SALINA, Kan. - It was a memorable highlight in the health care reform debate, one that will undoubtedly be replayed often in the coming months. Afterward, John McDonough, professor at the Harvard School of Public Health, credited Mitt Romney with the "most effective and persuasive rationale and defense of the individual mandate" to date during the presidential campaign.
Rick Santorum elicited the response from Romney during the January 27 debate between the remaining Presidential candidates in Florida. When he tried to attack "Romneycare," what many believe to be Gov. Mitt Romney's biggest policy success in Massachusetts and a model for the federal health care overhaul, Romney responded with one of his best moments of the evening. "If you don't want to buy insurance, then you have to help pay for ... your bill ... no more free riders. We're insisting on personal responsibility. Either get the insurance or help pay for your care."
Of course what many regard as a significant accomplishment for Romney will be an albatross for him should he prevail in the primary race to face off against Barack Obama in the fall. He insists that there are significant differences in the federal plan and the one he signed into law as governor. But McDonough, who was involved in the crafting of both, disagrees. He was quoted by National Public Radio after the recent debate as saying that "the essential architecture of the insurance reforms in the Affordable Care Act is taken wholly from the Massachusetts health reform law."
At this point the rhetoric over the Affordable Care Act has gotten so hot that most are content to sit and wait for the Supreme Court to rule on its constitutionality early this summer. Meanwhile it's interesting watching Romney dance around the health care bill he signed. Recently the journal Health Affairs published a favorable review of the first five years of the Massachusetts' plan. They take note of the fact that Emergency Room visits have been reduced and the numbers of uninsured are "quite low."
Romney has defended the Massachusetts' law at other moments in the campaign as well. When attacked by former rival Governor Rick Perry in a debate prior to the Iowa caucuses he responded that his state has the lowest percentage of uninsured kids in the country while Perry's state (Texas) has the highest.
The irony of such statements brings me back to the best summary I've heard of the debate surrounding health care reform. Following a summit at the University of Kansas on the subject in March of 2009 former Kansas congressman and senator Bob Dole remarked to reporters that "opposition (to health care reform) was driven by knee-jerk partisanship." He later amplified on the comment by telling the Kansas City Star that, "Sometimes people fight you just to fight you."
Dole was a founding member (along with former Senate Majority Leaders Howard Baker, Tom Daschle and George Mitchell) of the Bipartisan Policy Institute. The center issued a template for health care reform in June of 2009 which included an insurance mandate with no public option. In October of the same year Dole and Daschle issued a joint statement supporting the reform efforts. In his August 31, 2009, op-ed piece in the Washington Post, Dole called health care reform "the vital issue of our time."
If Dole is correct, and others share his concern about what our health care system has done to our federal budget deficit, we all have a stake in the Affordable Care Act's success. In a general election contest would Romney be able to simultaneously take credit for and distance himself from his signature achievement?