Wednesday, April 12, 2006

Health Politics: A Brief Shining Moment of Bipartisanship in Massachusetts

What a show it was! "A politician's dream," Governor Mitt Romney quipped.

Earlier today, Governor Mitt Romney held court at historic Faneuil Hall. It was a gaudy production with no detail left unscripted. The 300 ticketed guests arrived to the electricity of a rock concert, complete with fife and drum corps. Riffraff were kept far away by steel barricades.

Inside, invited quests were greeted by an elevated stage with a huge sign, MAKING HISTORY IN HEALTHCARE. It was an unsubtle, in-your-face reminder for those who don't recognize history when they see it. What does it remind you of?

The PR-dripping occasion was Governor Romney's signing of a health plan that, in his words, "will make health insurance available to every resident of Massachusetts within the next three years."

Appearing with the Republican Governor of this bluest of blue states were powerful Democratic leaders with whom he had been politicking for two years to hammer rival health-care plans into one. Senator Ted Kennedy was there smiling. So was state Senate President Robert Travaglini. Normally, both would be firing flaming arrows at the Republican Governor.

Instead, it was a love fest. Governor Romney praised the "courageous work" of Senate President Robert Travaglini and House Speaker Salvatore DiMasi. In a notable feat of bipartisanship, the bill passed 37-0 in the Senate and 154-2 in the House.

The Governor joked about sharing a stage with Senator Kennedy, saying the rare event was helping to reduce global warming because "hell has frozen over." Senator Kennedy took the lecturn and warmly praised the new plan. "You've given Massachusetts just what the doctor ordered," he said.

Governor Romney said: "An achievement like this comes around once in a generation, and it proves that government can work when both parties reach across the aisle for the common good. Today, Massachusetts is leading the way with health insurance for everyone, without a government takeover and without raising taxes."

The bill brings health insurance to 550,000 state uninsured residents who rely largely on public funds when they visit a doctor or have to go to the hospital, typically the emergency room. The law requires every individual in the state to acquire health insurance by July 1, 2007 or face fines beginning on January 1, 2008.

The requirement is modeled on the state's policy of mandatory car insurance. "We insist that everybody who drives a car has insurance," Romney said in an interview. "And cars are a lot less expensive than people."

In addition to the individual mandate, an employer mandate requires every employer with 10 or more employees to offer health insurance. Employers who do not contribute to their employee's health insurance will pay a $295 fee per employee. More businesses and individuals will be able to buy health insurance with pre-tax dollars, bringing down their costs signigicantly.

Individuals may choose from an expanded range of new and inexpensive policies offered by private insurors which are subsidized by the state. Uninsured people earning less than the federal poverty threshold may now get policies that have no premiums and only small co-payment fees for doctor or emergency room visits. Individuals making three times the poverty level can buy subsidized policies based on their ability to pay. The legislation strives for a premium of $250 to $300 per month.

The cost is expected to be $316 million the first year and more than $1 billion by the third year. But these amounts will not be additional spending, Governor Romney and Democratic leaders emphasize. Money is coming from federal re-imbursements, federal funding over two years of $770 million for developing a "demonstration project" to reduce the rate of the uninsured, and $1 billion already in the system to pay for care for the uninsured. That is why Mr. Romney can say that he is not raising taxes.

All in all, what Massachusetts has achieved is a statewide health plan unlike any other in the country. It is not based on the going-nowhere "health savings accounts" of the Bush Administration or the failed 1993 single-payer universal health care of President Clinton.

It is something new.

In the health-care debate, people tend to line up either for employers offering health insurance (liberals) or for individuals taking responsibility for seeking out and paying for coverage (conservatives). Result: deadlock and nothing happens. Instead of going with one or the other, Massachusetts did the unthinkable: both.

Another breakthrough innovation was combining individual and small-group insurance policies under a central agency, called a "connector," to offer a range of affordable health insurance options. Robert E. Moffit, director of the health policy center at the conservative Heritage Foundation said: "This idea of creating a consumer-based market is different. Nobody in America has ever done anything like this."

