Open Letter To RedState, Part I: Mandates and Health Care
Allow me to introduce myself. My name is Ryan Larsen. I’m a truth lover, chess player and avid political junkie. I co-founded WhyRomney.com, which is dedicated to correcting distortions and inaccuracies perpetrated against Mitt Romney.
Before WhyRomney, I wrote for Lyingliar.com. At Lyingliar, we debunked all of Al Franken’s big attacks, from his “Chelsea Clinton is a dog” smear against Rush, to his “Peabody” smear against O’Reilly.
Before Lyingliar, I was naive. I didn’t realize the lengths people went to in order to dishonestly paint others as dishonest. And that’s what I see people doing to Mitt Romney. Even on the issue of abortion, where Mitt Romney did in fact change his position, critics distort his record terribly. My next diary will address each of those misrepresentations.
While I would not accuse anyone at Red State of being dishonest, I do see people building camaraderie around attacking Mitt without regard to the accuracy of the claims they are spreading. With the future of the world literally at stake, we don’t have time for reckless accusations against the man who may be our nominee. I realize not everyone has time to discern fact from fable, but if you don’t have time to make accusations responsibly, you should not make them at all.
In this, an open letter to RedState, I will address the health care concerns many of you have. I don’t have all the answers, but I have insights which may be a game changer for some of you.
First, I want to thank Ben Domenech for his very good encapsulation of his concerns in a recent piece on RedState. Although I believe Mr. Domenech is mistaken in his assumptions, I believe his piece is otherwise intelligent and I’m using it as a reference for understanding the sincere angst felt by many regarding this issue. Also, see my response to Philip Klein.
Mr. Domenech wrote, “Romney is essentially using the waivers as a substitute for proposing an actual reform … Romney’s plan in Massachusetts … is all we have to go on when it comes to evaluating his model for reform as president.”
Romney laid out his plan in a highly publicized speech on May 12, 2011, calling for “Repeal and Replace.” Waivers are authorized in the bill itself, offering a chance for relief while working for repeal.
Skip to the 5:15 mark. Key features: Restore states to leadership, Empower individuals to purchase their own insurance, Focus federal regulation as opposed to it being over-bureaucratic, Reform our medical liability system, Introduce market forces to health care.
Romney has called for repeal many times, including twice in the Aug. 11 Iowa debate. From the start, Romney expressed opposition to the federal mandate and has remained consistent.
I realize Mr. Domenech may still be concerned, because of Romney’s “continued defense of his Massachusetts’ law, including the individual mandate.”
Romney, JD, cum laude, endorsed by Robert Bork, understands state versus federal: “I believe in the 10th Amendment of the Constitution. And that says that powers not specifically granted to the federal government are reserved by the states and the people.” When asked by the moderator why his state mandate was constitutional, Romney replied, “Are you familiar with the Massachusetts constitution? I am.”
Most people don’t realize Romney sought “an opt-out provision for people who wanted to forgo insurance and pay their own way” (HC p. 175). So, Romney did not want a complete mandate in the first place.
More importantly, in the paperback version, Romney says if he could go back he would provide “a tax break for those who have health insurance rather than a tax penalty for those without health insurance” (p. 194). The tax credit does not require an action or purchase on anyone’s part.
In other words, there would be no mandate. The tax credit is justifiable because the state was footing the bill for uninsured hospital patients. When someone acquires health insurance they are removing a costly liability from the state, and therefore deserving of the tax credit. Moreover, this is merely a broader application of a principle shared by Ronald Reagan, “Most employer contributions for employee health benefits should be tax free because this encourages employee health insurance.”
People wanting Romney to distance himself from the mandate already have their wish, without realizing it.
Romney discusses other changes he’d make, such as reinstating his vetoes which the legislature overrode, and making very different choices than the new administration which, for example, allows some people to pay nothing – thereby creating an incentive for free-riders to move into the state. The most costly provision added by the legislature is their requirement that insurance companies provide certain coverage, such as unlimited dental and in vitro fertilization treatments – vetoed by Romney, but overridden. Romney ends his explanation in the paperback with: “There is no question in my mind that our program could be significantly improved if it were managed by a conservative administration. Elections have consequences.”
