It would seem that the press coverage of Mitt Romney’s health care speech in Michigan yesterday was greater than media coverage of the Massachusetts law itself when it was held up as the model for federal reform legislation. This time, though, there were the elements of a good story, as defined by contemporary MSM journalism. There was a villain—the former governor turned presidential candidate who might repudiate the law he helped pass. There was drama—will he or won’t he say the Massachusetts law was a mistake after all? Yes, this was an easy story to do—a real crowd pleaser. Carefully scrutinizing the Massachusetts law is much harder. Reporters, take note: There’s plenty of room for that as a follow-up to Romney’s message du jour.
Some in the media tried to define the story before the story. “What Romney’s speech needs to say,” headlined a Politico story advising Romney to say four things: “I swear it’s different than Obamacare,” “Mea culpa. Sort of,” “Here’s why I could stomach the mandate,” and “Seriously, I’m offering something new here.” A Los Angeles Times Washington bureau story flatly said: “What would qualify as real news would be an unadulterated apology, a mea culpa, for his role in providing a model for what critics label “Obamacare.” My goodness! Were these news outlets taking a stand against Romney’s role in passing the Massachusetts law by suggesting he apologize? The Political Hotsheet from CBS News continued the theme with a headine screaming: “Mitt Romney refuses to apologize for Massachusetts health care plan.”
In his speech, Romney didn’t apologize for his part in putting the law on the books with its individual mandate, its penalties for not buying insurance, its shopping exchange called the Connector, or its lack of convincing controls on the price of medical care. To do so, he said, “wouldn’t be honest.” He said that pundits (not to mention the press—see above) had been pushing him to say his decision to sign the Massachusetts plan was a “boneheaded” mistake. He would not do so. Signing the law, he said, “was right for the people of my state.” And it was for thousands of residents who got state-subsidized coverage, for insurance companies that got new customers, and for the hospitals that got revenue from newly-insured patients. Whether the law has staying power, or is doomed because of the lack of cost containment is another matter—one that, for the most part, this crop of stories did not dwell on.
In an effort to have it both ways, Romney seemed to be playing the states’ rights card and arguing that the federal health reform law is big government. He said that what is right for one state is not necessarily right for the nation and that America’s founding fathers did not want a “king-like structure” grounded in a central government. That meant, he explained, that on his first day as president he would sign an executive order to help states get waivers to opt out of the federal law. There have been questions from the get-go about whether other states can indeed replicate the Massachusetts experiment. Will a mandate and its penalties achieve the same rates of insurance coverage in places like Mississippi or Texas that have a much higher proportion of their population without coverage than Massachusetts ever had?
This question is ripe for exploration, and so are the other parts of his “repeal and replace” strategy unveiled in the Ann Arbor speech. While news stories briefly outlined the elements of his proposal, there was little scrutiny or explanation for readers who might want to know if what he is saying has merit. For example, he wants to “empower individual ownership,” which means, in his context, giving a tax break to individuals to encourage them to buy insurance—a shop-worn Republican proposal that kind of sounds like the “personal responsibility” his staff talked about during legislative debate on the Massachusetts law. He would also make health care more competitive through “co-insurance products” that give consumers more of a stake in the cost of their health care—another shop-worn idea that can cause people to forego needed medical treatment as a recent study showed.
Doesn’t Romney know that insurance policies with high deductibles and lots of coinsurance are already the norm? And he wants to tackle malpractice reform, limiting the right to bring a lawsuit? Doesn’t every Republican politico want to do that—even though the evidence shows that defensive medicine and malpractice suits contribute relatively little to the nation’s health care tab?
Instead of amplifying these points, some outlets decided to fact-check others he made, a trivial exercise that added little to the discussion that needs to happen as his campaign moves ahead. “There’s no government insurance program,” Romney said. Politico begged to differ, pushing out a story saying that Massachusetts does have a government-administered plan: Commonwealth Care, which is run by a state agency and supervises the subsidized coverage for low-income residents. Well, yes, that’s true, but Massachusetts health insurance is hardly a model of national health insurance programs like other developed nations have. Romney probably had that in mind when he made his comment. ABC News also tried to catch Romney when he said the law didn’t raise health care costs. While conceding that the “law itself didn’t put a major dent in the state’s budget,” ABC News said it “failed to curb overall costs for policyholders.” Was ABC News suggesting that Romney was lying or simply uttering a half truth? Things get tricky here.
There’s a lot for the press to examine as Romney’s campaign progresses. But the semantic details of whether the state’s program is government-run are a sideshow. The public needs to know if his “repeal and replace” proposals are really any different from any other Republican’s, and whether they will control costs in a way that will make both the Massachusetts law and the federal law sustainable for the long-haul. That’s the takeaway from Mitt Romney’s speech.
Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.