More than anyone else during any of the previous Republican presidential debates, Rick Santorum took dead aim tonight at the similarities between Romneycare and Obamacare. Arguing that those similarities could pose great problems for the Republican party and for the prospects for repeal if Mitt Romney were to win the nomination, Santorum implored GOP voters to remember, “We can’t give this issue away in this election.”

The exchange over Romneycare and Obamacare began when Santorum responded to a health care question from an audience member. He said, “Governor Romney was the author of Romneycare, which is a top-down government-run health care system which, [I] read [in] an article today, has 15 different items directly in common with Obamacare, everything from the increase in the Medicaid program…to [the] mandate you buy something [as] a condition of breathing, [the] mandate that you buy an insurance policy….”

Santorum argued that Romney’s Massachusetts health care overhaul is “pretty much a model for what Obamacare is going to look like: the highest health care costs in the country, 27 percent above the average...[and] 94 percent of the people in Massachusetts are now insured, but there was just a survey that came out and said one in four don’t get the care they need because of the high cost. So, you have a card, you’re covered, but you can’t get care.”

In his book, No Apology, Romney admitted that getting “overall health-care costs for everyone [in Massachusetts] to actually go down…is the task that remains.” However, in response to Santorum’s critique, Romney stood by Romneycare:

“The system that we put in place in our state was something we worked out with the labor community, the health care community, business, and the citizens of the nation. We came together, it was voted [on] by a 200-person legislature. Only two voted no.

“Our system has a lot of flaws, a lot of things I'd do differently. It has a lot of benefits. The people of the state like it by about three to one.”

Romney didn’t mention that the people of that state also voted for Barack Obama by nearly two to one.

Without having said how Romneycare differs from Obamacare, Romney concluded by saying, “We consider it very different than Obamacare.” He then shifted his focus to Obamacare itself, saying, “If I were president, [on] day one I will take action to repeal Obamacare. It’s bad medicine. It’s bad economy. I’ll repeal it.”

He added, “I believe the people of each state should be able to craft programs that they feel are best for their people. I think ours is working pretty well.”

Santorum pounced:

“What Governor Romney just said is that government-run top-down medicine is working pretty well in Massachusetts, and he supports it. Now, think about what that means — going up against Barack Obama…you are going to claim, well, top-down government-run medicine on the federal level doesn’t work, and we should repeal it. And he’s going to say, wait a minute, Governor. You just said that top-down government-run medicine in Massachusetts works well.

Santorum added, “Folks, we can’t give this issue away in this election. It is about fundamental freedom.”

Romney then replied by issuing a defense of Romneycare that sounded a lot like the defense that Obama (who might have even been taking notes) is likely to give of Obamacare: “I didn’t say I’m in favor of top-down government-run health care. Ninety-two percent of the people in my state had insurance before our plan went in place.” (For Obamacare, it’s nearly the same percentage of people, only nationwide) “And nothing changes for them. They own the same private insurance they had before.” (As Obama likes to say, “If you like your health care plan, you can keep your health care plan.”) “And for the 8 percent of people who didn't have insurance, we said to them, if you can afford insurance, buy it yourself, any one of the plans out there, you can choose any plan.” (The same is true for Obamacare — except, as in Romneycare, for the large numbers of people who get shuttled onto Medicaid.) “There’s no government plan.” (There isn’t one in Obamacare either, as the public outcry caused the “public option” to be nixed.)

Referring to the individual mandate, Romney added, “We are insisting on personal responsibility.”

Santorum responded, “Does everybody in Massachusetts have a requirement to buy health care?”

Romney replied, “Everyone has a requirement to either buy it or pay the state for the cost of providing them free care.”

Santorum said, “Just so I understand this, in Massachusetts, everybody is mandated as a condition of breathing in Massachusetts, to buy health insurance, and if you don’t, and if you don’t, you have to pay a fine.”

Moments later, as the discussion over Romneycare and Obamacare continued, Romney rebuked Santorum, saying, “First of all, it's not worth getting angry about.”

Romney then reiterated that his fundamental objection to Obamacare, apart from it being an affront to federalism, is apparently that he doesn’t like the way it’s funded: “Look, I know you don’t like the plan that we had [in Massachusetts]. I don’t like the Obama plan. His plan cuts Medicare by $500 billion. We didn’t, of course, touch anything like that. He raises taxes by $500 billion. We didn’t do that.”

Romney then repeated his claim that somehow Obamacare, which requires that essentially everyone buy government-approved health insurance, deals with “100 percent of the people of the country,” whereas Romneyacare, which requires that essentially everyone buy government-approved health insurance, only deals with “the 8 percent of the people that were uninsured.”

Moments later, he asserted, “If I'm president of the United States, I will stop it [Obamacare]. And in debating Barack Obama…I will be able to point out that what he did was wrong.” He then repeated his mantra: “It was bad medicine, it's bad for the economy, and I will repeal it.”

Santorum got in the last word: “[W]hat Governor Romney said is just factually incorrect. Your mandate is no different than Barack Obama’s mandate. It is the same mandate….You take over 100 percent [of health care], just like he takes over 100 percent....The same fines that you put in place in Massachusetts are [the] fines that he puts in place in the federal level. Same programs.”

The exchange offered a stark reminder of one inescapable set of facts: President Obama spent the bulk of his first 15 months in office ramming his signature legislation down the throats of the American people. Yet, as his State of the Union Address made clear, he’d rather not bring it up. So if Republicans are going to have a mandate to repeal this unprecedented threat to liberty and fiscal solvency, they will have to bring it up — or, rather, their nominee will have to bring it up. And he will have to know why he opposes it — not merely that he does.

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