Mitt Romney is standing by the principles but not the specifics.
So, when we say Romney is sticking to his plan, what we are really saying is that Romney still believes in the following measures at a state level for MA: First, “creating incentives for those who can afford insurance to actually purchase it.” Second, creating “an exchange to help make buying insurance easier for individual – as opposed to corporate – buyers.” And third, “helping the poor buy their own private insurance with a sliding-scale subsidy. The government’s share of the cost comes from redirecting the federal funds that are currently sent to providers” (PB, p. 191).
What he is “standing by,” is not cause for much alarm. The question now, I think, is whether Romney can be excused for instituting the mandate to begin with. Well, the underlying context was a state of disarray in MA, which had the highest health care costs in the nation. The legislature wanted to amend the Constitution to make health care a right. Romney found a better solution. He had the Heritage Foundation and other conservatives on board, he had the overwhelming support of the legislature, the media and the people of MA. And there was an absence of vocal critics. I’m sure he realized a small minority of people in MA didn’t like it, but they weren’t very vocal at the time. So Romney had every reason to lump the mandate in with other well-accepted mandates like the mandates for purchasing/acquiring car insurance, clothing and babyfood.
But if you insist Romney should not be excused, I ask on what principle you rely, and whether you put that principle ahead of the Original Intent of the Founders. Did Samuel Adams infringe on liberty when he mandated that the kindred of any poor person in MA “shall be holden to support such Pauper?” (1793, “An Act Providing For The Relief And Support, Employment And Removal Of The Poor”). Samuel Adams invented the concept of “States’ Rights.” Did he not understand the role of state law?
If Romney made a mistake, then Samuel Adams made a mistake. Will the Tea Party movement, which derives its name from an act of American Revolution which took place in Massachusetts, fail to excuse a Founding Father from Massachusetts, a signer of the Declaration of Independence?
The Founders understood we not only have God-given rights but also have God-given responsibilities. Short of discovering new land in the world and defending it alone, we all rely on a community to defend our land and liberty. God has put us together, and one of our rights and responsibilities is to work together in determining how best to serve society. At the most fundamental level, this is true in the family. Parents have a God-given responsibility to love, protect and care for their children. A child, in turn, has a God-given responsibility to love and submit to their parents. This is true even though it is not written in the Constitution. It is God-given, and each state is a guardian of that responsibility.
We have a right to demand that other people uphold their responsibilities, ranging from wearing clothes, receiving an education and paying taxes, to giving one’s life for their country.
For instance, John Hancock more than once mandated that virtually all men furnish themselves, at their own expense, with a Musquet, rod, bayonet, flint and knapsack, or else “pay a fine not exceeding twenty shillings in proportion to the Articles of which he shall be deficient.” Hancock’s Massachusetts mandates were soon copied by other states and, under federal militia authority granted in the U.S. Constitution, ultimately inspired a federal militia mandate enacted under President George Washington. (more details)
The commerce clause enabled the federal government to act in some respects like a state, on questions relating to navigable waters which states have no jurisdiction over. And when given that chance to act like a state, the Founders created a health care mandate for ships to enlist the aid of an apothecary and store a chest of medicines (details). Since this mandate to purchase health care goods fell within that limited scope of the commerce clause, it does not constitute a precedent for federal action outside of navigable waters but significantly sets a precedent for state health care mandates.
Discerning of rights and responsibilities is done at the state level and according to the understanding of the people, unless delegated to the federal government in the U.S. Constitution. The brilliance of state governance is that states compete with each other using principles of free market capitalism, and yet also are free to adopt the ideas that work in other states and learn from their errors, creating a win/win situation prompting each other to success. Federal government intervention disrupts the process, as it eliminates experimentation and trial and error, taking away from citizens the freedom to choose different approaches and to disagree with people in neighboring states.
Like the Founding Fathers, Ronald Reagan supported the right of states to exercise wide discretion with respect to how they govern themselves. As Reagan explained, “The nature of our constitutional system encourages a healthy diversity in the public policies adopted by the people of the several States according to their own conditions, needs, and desires. In the search for enlightened public policy, individual States and communities are free to experiment with a variety of approaches to public issues.” (October 26, 1987)
200 years earlier, James Madison explained the same concept,”The powers delegated by the proposed Constitution to the federal government are few and defined. Those which are to remain in the State governments are numerous and indefinite.” (January 26, 1788)
While states keep each other in check through competition, the federal government has no one to keep it in check except it’s own branches, which highlights the importance of electing people to office who understand and defend the constitution.
