During tonight’s Republican presidential debate, Mitt Romney’s Massachusetts health care legislation was a hot topic of discussion, as he was challenged on it more strongly than in any previous debate. Rick Santorum was the first to advance the topic, saying, “Governor Romney, you just don't have credibility, Mitt, when it comes to repealing Obamacare. You are — your plan was the basis for Obamacare. Your consultants helped Obama craft Obamacare. And to say that you’re going to repeal it, you just — you have no track record on that — that we can trust you that you're going to do that.”

Romney replied: “You know, this I think is either our eighth or ninth debate. And each chance I've had to talk about Obamacare, I've made it very clear, and also in my book. And at the time, by the way, I crafted the [Massachusetts] plan, in the last campaign, I was asked, is this something that you would have the whole nation do? And I said, no, this is something that was crafted for Massachusetts. It would be wrong to adopt this as a nation.”

Santorum responded, “Governor, no, that’s not what you said,” adding, “It was in your book that it should be for everybody.” Rick Perry then interjected, “You took it out of your book,” and Santorum repeated that same charge, verbatim.

Romney replied, “Let me make it very clear.” (The moderator, Anderson Cooper, then interjected and gave him 20 more seconds.) “And — look — we’ll let everybody take a look at the fact checks,” Romney continued. “I was interviewed by Dan Balz. I was in interviewed in this debate stage with you four years ago. I was asked about the Massachusetts plan, was it something I'd impose on the nation? And the answer is absolutely not. It was something crafted for a state.”

In fact, however, as Newsweek writes, “During a speech in Baltimore on Feb. 2, 2007, Romney outlined his ambitions for the Massachusetts plan. ‘I'm proud of what we’ve done,’ he said. ‘If Massachusetts succeeds in implementing it, then that will be a model for the nation.’”

At the very least, Romney has clearly viewed his efforts as a model for other states across the nation. On April 11, 2006, the day before he signed his health care legislation into law, he wrote in a Wall Street Journal op-ed (called “Health Care for Everyone? We Found a Way”), “How much of our health-care plan applies to other states? A lot.”

In his book, No Apology, he wrote of Ted Kennedy (on page 174 in the hardback edition), “[T]o his credit he saw an opportunity to work in a bipartisan fashion to try an experiment that might become a model for other states.” Three pages later (on page 177), Romney wrote, “From now on, no one in Massachusetts has to worry about losing his or her health insurance if there is a job change or a loss in income; everyone is insured and pays only what he or she can afford….We can accomplish the same thing for everyone in the country….”

ABC News reports that those last 11 words were removed in the book’s paperback version, validating Santorum’s and Perry’s claim.

The exchange continued from there. Santorum said, “Mitt, the governor of Massachusetts just is coming forward saying we have to pick up the job left undone by Romneycare, which is doing something about cutting health care costs. What you did is exactly what Barack Obama did: focused on the wrong problem. Herman [Cain] always says you’ve got to find the right problem. Well, the right problem is health care costs. What you did with a top-down, government-run program was focus on the problem of health care access. You expanded the pool of insurance without controlling costs. You've blown a hole in the budget up there. And you authored in Obamacare, which is going to blow a hole in the budget of this country.”

Romney replied, “I’m sorry, Rick, that you find so much to dislike in my plan, but I’ll tell you, the people in Massachusetts like it by about a 3-1 margin.” But given that the people of Massachusetts voted for Barack Obama by a 26-point margin, Al Gore by a 27-point margin, and gave South Dakota senator George McGovern his sole state (by a 9-point margin), this might not be the best line of argument in a GOP race.

Shortly thereafter, Romney added, “Now, I can tell you this, it’s absolutely right that there’s a lot that needs to be done. And I didn’t get the job done in Massachusetts in getting the health care costs down in this country. It’s something I think we have got to do at the national level. I intend to do that.”

He then reiterated his support for repeal: “But one thing is for sure. What Obama has done is imposed on the nation a plan that will not work, that must be repealed.”

