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The Man Who Likes Mandates

Mar 26, 2012, Vol. 17, No. 27 • By WILLIAM KRISTOL
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Why is there still so much resistance among Republican primary voters to Mitt Romney, the likely but not inevitable GOP nominee? Perhaps the deepest reason is this: At a moment in history when we need a bold commitment to reform, a fundamental willingness to limit the state and revitalize self-government, Romney’s achievements and qualifications seem out of step with the times.

Photo of Mitt Romney

Gov. Mitt Romney with Sen. Edward Kennedy at the signing ceremony for Romneycare in Boston, April 12, 2006

AP IMAGES / Elise Amendola

Consider a revealing debate moment. It’s not from this year’s campaign but from 2008, when Obamacare did not yet exist. Here’s an exchange from the debate among Republican candidates at St. Anselm College in New Hampshire on January 5 that year:

* * *

Charlie Gibson: Governor Romney’s system has mandates in Massachusetts, although you backed away from mandates on a national basis.

Mitt Romney: No, no, I like mandates. The mandates work.

Fred Thompson: I beg your pardon? I didn’t know you were going to admit that. You like mandates.

Romney: Let me—let me—oh, absolutely. Let me tell you what kind of mandates I like, Fred, which is this. If it weren’t .  .  . 

Thompson: The ones you come up with.


Romney: Here’s my view: If somebody—if somebody can afford insurance and decides not to buy it, and then they get sick, they ought to pay their own way, as opposed to expect the government to pay their way. And that’s an American principle. That’s a principle of personal responsibility. 

So, I said this: If you can afford to buy insurance, then buy it. You don’t have to, if you don’t want to buy it, but then you got to put enough money aside that you can pay your own way, because what we’re not going to do is say, as we saw more and more people .  .  .

Gibson: Governor, you imposed tax penalties in Massachusetts.

Romney: Yes, we said, look, if people can afford to buy it, either buy the insurance or pay your own way; don’t be free riders and pass on the cost to your health care to everybody else, because right now .  .  . 

Thompson: The government is going to make you buy insurance .  .  . 

Romney: No, the government is going to stop .  .  . 

Thompson: and make you pay—I mean, the state—your state plan, which is, of course, different from your national plan, did require people to make that choice, though. The state required them to do that. What was the penalty if they refused? .  .  . 

Romney: If somebody is making, let’s say $100,000 a year, and doesn’t have health insurance, and they show up at the hospital, and they need a $1,000 repair of some kind for something that’s gone wrong. And they say, “Look, I’m not insured, I’m not going to pay.” Do you think they should pay or not?

Thompson: Did your plan cut people off at $100,000? Was that the level?

Romney: No, actually .  .  . 

Thompson: Did it only apply to people with $100,000 income and over?

Romney: It actually applies to people at three-times federal poverty. They pay for their own policy. At less than three-times federal poverty, we help them buy a policy, so everybody is insured, and everybody is able to buy a policy that is affordable for them. The question is this, again, if someone could afford a policy and they choose not to buy it, should they be responsible for paying for their own care? Or should they be able to go to the hospital and say, “You know what? I’m not insured. You ought to pay for it.” What we found was, one-quarter of the uninsured in my state were making $75,000 a year or more. And my view is they should either buy insurance or they should pay their own way with a health savings account or some other savings account.

Gibson: We have an expression in television: We get in the weeds. We’re in the weeds now on this. .  .  . Yes or no, in your national plan, would you mandate people to get insurance? .  .  .

Romney: I would not mandate at the federal level that every state do what we do. But what I would say at the federal level is, “We’ll keep giving you these special payments we make if you adopt plans that get everybody insured.” I want to get everybody insured.

Gibson: Okay.

Romney: In Governor Schwarzenegger’s state, he’s got a different plan to get people insured. I wouldn’t tell him he has to do it my way. But I’d say each state needs to get busy on the job of getting all our citizens insured. It does not cost more money.

* * *

Thus spake Mitt Romney, able technocrat and clear-eyed manager. The well-informed technocrat looks at the current health care system and sees an inability to form stable insurance pools because of problems of adverse selection and free riders. Those problems can be solved—or at least addressed—by mandating that everyone buy coverage. Thus, Romney volunteers, “I like mandates. The mandates work.”

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