For this same reason, perhaps the single most destructive consequence of applying a mandate at the federal level is that it takes away our ability to measure the effectiveness of the mandate. To put this in terms of science, it removes the controls. For instance, if conditions worsen after a federal mandate goes into effect, the federal government can claim conditions would have been even worse without the mandate. The federal government gets away with this because there are no controls to prove otherwise. However, if conditions improve after a federal mandate goes into effect, the federal government attributes the improvement to the mandate. In contrast, when an individual state implements a mandate it can compare its progress with national trends across the other states. If conditions worsen or improve, the state can ask how conditions have fared compared with other states.
Romney understood that in the liberal state of Massachusetts the legislature he had to work with might add provisions he objected to – and they did. He also understood that future elected officials might add even more imprudent features to the plan – and they have. But he understood that as long as the federal government stayed out of the matter, aside from continuing to provide standard (non-“stimulus”) aid to each state (which Massachusetts incorporates into its health care plan, and other states continue to use for hospital bailouts; these are funds the states paid to the federal government in the first place, so this really only constitutes the federal government returning what the state paid. Massachusetts receives more than some states because it has higher income and pays more taxes), Massachusetts state law would be kept in check by the capitalist forces imposed by other states, thereby narrowing unwise expansion and forcing a pruning of provisions which fail. However, the enemy of states’ rights, federal intervention, threatens setbacks.
Obama’s unsustainable policies have used borrowed money to bail out states even when they continue failed policies, thereby artificially suspending capitalist forces between states. Massachusetts liberals have changed Romney’s health care plan, and although the plan has still been effective, only time will tell if their changes will be sustainable. Possibly the worst thing that could happen is for the federal government to continue bailing out states instead of allowing capitalist pressure to force states to restructure their policies. In the case of Massachusetts, this would mean a return to Romney’s original health care plan, ideally including a repeal of the provisions which Romney vetoed but which the legislature overrode. Romney structured his original plan to ensure no increased cost to the state. Romney reorganized and streamlined the state medical budget to work with citizens toward acquiring private insurance policies, successfully insuring virtually every citizen.
At the time of the Founding, it was not uncommon to mandate public service by imposing a monetary penalty on anyone who refused an appointment to town office. This was, for instance, the case with public servants in Virginia. Thomas Jefferson supported imposing penalties on those who refused public service appointments, and signed legislation to specifically impose such a penalty in two towns, on Oct. 1779 (Chap. 25). Should Thomas Jefferson be excused?
These laws were also enforced in Virginia by Founding Fathers Patrick Henry and Benjamin Harrison V.
Also at the time of the founding, most states had laws mandating that if a neighbor wanted a fence along someone’s property line, which most states considered the default assumption, one was obligated to build and maintain an equal share of the fence, to a height and composition specified by law. A typical penalty for failing to follow the mandate was at least the cost of building and repair, and in some states up to twice that cost. Fence-viewers were appointed to examine the fences. And, of course, anyone refusing to be a fence-viewer usually had to pay a penalty.
Fence mandates were directly enforced by:
Benjamin Franklin (President of Pennsylvania, Prominent Founding Father)
John Jay (Federalist Papers, First Chief Justice of The Supreme Court and Governor of New York)
John Hancock (President of the Continental Congress, First signer of the Declaration of Independence, First Governor of Massachusetts, Third Governor of Massachusetts)
Samuel Adams (Founding Father, Governor of Massachusetts)
Are the Founding Fathers merely FINOs (Founders In Name Only) and PINOs (Patriots In Name Only)? Or have critics missed something important that Romney understood all along. State’s grow by experimenting. Romney had the ultimate “excuse” for his health care experiment, the MA constitution, as penned by John Adams:
“Government is instituted for the common good; for the protection, safety, prosperity and happiness of the people; and not for the profit, honor, or private interest of any one man, family, or class of men: Therefore the people alone have an incontestable, unalienable, and indefeasible right to institute government; and to reform, alter, or totally change the same, when their protection, safety, prosperity and happiness require it.”