For a full description of the plan, see

Though two states, Hawaii and Maine, offer near-universal access to health insurance, no state has made health insurance coverage a legal requirement. Uwe E.Reinhardt, professor of economics and public affairs at Princeton University said, "Massachusetts is the first state in America to reach full adulthood. The rest of America is still in adolescence."

Former U.S. Health and Human Services Secretary Tommy G. Thompson and former Republican governor of Wisconsin, called the Massachusetts plan "ground-breaking legislation." He said that Governor Romney is "showing us a better way, one I hope policy-makers in Statehouses and Congress will follow to build a healthier and stronger America."

Senator Hillary Clinton (D-N.Y.), who knows the pitfalls of drawing up a health plan and who views Governor Romney as a possible rival in 2008, had only positive things to say about the Massachusetts plan. "To come up with a bipartisan plan in this polarized environment is commendable," she said.

The Democratic strategist James Carville, architect of Bill Clinton's successful 1992 presidential campaign, said: "It's a feel-good story, this Romney thing. Republican Governor. Democratic Legislature. Romney is an ascendant guy."

Like all politicians, he gets himself seen around ordinary voters. Here he served turkey at the Goodwill Annual Thanksgiving Dinner in Roxbury, Mass. Judging from the smiles, he did a good job.

He's also good at covering tracks that would not be helpful in his planned 2008 presidential campaign. In an op-ed piece in The Wall Street Journal on the day before the signing, he wrote: "My Democratic counterparts have added an annual, $295 per-person fee charged to employers that do not contribute toward insurance premiums for any of their employees. The fee is unnecessary and probably counterproductive, and so I will take corrective action."

Democratic leaders came to the signing not knowing what Governor Romney meant by corrective action. They quickly learned from scuttlebutt and then formally in a letter to legislators and a press release on the day of the signing, April 12. He would veto the $295 fee to employers.

Top Democrats were surprised and angered. Because they were not told of the planned veto before the signing, they felt sandbagged. If they had known, they could have responded at the signing with the national media on hand. Instead, seduced into attending, they had to stand there smiling while Governor Romney basked in media attention.

No Democrat was more annoyed than House Speaker Salvatore DiMasi who had insisted on the contribution from employers as a condition of his support. The bill would never have passed without Speaker DiMasi's support. He gave his support and in return got -- the Governor's appreciation.

Ditto Senate President Robert Travaglini, who supported the bill expecting protection of funding for the Boston Medical Center and Cambridge Health Alliance. Both hospitals serve low-income populations. As this is being written, there is a flurry of speculation that Governor Romney will veto an income stream for the two hospitals as the state moves their uninsured patients into the new system.

Both Mr. DiMasi and Mr. Travaglini let it be known that Governor Romney's vetoes will be overridden, which the overwhelmingly Democratic Legislature can easily do.

Senator Mark C. Montigny, former Senate chairman of the Joint Committe on Healthcare said that now that Governor Romney has a health bill, he is "running away from Massachusetts" and joining conservative forces against the state's Democratic liberal establishment.

Also on the morning of the signing, the editorial pages of The Boston Globe and The Wall Street Journal weighed in. Under the title, DON'T CHANGE A COMMA, The Boston Globe, urged Governor Romney not to "spoil the event by vetoing or seeking to change any portion of this historic compromise."

The Wall Street Journal, a powerful conservative voice, noted the raves Governor Romney was getting for passing legislation promising "universal" health insurance but wrote that his "national model" didn't measure up to the political and media hosannas.

The Journal said that "Romney Care" was not market-based enough, punishes business owners, and forces individuals to buy health insurance instead of "deregulating the market for private health insurance." The Journal called the plan "a recipe for higher taxes and more government intervention down the road."

