The sequel is rarely as good as the original. That's true in movies and, it turns out, in health reform, too.
Mitt Romney got it right the first time: As governor of Massachusetts, he championed a plan that required virtually everyone to have health insurance and provided subsidies for those who couldn't afford it. The state still struggles with cost containment, but RomneyCare, the original, produced near-universal coverage and served as a model for the national reform President Obama pushed through Congress in 2010.
Of course, RomneyCare's similarity to ObamaCare, which is highly unpopular with Republicans, became a tricky political problem once Romney sought the GOP presidential nomination. He now says the Massachusetts plan is right for his state but is a terrible idea for the entire nation. Romney has never made a convincing case, however, for why the country should have 50 health care systems. Is a heart attack in Montana really all that different from one in Massachusetts?
Now, ahead of the pending Supreme Court ruling on challenges to ObamaCare, the Republican candidate has added a few more details to RomneyCare, the sequel. The plan he described in a speech this week in Orlando deserves serious attention because the court could strike down ObamaCare or leave it in tatters. And even if the law survives, Romney has vowed to do everything he can to dismantle it, starting on his first day in the White House.
So what would RomneyCare II look like?
First, there are some good ideas, such as cracking down on malpractice awards. The pernicious way that lawsuits push doctors to over-test and over-treat got short shrift in Obama's reform. And Romney's mantra that health care should be more like the "consumer market" could help patients comparison shop.
But, overall, RomneyCare II is shaping up as an evolving grab bag of familiar bromides and policy ideas that constitute a profoundly inadequate follow-up to his initial effort.
For one thing, applying market principles has limits. Allowing people to buy insurance across state lines sounds smart, for instance, but in practice it steers people toward states with the low standards and cheap policies that are all but useless in the event of real illness. Setting minimum coverage standards, as ObamaCare will do, is a way to prevent people from going bankrupt just because they get sick.
Also unconvincing is Romney's plan for fixing one of health care's biggest problems — ensuring that people with pre-existing conditions can get coverage. This week, three major health insurers said they would continue to offer some of ObamaCare's popular new benefits even if the law is struck down, but they drew the line at covering applicants with pre-existing conditions. Absent a requirement that people buy insurance before they get sick or injured, insurers simply can't afford to take all comers.
Romney would leave the issue pretty much up to the states, insisting that they "have responsibility to care for their people in the way they feel best." But that includes states such Massachusetts, where RomneyCare I has ensured that only about 2% of residents go without health insurance, and Texas, which last year ranked dead last among the states in health coverage. One-fourth of Texans had none. A state-by-state approach means millions of Americans will go without.
And there's the larger problem. If the goals are to expand coverage, help people with existing conditions get affordable insurance, and make sure you don't lose your coverage if you lose your job, RomneyCare II falls well short of what's needed. If this were a film, it wouldn't deserve any Oscar nominations.