Monday, October 3, 2011

An Open Letter To Red State

This is a cross-post from Into Right Field
Allow me to introduce myself. My name is Ryan Larsen. I’m a truth lover, chess player and avid political junkie. I co-founded, which is dedicated to correcting distortions and inaccuracies perpetrated against Mitt Romney.
Before WhyRomney, I wrote for At lyingliar, we debunked all of Al Franken’s big attacks, from his “Chelsea Clinton is a dog” smear against Rush, to his “Peabody” smear against O’Reilly.
Before lyingliar, I was naive. I didn’t realize the lengths people went to in order to dishonestly paint others as dishonest. And that’s what I see people doing to Mitt Romney. Even on the issue of abortion, where Mitt Romney did in fact change his position, critics distort his record terribly.
While I would not accuse anyone at Red State of being dishonest, I do see people building camaraderie around crucifying Mitt with false accusations. With the future of the world literally at stake, we don’t have time for reckless accusations against the man who may be our nominee. I realize not everyone has time to discern fact from fable, but if you don’t have time to make accusations responsibly, you should not make them at all.
In this, an open letter to Red State, I will address the health care concerns many of you have. I don’t have all the answers, but I have insights which may be a game changer for some of you.
First, I want to thank Ben Domenech for his very good encapsulation of his concerns in a recent piece on Red State. Although I believe Mr. Domenech is wrong in his assumptions, I believe his piece is otherwise intelligent and I’m using it as a reference for understanding the sincere angst felt by many regarding this issue.
Mr. Domenech wrote, “Romney is essentially using the waivers as a substitute for proposing an actual reform … Romney’s plan in Massachusetts … is all we have to go on when it comes to evaluating his model for reform as president.”
Romney laid out his plan in a highly publicized speech on May 12, 2011, calling for “Repeal and Replace.” Waivers are authorized in the bill itself, offering a chance for relief while working for repeal.
Skip to the 5:15 mark. Key features: Restore states to leadership, Empower individuals to purchase their own insurance, Focus federal regulation as opposed to it being over-bureaucratic, Reform our medical liability system, Introduce market forces to health care.
I realize Mr. Domenech may still be concerned, because of Romney’s “continued defense of his Massachusetts’ law, including the individual mandate.”
Romney, JD, cum laude, endorsed by Robert Bork, understands state versus federal: “I believe in the 10th Amendment of the Constitution. And that says that powers not specifically granted to the federal government are reserved by the states and the people.” When asked by the moderator why his state mandate was constitutional, Romney replied, “Are you familiar with the Massachusetts constitution? I am.”
Most people don’t realize Romney sought “an opt-out provision for people who wanted to forgo insurance and pay their own way” (HC p. 175). So, Romney did not want a complete mandate in the first place.
More importantly, in the paperback version, Romney says if he could go back he would provide “a tax break for those who have health insurance rather than a tax penalty for those without health insurance” (p. 194). The tax credit does not require an action or purchase on anyone’s part.
In other words, there would be no mandate. The tax credit is justifiable because the state was footing the bill for uninsured hospital patients. When someone acquires health insurance they are removing a costly liability from the state, and therefore deserving of the tax credit. Moreover, this is consistent with a principle shared by Ronald Reagan, “Most employer contributions for employee health benefits should be tax free because this encourages employee health insurance.”
People wanting Romney to distance himself from the mandate already have their wish, without realizing it.
Romney discusses other changes he’d make, such as reinstating his vetoes which the legislature overrode, and making very different choices than the new administration which, for example, allows some people to pay nothing – thereby creating an incentive for free-riders to move into the state. The most costly provision added by the legislature is their requirement that insurance companies provide certain coverage, such as unlimited dental and in vitro fertilization treatments – vetoed by Romney, but overridden. Romney ends his explanation in the paperback with: “There is no question in my mind that our program could be significantly improved if it were managed by a conservative administration. Elections have consequences.”
Mitt Romney is standing by the principles but not the specifics.
So, when we say Romney is sticking to his plan, what we are really saying is that Romney still believes in the following measures at a state level for MA: First, “creating incentives for those who can afford insurance to actually purchase it.” Second, creating “an exchange to help make buying insurance easier for individual – as opposed to corporate – buyers.” And third, “helping the poor buy their own private insurance with a sliding-scale subsidy. The government’s share of the cost comes from redirecting the federal funds that are currently sent to providers” (PB, p. 191).