Did Governor Romney screw up? Did the presidential hopeful take a bad fall right out of the gate? The short answer is no. Displaying deft political skill, he has managed to win whichever way he actually loses. By vetoing the $295 business fee, read "tax," he warms hearts on the right while sticking Democrats with the blame if the plan fails. If it works, he takes all the credit.


Let his Democratic colleagues be annoyed at his last-minute political two-step; he doesn't need them any more. He will not be appearing on stage with Senator Kennedy any time soon. He doesn't have to speak again to Senate President Travaglini and House Speaker DiMasi unless he feels like it.

They're toast and he's out of here, off to the presidential races. In the political mirror, he reflects an impressive image. He is tall, trim, with a full head of black hair with a touch of distinguishing grey. He has handsome, chiseled features to make any healthy woman's heart flutter. He has a quick, white smile. He is photogenic and looks great on TV.

Oh, you think these surface things don't matter? Wrong. Dashing good looks are a tremendous political asset for a presidential candidate. The political pros know it. We all know it; nobody wants to admit it or talk about it, that's all. But Mitt Romney's movie-star looks count big-time.

He's more than a pretty face, too. By all accounts, he is a nice guy who seems able to get along with everybody, such as tough Democrats like Robert Travaglini and Salvatore DiMasi. On the health bill, he two-faced them at the last minute. But because they like the guy, they responded with nothing more than a little proforma grumbling.

He's a straight arrow, married for 36 years, five grown sons and eight grandchildren. A Morman, he spent two years as a missionary in France as a young man. He graduated from Brigham Young with highest honors, went on to Harvard Business School (MBA), then to Harvard Law School where he got a law degree.

He's a clean liver, amazingly so. He's religious. He doesn't drink, smoke, or use off-color language. The closest he comes to swearing is "bloomin' ," as in: Can you believe those bloomin' Democrats? He won't have an affair with a cute young intern.

He's loaded with money, which he made as the co-founder and managing partner of Bain Capital, a Boston private equity firm. Bain invested in Staples when it had one store. It now has 1,700. Another big investment success was Domino's Pizza. As head of the 2002 Winter Olympics in Salt Lake City, he turned a faltering organization into a spectacular success, turning a $100 million profit. In presidential politics, money talks.

For some time now, Mitt Romney has been taking a lot of trips outside of Massachusetts. He has been going to out-of-state Republican gatherings where he turns on the charm, acts presidential, and talks the talk. In smooth, measured tones (great voice, another plus), he gets solidly on board with every single conservative issue.

If he tried to do the same thing in Massachusetts, people would throw vegetables at him. I happened to catch a speech he made in South Carolina a year ago. Everything he said was down-the-line, hard-line, right wing. Then he comes back to Massachusetts and smiles and puts out a wholly different message more notable for what is unsaid than what is said. Doesn't he know that people here can get C-Span?

But it is working. Nationally, Mitt Romney has moved up from the third-tier of presidential possibilites to the first tier. He appeared on the cover of American Spectator with the headline ROMNEY ROCKS! He was cover boy for National Review with a headline of MATINEE MITT. The NR cover described him as "charming, smart, conservative, now starring in Massachusetts. Governor Romney could be a premier attraction in the 08 GOP primaries."

And now we have all the red-hot national publicity from the new health initiative in Massachusetts. While Washington D.C. and the states, remain paralyzed on health care, Mitt Romney is out there as the one person who had the guts and vision to make it happen in Massachusetts.

Can't you just see the commercial centered around the happening at Faneuil Hall (filmed by Mr. Romney's producers)?

Shot of the historic building and arriving guests. Pan around interior. Show Mitt Romney chatting and back-patting Democratic leaders. Snippets of praise from each of them. Long excerpts from the Governor's speech. With huge mural of Daniel Webster and John Quincy Adams in the background, show the Governor signing the bill, presidential style, with pen after pen and handing them out. Prolonged applause. Louder applause over shots of ordinary Massachusetts citizens gratefully receiving health care. Fadeout to a close-up face shot of Mitt Romney saying:


So long and keep moving.