Monday, October 1, 2012

Another Installment of the War on Broccoli

During an interview on 60 Minutes, Romney was asked if the government had a responsibility to provide healthcare to million Americans who do not have it, and he replied: “We do provide care for people who don’t have insurance. If someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care.” When asked in an earlier interview on Morning Joe whether he believed in universal healthcare coverage, Romney said, “Look, it doesn't make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care, for which they have no responsibility.” Romney can, of course, explain why his statements are somehow consistent with the Republican platform. Democrats can, of course, use his statements as an illustration of Romney’s lack of a true center, a flip-flopper.

My interest in those statements has to do with the broccoli mandate.

In making those statements, Romney was siding with the liberal judges on the U.S. Supreme Court who were of the opinion that, because uninsured persons must be provided care in hospital emergency rooms, the federal government had jurisdiction under the commerce clause to pass a law with a mandate requiring all people to maintain health insurance. It is not as though Romney was somehow not aware of the connection. He made the logical/legal connection as governor of Massachusetts and called it a personal epiphany: a) uninsured Massachusetts residents received healthcare because federal law requires hospitals to treat people with emergency medical conditions; b) the cost of treating uninsured patients was being paid for by insured patients; and c) insured patients would pay less for care if the cost of caring for the uninsured in emergency rooms was used instead to buy insurance for them so they would get care before acute conditions worsened.

Obviously, Romney was not the first to have such an “epiphany” but he deserves credit for being governor of the first state to translate the epiphany into legislation.

If Romney were somehow insulated from his handlers and able to speak his mind, I believe he would admit that the mandate in the Affordable Care Act was constitutional—under the commerce clause and not solely under congressional taxing authority a la Roberts. His problem with it is not legal; it is political and economic. The political problem is straightforward: it is Obamacare, a hot button that works with a certain constituency. He would have to be absolutely against it even if it worked better than advertised. The economic problem is more complex. I do not believe Romney’s statements that Americans already have a kind of universal healthcare—i.e., the emergency room—constitute some sort of flip-flop. His priorities have simply changed from when he was governor of Massachusetts. His epiphany was economically neutral. The theory was that the government would pay for universal healthcare by reducing the cost of uncompensated care in hospital emergency rooms. The same theory underlies the ACA and is being used to justify dramatic reductions in Medicare and Medicaid. So, what happened to the economic epiphany he had as Governor? Did new thinking prove the theory unsound?

No. Romney has simply embraced a more fundamental economic priority: reducing taxes on wealthy taxpayers. Everything else is secondary—one might even say expendable.