Cooper then said to Newt Gingrich, “Speaker Gingrich, you’ve also been very critical of Mitt Romney’s plan…on Obamacare….”

In perhaps the most blistering health care critique of the night, Gingrich responded, “The Boston Herald today reported that the state of Massachusetts is fining a local small business $3,000 because their $750-a-month insurance plan is inadequate, according to the bureaucrats in Boston. Now, there’s a fundamental difference between trying to solve the problems of this country from the top down and trying to create environments in which doctors and patients and families solve the problem from the bottom up. And candidly, Mitt, your plan ultimately, philosophically, it’s not Obamacare, and that’s not a fair charge. But your plan essentially is one more big government, bureaucratic, high-cost system, which candidly could not have been done by any other state because no other state had a Medi[caid] program as lavish as yours, and no other state got as much money from the federal government under the Bush administration for this experiment. So there’s a lot of big government behind Romneycare — not as much as Obamacare, but a heck of a lot more than your campaign is admitting."

Romney and Gingrich then went back and forth on the extent to which the individual mandate could be traced to Gingrich. Romney claimed, “Newt, we got the idea of an individual mandate from you.” Gingrich replied, “Wait a second. What you just said is not true. You did not get that from me. You got it from the Heritage Foundation.” And shortly thereafter, Gingrich acknowledged that he’d supported the Heritage Foundation’s individual mandate proposal “against Hillarycare.”

Romney continued, “[W]e don’t have a government insurance plan [in Massachusetts]. What we do is rely on private insurers, and people — 93 percent of our people who are already insured, nothing changed. For the people who didn’t have insurance, they get private insurance, not government insurance.”

The problem with this response is (A) it could just as easily be used as a defense of Obamacare, and (B) it’s partially false.

Obamacare also doesn’t have “a government insurance plan”; its proposed government-run “public option” initially galvanized public opposition more than any other single feature of the overhaul, and as a result the Democrats eventually abandoned it. In his book, expecting a public option to be part of Obamacare, Romney emphasized this as a key distinction between his own efforts and Obama’s (page 176): “In 2009, the national health-care policy supported by President Barack Obama was often and erroneously reported as being based up on [sic] the plan we had enacted in Massachusetts. There were some very big differences — in particular, our plan did not include a public insurance option.” But, in the end, neither does Obama’s.

(In another sense, Obamacare does have a government insurance plan, in that it calls for a colossal expansion of Medicaid, extending it into parts of the middle class. But the Massachusetts health care legislation also significantly expanded Medicaid.)

Romney’s 93 percent claim is false and is akin to saying that for the 90 percent of Americans who were already insured (pre-Obamacare), nothing will change under Obamacare. Both in Massachusetts and under Obamacare, however, essentially everyone — not just 7 or 10 percent of residents — is forced to buy government-approved health insurance under penalty of law. Moreover, those who already have insurance risk losing their preexisting insurance, face the certain prospect of losing some of their liberty as the government takes over an increased portion of their lives, and have to contend with even faster rising health costs — which we have seen in Massachusetts and which the Medicare chief actuary predicts we’ll see under Obamacare.

A few minutes later, Cooper asked Herman Cain, Is there any aspect of so-called Obamacare that you would keep?” Cain replied, “I think we all agree that Obamacare must be repealed because it is a disaster. And the more we learn about it, and the more time goes along, the more we see. We’re all in agreement with that.”

Cain continued, “But here’s where I would start in answering that question. It’s called H.R. 3400” — a sensible, well-conceived proposal introduced in the midst of the Obamacare debate by Dr. Tom Price (R., Ga.), who was then the head of the Republican Study Committee, and 54 cosponsors. Cain added, “This was introduced back in 2009, but you didn’t hear a lot of talk about it. Instead of government being imposed on our system…it basically passes market-centered, market-driven, patient-centered sort of reforms to allow association health plans, to allow loser-pay laws, to allow insurance products to be sold across state lines, and a whole list of other things. So that’s a great place to start.”

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