Romney Talks Tough on Health Care

But what’s he really saying?

Mitt Romney is talking tough these days about health care and touts his Massachusetts plan as a national model. His words are classic spin, baffling even the health-care cognoscenti, and average voters have few clues about the meaning of much of what he says. Follow-up questions might help, but if reporters are asking them, their answers aren’t showing up in print. Some examples:

Romney told a group of Las Vegas businessmen: “Now that we got the rates down so they’re more affordable…either buy a health care policy or pay your own way at the hospital. But no more showing up expecting free care from the government or from the hospital.” What free care? Uninsured folks who go to emergency rooms get bills that every hospital tries very hard to collect. (Just ask Sergio A. Olaya, the twenty-one-year-old man who runs the elevators in the Senate chambers, where health care is so often debated. He is struggling to pay off a $255,000 bill his uninsured mother ran up before her death, and is hounded by collection agencies, as Robert Pear reported November 25 in The New York Times.)

Stumping in Iowa, Romney said health care reform that targets the private industry helps to make care more equal. Reporters might ask: Just how does that happen? U.S. health care is provided by private industry now—private drug companies, for-profit hospitals and nursing homes, and, for the vast majority of Americans (with the exception of those on Medicare and Medicaid), insurance is provided by private insurance carriers. The literature is full of studies that show widespread disparities under the current medical system.

The Iowa City Press-Citizen missed the chance to pin Romney down when he opined that insurance should be offered directly to individuals and not through employers. That way, he said, insurance companies compete on a person-to-person basis, and the costs go down. Does Romney know that buying insurance individually is the most expensive way to get coverage? Obtaining it through large groups, such as large employers, is the cheapest way to go because risk is spread over lots of people. Perhaps a comparison chart in the paper illustrating this basic principle of insurance would enlighten him and readers in Iowa City.

Speaking to a group of 500 students at Des Moines University, Romney said the federal government needs to loosen regulations on the nation’s health insurance providers, increasing competition and thereby lowering patient costs. As president, he told the crowd, he would hand more authority to state health programs and create incentives for deregulating the insurance market. Last time I checked, health insurance, like all insurance, is regulated by the states, not the federal government. Back in 1945 Congress passed the McCarran-Ferguson Act giving insurance carriers a limited exemption from antitrust laws in exchange for state regulation. Thanks to reduced antitrust oversight, the nation’s health insurance companies have combined themselves into a handful of mega carriers that dominate the market. Nothing has prevented United Health Care and Wellpoint, the country’s biggest health insurers, from gobbling up smaller companies to market the products some of those small fry created. Stock analysts cheered—good for corporate growth, they said. If Romney is suggesting a break up for United and Wellpoint to achieve his goal of more competition, that point didn’t register with the Register.

The press needs to take a hard look at Romney’s Massachusetts plan, which calls for people not covered through employers or public programs to buy their own insurance. With California about to adopt a similar law and Colorado and other states taking a keen interest, voters and policymakers need to know the real story. The Arizona Republic brushed off that story in a piece about Republicans moving in on a traditionally Democratic issue. The Republic did say the final verdict on the Massachusetts program was not in. True enough. But then it went on to say “but experts say the early signs are positive.” Which experts?

The Salem News in Massachusetts did look at the numbers and found some shortcomings: between 200,000 and 400,000 people had not enrolled before the mid-November deadline for picking a plan. The state is having trouble finding people to sign them up. A $600,000 media campaign hadn’t done the trick. The plan’s governing body, the Commonwealth Health Insurance Connector Authority, says that “it will take several years to implement” the law. In Sunday’s New York Times, John McDonough, who heads an advocacy group and has been a strong supporter of the state’s approach, conceded that he found it breathtaking that political leaders were calling for an individual mandate well before there was any way to measure success in Massachusetts.

If health care is to be a real issue at the voting booth and not just something people care deeply about, which polls suggest they do, it’s time for the media to look behind Romney’s tough words. The press is letting him get away with nonsensical statements that should be challenged. Instead of just writing down what he says, how about a couple of sentences that explain the remarks and put them in context? Are we too timid to challenge him?

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.