What he is “standing by,” is not cause for much alarm. The question now, I think, is whether Romney can be excused for instituting the mandate to begin with. Well, he had the Heritage Foundation and other conservatives on board, he had the overwhelming support of the legislature, the media and the people of MA. But if you insist Romney should not be excused, I ask you this: Did Samuel Adams infringe on liberty when he mandated that the kindred of any poor person in MA “shall be holden to support such Pauper?” (1793, “An Act Providing For The Relief And Support, Employment And Removal Of The Poor”). Samuel Adams invented the concept of “States’ Rights.” Did he not understand the role of state law?
If Romney made a mistake, then Samuel Adams made a mistake. Will the Tea Party movement, which derives its name from an act of American Revolution which took place in Massachusetts, fail to excuse a Founding Father from Massachusetts, a signer of the Declaration of Independence?
Here is what critics are missing, but Romney has grasped all along. He has the ultimate “excuse,” the MA constitution, penned by Samuel Adams’ cousin, John Adams. Part 1, Article 10:
“Each individual of the society HAS A RIGHT TO BE PROTECTED by it in the enjoyment of his life, liberty and property, according to standing laws. HE IS OBLIGED, CONSEQUENTLY, TO CONTRIBUTE HIS SHARE TO THE EXPENSE OF THIS PROTECTION; TO GIVE HIS PERSONAL SERVICE, OR AN EQUIVALENT, WHEN NECESSARY; but no part of the property of any individual, can, with justice, be taken from him or applied to the public uses without his own consent, OR THAT OF THE REPRESENTATIVE BODY OF THE PEOPLE. In fine, the people of this Commonwealth are not controllable by any other laws, than those to which their constitutional representative body have given their consent…”
It is the right, therefore, of every individual residing in Massachusetts to be protected by it in whatsoever fashion is determined by the people through their representative body.
Those who are not willing to abide the precepts of the Massachusetts constitution are free to reside in a different state. They are not free however to abdicate personal responsibility for knowing the constitutional expectations associated with their choice to reside in the state of Massachusetts.
At this point, I’d like to turn my attention back to the concerns expressed by Mr. Domenech, who said Mitt Romney’s campaign, “took time to bash yet another health care study illustrating how his reforms in Massachusetts raised premium costs and cost the state jobs…”
Romney’s campaign did dismiss the study as invalid, but if the results are indeed invalid then we shouldn’t fault the Romney campaign for saying so. The first problem is that the study is limited to determining the impact of health care cost increases on the surrounding economy. The study is not designed to determine what caused the increase in health care costs to begin with. The study, in other words, had no basis for concluding anything about Romneycare.
But it gets worse. The study makes this assumption because it defers to an earlier study.
That study, in perhaps a Freudian slip, states at one point: “We employed the same mythology.” And, indeed, there is “mythology” in their methodology. Their trend numbers, which they use in comparing health costs under Romneycare with costs before Romneycare, are faulty. For instance, in Table 11 their “trend” numbersclaim that costs in 2006 were expected to decline from 2005, but this is clearly a false trend since costs had increased every year since 1998.
They then subtract their false trend numbers from the actual cost increase, creating the impression that costs rose at a faster rate. The bogus numbers compound each year, as the false trend numbers get further off course. We can see this play out in each of their tables. Consider table 12, insurance premiums for an average single plan. From 2000 to 2005, costs increased by $1500; meanwhile, from 2004 to 2009, costs only increased by $1100. That’s a downward trend. Yet the study claims that the premium rate in 2009 was $215 higher than the trend.
This disqualifies both studies. The first study was based on the difference between actual numbers and false trend numbers. The second study is based on the first study.
Even with the flaws with Romneycare, despite the costly provisions added by the legislature and new governor, it has slowed the rate of many health care cost increases in Massachusetts – despite the aging population of baby boomers (hip and knee replacements are up dramatically, as well as MRI/CT scans, and mobility scooters). In all, it is working. Think how effective it would be if Romney had been able to do it his way. As he said, “There is no question in my mind that our program could be significantly improved if it were managed by a conservative administration.”
Using the raw data contained in their own tables, let’s look at how costs have slowed. Keep in mind that Romneycare went into effect in 2007. To measure it’s effectiveness we start with the previous year, 2006, so as to contrast the status prior to the law taking effect with the most current status reflected in available numbers.
Table 9: State medicaid spending increased by $1.4 billion from 2003 through 2006, and by $1.5 billion from 2006 through 2009. Again, the slight increase is attributable to the aging population.
Table 10: Medicare Advantage monthly rate increased by $166 from 2002 through 2006, and by only $139 from 2006 through 2010.
