Mike Huckabee, presumed presidential aspirant, is preaching the gospel of socialized medicine by attacking the Massachusetts reform law, of all things. “If our goal in health-care reform is better care at lower cost, then we should take a lesson from RomneyCare, which shows that socialized medicine does not work,” Huckabee writes in his new book, A Simple Government—a kind of pre-Iowa guide to the candidate’s thinking.
Massachusetts health reform is hardly what I would call socialized medicine. It is classic free enterprise. In fact, the state’s law pushed the country further away from national health insurance with its key ingredients—universal coverage, low administrative expenses, and limits on what medical providers can charge. In Massachusetts, residents buy their insurance from a small number of private insurance carriers and get their care from highly concentrated health care systems that give some of the costliest care in the world, and did even before Massachusetts passed its law in 2006.
The state does not sell insurance, but it does operate the Connector, where people shop for coverage. And like the federal law, there is the mandate that everyone carry insurance. I suppose some people conflate a government requirement to buy coverage with the government being in the business of selling it. But Huckabee doesn’t make that distinction. Tossing around the term “socialized medicine” is still a good way to get people to hate health reform.
Huckabee is a good Republican soldier, and at the moment attacking health care is the political weapon of choice. His first aim is likely rival Mitt Romney, who had a heavy hand in designing the Massachusetts plan. He says Romney should apologize for passing a plan that Huckabee claims does not work. Romney, sensing the public and Republicans are equating Massachusetts reform with the federal reform (they are very close cousins), is running for cover. In his own book, No Apology: Believe in America, Romney blames the Massachusetts legislature for changing his plan, and current governor Deval Patrick for poorly implementing it.
Time out. It’s important to remember that many elements of the Massachusetts plan are pure Romney, no matter what he says now. Clearly they are not socialized medicine. Early on, Romney’s staff circulated a document saying that the organizing principles of the law were “a culture of insurance” and “personal responsibility.” A 2008 campaign ad noted that the governor “signed a market-based reform into law that provided every citizen affordable health insurance without raising taxes or creating a massive government-controlled system.”
Huckabee addresses this affordable thing in A Simple Government—a simple book written at a simple reading level with simple-minded arguments with dubious connections. His thirteen-page chapter on health care doesn’t take long to read, and offers few specifics or solutions. He does say Bay State insurance premiums have increased a lot but doesn’t talk about the reluctance of the Massachusetts medical establishment to charge less for their services, and that it’s unclear whether they will go along with recently proposed ideas for slowing down cost increases.
Instead, he argues, if people in Massachusetts are paying so much more, they must be getting better care, but they aren’t. As proof, he asserts: “By almost three to one, Massachusetts residents believe that the quality of their care has been reduced.” That’s hardly solid evidence, since researchers have found that people often believe they are getting good care when they really are not.
He does offer his own cost containment solutions, typical Republican nostrums that have been around for years: letting insurance companies sell across state lines, for example. A path for doing that is already in the federal health reform law; in certain states, companies will be able to do that in 2016. Some experts think that might accelerate the consolidation in health insurance and further boost premiums rather than reduce them. Huckabee also wants tort reform (almost all Republicans do), and wants to eliminate employer-provided health insurance and make the system “consumer-based”—an every-man-for-himself approach. When employers handle the payments, “workers don’t care,” he says, adding “when people don’t question whether or not they really need a test or procedure, it’s probably because they have too little skin in the game.”
The health chapter glibly implies that most health problems are of people’s own making—they eat too much, don’t exercise, and skip preventive tests. He cites the case of Safeway, whose CEO, Stephen Burd, testified before Congress saying that the company’s Healthy Measures program, which monitors such things as cholesterol and blood pressure for employees, resulted in its health care costs remaining flat while those of other companies increased by 40 percent. If the nation had adopted Safeway’s approach in 2005, the nation’s health care bill would have been $550 billion less. “That’s a heck of better record than anything Congress has passed or even proposed!” Huckabee writes. “Why didn’t they listen to Burd?” Perhaps they didn’t listen because experts who know something about the subject challenged Burd’s claim—which Campaign Desk reported.
The health gospel according to Mike sounds sooooo reasonable, and it comes across that way on the stump. The problem is there’s a back story to just about everything he says.
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.