“The people of this commonwealth have the sole and exclusive right of governing themselves, as a free, sovereign, and independent state; and do, and forever hereafter shall, exercise and enjoy every power, jurisdiction, and right, which is not, or may not hereafter, be by them expressly delegated to the United States of America in Congress assembled.”
These clauses iterate in the strongest of terms the right of the people to have their government do what they want it to do.
Courts also find preambles useful in ascertaining the intentions behind, and meanings of, operative statutory provisions. And the Constitution’s preamble likewise stresses the role of government in MA and the ability of the people to shape that role:
“The body politic is formed by a voluntary association of individuals: it is a social compact, by which the whole people covenants with each citizen, and each citizen with the whole people, that all shall be governed by certain laws for the common good.”
“The end of the institution, maintenance, and administration of government, is to secure the existence of the body politic, to protect it, and to furnish the individuals who compose it with the power of enjoying in safety and tranquility their natural rights, and the blessings of life: and whenever these great objects are not obtained, the people have a right to alter the government, and to take measures necessary for their safety, prosperity and happiness.”
In light of these clauses, we can understand the obligation spoken of by John Adams in Part I, Article X:
“Each individual of the society HAS A RIGHT TO BE PROTECTED by it in the enjoyment of his life, liberty and property, according to standing laws. HE IS OBLIGED, CONSEQUENTLY, TO CONTRIBUTE HIS SHARE TO THE EXPENSE OF THIS PROTECTION; TO GIVE HIS PERSONAL SERVICE, OR AN EQUIVALENT, WHEN NECESSARY; but no part of the property of any individual, can, with justice, be taken from him or applied to the public uses without his own consent, OR THAT OF THE REPRESENTATIVE BODY OF THE PEOPLE. In fine, the people of this Commonwealth are not controllable by any other laws, than those to which their constitutional representative body have given their consent…”
(CONSTITUTION OF THE COMMONWEALTH OF MASSACHUSETTS, Part 1, Article 10, emphasis added)
It is the right, therefore, of every individual residing in Massachusetts to be protected by it in whatsoever fashion is determined by the people through their representative body.
Those who are not willing to abide the precepts of the Massachusetts constitution are free to reside in a different state. They are not free however to abdicate personal responsibility for knowing the constitutional expectations associated with their choice to reside in the state of Massachusetts, which includes being called to bear such mandates when deemed appropriate by the state as a whole.
At this point, I’d like to turn my attention back to the concerns expressed by Mr. Domenech, who said Mitt Romney’s campaign, “took time to bash yet another health care study illustrating how his reforms in Massachusetts raised premium costs and cost the state jobs…”
Romney’s campaign did dismiss the study as invalid, but if the results are indeed invalid then we shouldn’t fault the Romney campaign for saying so. The first problem is that the study is limited to determining the impact of health care cost increases on the surrounding economy. The study is not designed to determine what caused the increase in health care costs to begin with. The study, in other words, had no basis for concluding anything about Romneycare.
But it gets worse. The study makes this assumption because it defers to an earlier study.
That study, in perhaps a Freudian slip, states at one point: “We employed the same mythology.” And, indeed, there is “mythology” in their methodology. Their trend numbers, which they use in comparing health costs under Romneycare with costs before Romneycare, are faulty. For instance, in Table 11 their “trend” numbers claim that costs in 2006 were expected to decline from 2005, but this is clearly a false trend since costs had increased every year since 1998.
They then subtract their false trend numbers from the actual cost increase, creating the impression that costs rose at a faster rate. The bogus numbers compound each year, as the false trend numbers get further off course. We can see this play out in each of their tables. Consider table 12, insurance premiums for an average single plan. From 2000 to 2005, costs increased by $1500; meanwhile, from 2004 to 2009, costs only increased by $1100. That’s a downward trend. Yet the study claims that the premium rate in 2009 was $215 higher than the trend.
This disqualifies both studies. The first study was based on the difference between actual numbers and false trend numbers. The second study is based on the first study.
