening to rather than just talking at people who are not already on that side. So in that spirit, I’m going to give an example of a Republican politician listening . . . to conservatives..on health care. That Republican is Mitt Romney.
Now, let’s face it. Romney the “severe conservative” isn’t naturally all that good at talking to those of us on the right. Romney was also in a pretty weak political position. Obamacare was a combination of health insurance coverage mandates, an individual insurance purchase mandate, guaranteed issue, and community rating. Romneycare had instituted coverage mandates and the individual insurance purchase mandate while retaining guaranteed issue and community rating. The two policies were about as similar as could be and both tended to push health insurance further down the road of comprehensive third party medical care prepayment that market-oriented health care analysts think we should get away from. Romney was running for the nomination of a party that hated Obamacare. What was he going to do? The way he talked his way out of (most of ) his health care problem is pretty impressive and a little disturbing.
The June 23, 2011 Republican presidential debate is remembered as the debate where former Minnesota governor Tim Pawlenty choked on his foolish “Obamneycare” formulation. Pawlenty had referred to “Obamneycare” during the previous weekend, but Pawlenty refused to repeat the phrase to Romney’s face and it made Pawlenty look like a huge weasel. You should either watch the debate on YouTube or read the transcript to really get a sense of Pawlenty’s squirming. But I think it was Romney’s earlier answer to a question about the similarities between Obamacare and Romneycare that is more important for the long-term. Romney said that the differences between the two laws were:
Obamacare spends a trillion dollars. If it were perfect — and it’s not perfect, it’s terrible — we can’t afford more federal spending.
Secondly, it raises $500 billion in taxes. We didn’t raise taxes in Massachusetts.
Third, Obamacare takes $500 billion out of Medicare and funds Obamacare. We, of course, didn’t do that.
And, finally, ours was a state plan, a state solution, and if people don’t like it in our state, they can change it. That’s the nature of why states are the right place for this type of responsibility. And that’s why I introduced a plan to repeal Obamacare and replace it with a state-centric program.
There is a lot wrong with this answer. Romneycare didn’t spend a trillion dollars or raid Medicare because Romneycare’s coverage expansion was funded with federal Medicaid dollars. Romney never addresses the structural similarities between Obamacare and Romneycare and the problems with a comprehensive third party prepayment model of medical financing. The good news for Romney is that most of these problems are out of the audience’s sight. Most people didn’t know about the federal dollars used for Romneycare and the audience wasn’t reading James Capretta’s critique of health care financing. Romney was counting on his audience not knowing a lot.
But what is striking about Romney’s answer is how seriously it takes conservative concerns about federal spending levels, tax levels, Medicare sustainability, and federalism. Romney has a sense of what concerns conservatives and has produced a clear, concise, and factually true (if in places misleading) argument about why Romney’s record is consistent with conservative principle.
Now let’s look at what Pawlenty had to say. Pawlenty should have been is a stronger position. He hadn’t signed Father of Obamacare into law. All Pawlenty could say for himself was that “We didn’t use top-down government mandates and individual requirements from government. We created market alternatives and empowered consumers. I think that’s the way to fix health care in the United States of America.”
The problem was that Pawlenty didn’t give us any idea what those “market alternatives” were or how those “empowered consumers” were better off. At the end of this exchange, you had a better sense of why Romneycare was consistent with conservative principle than you did of whatever it is that Pawlenty did in Minnesota. Pawlenty just expected a Pavlovian reaction to his invocation of “market alternatives.” Romney, even with all his baggage, won this health care exchange (and most of the health care exchanges during the Republican debates)because he had listened enough to know what conservative priorities were on health care policy and crafted his argument accordingly.