Table 11: Medicare Personal Health Care expenditures increased by 1.4 billion from 2003 through 2006, and by only 1.3 billion from 2006 through 2009.
Table 12: Average Insurance Premium (Single) increased by $952 from 2003 through 2006, and by only $820 from 2006 through 2009.
Table 13: Average Insurance Premium (Family) increased by $2423 from 2003 through 2006, and by $2433 frp, 2006 through 2009. Only ten dollar difference between cost increases.
Mr. Domenech voiced a secondary concern which I feel needs to be addressed because it is in the context of accusing Mitt Romney of a factual error: “the overwhelming number of those newly covered are subsidized by other taxpayers, and are on Medicaid, not private market-based insurance.”
“The plan expands opportunities for Medicare beneficiaries to use their benefits to enroll in private health plans as an alternative to traditional Medicare coverage” – Ronald Wilson Reagan
The insurance is private, just as Romney said, and is subsidized by government aid more than Romney wanted. The private insurance plans are different from each other, and thus are indeed market based, though not as much as Romney wanted due to mandates imposed by the legislature.
Why did Romney work with the legislature? On February 9, 1983, when Ronald Reagan was asked about people who said he was “moving away from the policies and principles” that got him elected, Reagan responded by explaining that compromise is not retreat: “I’m not retreating an inch from where I was. But I also recognize this: There are some people who would have you so stand on principle that if you don’t get all that you’ve asked for from the legislature, why, you jump off the cliff with the flag flying. I have always figured that a half a loaf is better than none, and I know that in the democratic process you’re not going to always get everything you want. So, I think what they’ve misread is times in which I have compromised.”
Indeed, if there is a gold standard, that standard is Ronald Reagan. But in his last two years as President, Reagan had to compromise with a Democratic Senate on his judicial appointments. Reagan nominated Anthony Kennedy to the Supreme Court, even though Kennedy showed clear signs of being pro-choice, by citing Roe v Wade favorably and expressing a belief in a constitutional right to privacy. With the new Democratic Senate, Reagan could not appoint a clear conservative to the Supreme Court and had to compromise with a nominee the Senate would confirm.
Reagan had first nominated a clear pro-life conservative, Robert Bork, for the seat which ultimately became occupied by Anthony Kennedy. Announcing the nomination on July 1, 1987, Reagan remarked, “Judge Bork is recognized as a premier constitutional authority. His outstanding intellect and unrivaled scholarly credentials are reflected in his thoughtful examination of the broad, fundamental legal issues of our times.”
However, the late Senator Ted Kennedy was noted for leading a strong opposition to Bork in the Senate. Ted Kennedy was Senator from Massachusetts, where he reflected the climate Romney worked in as governor of that state.
Bork, who knows from firsthand experience what Romney faced in “Ted Kennedy’s Massachusetts,” endorsed Mitt Romney for President in 2007 and 2011. He is actively serving as chair of Romney’s legal advisory commission.
Mr. Domenech says Mitt has “continued to maintain his approach is a ‘Republican way to reform the marketplace’”
Mitt has from the beginning stood by the principles which I outlined earlier, and has consistently stated that those guidelines could be a useful model for other states to work with. He has dropped other aspects which he once supported, and has consistently opposed many aspects which were foisted upon the health care plan against his desires. In the context of it being a “Republican” plan, Reagan told Gorbachev to “tear down this wall,” but did not insist the entire Soviet government change overnight. Republicans understand that leaders in a war zone need space to operate differently depending on terrain. Our Republican leaders in liberal terrain need that same freedom. A Republican idea looks different depending on whether it’s implemented in a liberal or conservative terrain. But Romney moved in the right direction. The alternative proposed in MA was to make health care a constitutional right.
As far as comparing MA with other states, premiums were high compared to the rest of the nation, before Romneycare. They are high now, they were high then. However, Rhode Island and New Jersey were right behind MA. The obvious correllation here is that RI, NJ and MA are by far the three most densely populated states in the nation. When you receive an MRI scan, the hospital charge is primarily for their investment in purchasing the scanner in the first place, not the cost of the actual scan. Likewise, additional costs accrue in densely populated states. Land costs more, so hospitals cost more. Construction is more crowded, cumbersome and costly. The initial expenditure is higher, and so then are the costs to recoup that expenditure.
Massachusetts has the second highest personal income per capita, and personal disposable income per capita, behind only Connecticut. Disposable income influences the health care decisions people make, such as how often to visit their doctor and to seek care at a hospital. This affects cost.

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