Even with the flaws with Romneycare, despite the costly provisions added by the legislature and new governor, it has slowed the rate of many health care cost increases in Massachusetts – despite the aging population of baby boomers (hip and knee replacements are up dramatically, as well as MRI/CT scans, and mobility scooters) and rising obesity rates. In all, it is working. Think how effective it would be if Romney had been able to do it his way. As he said, “There is no question in my mind that our program could be significantly improved if it were managed by a conservative administration.”
Using the raw data contained in their own tables, let’s look at how costs have slowed. Keep in mind that Romneycare went into effect in 2007. To measure it’s effectiveness we start with the previous year, 2006, so as to contrast the status prior to the law taking effect with the most current status reflected in available numbers.
Table 9: State medicaid spending increased by $1.4 billion from 2003 through 2006, and by $1.5 billion from 2006 through 2009. Again, the slight increase is attributable to the aging population.
Table 10: Medicare Advantage monthly rate increased by $166 from 2002 through 2006, and by only $139 from 2006 through 2010.
Table 11: Medicare Personal Health Care expenditures increased by 1.4 billion from 2003 through 2006, and by only 1.3 billion from 2006 through 2009.
Table 12: Average Insurance Premium (Single) increased by $952 from 2003 through 2006, and by only $820 from 2006 through 2009.
Table 13: Average Insurance Premium (Family) increased by $2423 from 2003 through 2006, and by $2433 frp, 2006 through 2009. Only ten dollar difference between cost increases.
Mr. Domenech voiced a secondary concern which I feel needs to be addressed because it is in the context of accusing Mitt Romney of a factual error: “the overwhelming number of those newly covered are subsidized by other taxpayers, and are on Medicaid, not private market-based insurance.”
“The plan expands opportunities for Medicare beneficiaries to use their benefits to enroll in private health plans as an alternative to traditional Medicare coverage” – Ronald Wilson Reagan
The insurance is private, just as Romney said, and is subsidized by government aid more than Romney wanted. The private insurance plans are different from each other, and thus are indeed market based, though not as much as Romney wanted due to mandates imposed by the legislature.
Why did Romney work with the legislature? On February 9, 1983, when Ronald Reagan was asked about people who said he was “moving away from the policies and principles” that got him elected, Reagan responded by explaining that compromise is not retreat: “I’m not retreating an inch from where I was. But I also recognize this: There are some people who would have you so stand on principle that if you don’t get all that you’ve asked for from the legislature, why, you jump off the cliff with the flag flying. I have always figured that a half a loaf is better than none, and I know that in the democratic process you’re not going to always get everything you want. So, I think what they’ve misread is times in which I have compromised.”
Mr. Domenech says Mitt has “continued to maintain his approach is a ‘Republican way to reform the marketplace’”
Mitt has from the beginning stood by the principles which I outlined earlier, and has consistently stated that those guidelines could be a useful model for other states to work with. He has dropped other aspects which he once supported, and has consistently opposed many aspects which were foisted upon the health care plan against his desires. In the context of it being a “Republican” plan, Reagan told Gorbachev to “tear down this wall,” but did not insist the entire Soviet government change overnight. Republicans understand that leaders in a war zone need space to operate differently depending on terrain. Our Republican leaders in liberal terrain need that same freedom. A Republican idea looks different depending on whether it’s implemented in a liberal or conservative terrain. But Romney moved in the right direction. The alternative proposed in MA was to make health care a constitutional right.
As far as comparing MA with other states, premiums were high compared to the rest of the nation, before Romneycare. They are high now, they were high then. However, Rhode Island and New Jersey are right behind MA. The obvious correllation here is that RI, NJ and MA are by far the three most densely populated states in the nation. When you receive an MRI scan, the hospital charge is primarily for their investment in purchasing the scanner in the first place, not the cost of the actual scan. Likewise, additional costs accrue in densely populated states. Land costs more, so hospitals cost more. Construction is more crowded, cumbersome and costly. The initial expenditure is higher, and so then are the costs to recoup that expenditure. Insurance companies can afford those higher costs because residents can pay higher premiums withMassachusetts having the second highest personal income per capita, and personal disposable income per capita, behind only Connecticut.