Yuval Levin and Ramesh Ponnuru yesterday offered one way for Mitt Romney to distinguish his Massachusetts health-care exchanges plan from Barack Obama's federal health-care exchanges plan:
So what, then, should Governor Romney say, if he is the nominee and President Obama suggests that his health-care plan is modeled on the one the Republican enacted? Something, we suggest, like the following:
“Nice try. Your health-care plan, Mr. President, spends a trillion dollars on yet another uncontrollable federal entitlement program and on a massive expansion of a failing Medicaid system. It has an unconstitutional rationing board cut hundreds of billions from Medicare without being answerable to the public, without giving seniors more options, and without using the money to shore up the program or reduce the deficit. It raises hundreds of billions in taxes on employment, investment, and medical research; and after all of that, it wouldn’t even reduce the growth of health-care costs, which is the heart of the problem. And your defense of all that is that it was based on a state program that doesn’t actually do any of those things?
Jonathan Chait rebuts:
But that is what Romney is already saying, right down to the "nice try." And what it’s saying, basically, is that Obama was fiscally responsible. Romney, owing to a quirk of federal funding, was able to finance his plan with a windfall grant from Washington, meaning he didn’t need to come up with any painful cuts to cover his insurance expansions. Obama raised taxes and found inefficient spending within the Medicare system to finance covering the uninsured. And one of the biggest elements of his tax increase was a reduction in the tax deduction for expensive private plans – basically, the strongest version Obama could get through Congress of a staple idea urged by conservatives, which is to eliminate the tax code’s favoritism for employer-sponsored insurance.
I'd propose a different answer for Romney:
"The devil is always in the details. Yes, you adopted the basic design I pioneered in Massachusetts. You're welcome. But then you added features that ruined a good basic concept. You finance your plan with the worst kind of tax increases: tax increases on work, saving, and investment. You expand coverage mostly by expanding our broken Medicaid system: more than half the people who will gain coverage under your plan gain coverage from Medicaid, not private insurance. You're extending federal benefits by adding new costs onto state governments. Yes, you give the states a bit of money to help for a short period of time. Over the longer haul, your plan will force up state taxes as well as federal taxes.
State governments aren't well positioned to control costs. Only the federal government can do that. Yet your plan's cost controls are inadequate and worse.
Here's where we agree: we both want health coverage for all Americans. I'm not going to turn back the clock on that. But you did it the wrong way. I know how to fix it."