I watched the Republican presidential candidates’ debate last night, and darn it if that Mitt Romney isn’t an attractive speaker. If you didn’t know anything about health care or the reforms he enacted in Massachusetts, you’d think he had that problem licked. 

So here’s a reality check.  What Romney said about health care (according to the New York Times) appears in bold italics.

“[In Massachusetts,] we said: ‘You know what? We [have] got to find a way to get everybody insured….’”

Here, the candidate reveals his desire to do something that is 100 percent impossible. To be clear: It is impossible to give everyone health insurance. 

Some people with known, high-cost conditions are uninsurable. So even if you claim you are providing “insurance” to an uninsurable person, you are not, because it’s only insurance if there is uncertainty about whether a subsidy will be needed. If there’s no uncertainty, it’s just plain subsidy — not insurance. 

Markets don’t provide “insurance” to uninsurable people. Only government does that. So when people say they want to “get everybody insured,” rest assured, they are about to propose more government.

“And the last thing we want is to have the government take over health care, because anything they take over gets worse, not better….”

I agree with this sentence, because it completely contradicts the sentence that came immediately before it. 

“We’re not going to turn to Washington, because Washington makes a mess….”

Actually, a significant portion of the funding for RomneyCare came from Washington. Indeed, it was because Washington was about to yank $385 million in Medicaid funding that Massachusetts turned to Washington with a plan to keep that money flowing. Sure did make a mess, though — no argument there.

“We said: ‘We need to find a way to get everybody in our state insured with private insurance….’”

Funny, that’s exactly what Hillary Clinton tried to do in 1993.  

“The half a million who didn’t have insurance, all the people worried that if they lost their job, they’d lose insurance — we said we got to find a way to get them insured without raising taxes….”

RomneyCare imposed a slew of new taxes. Romney’s defenders like to claim that the plan did not include a broad-based tax increase. But it did increase government spending, which is essentially the same thing. 

“…without a government takeover…”

The government can take over your health care by taxing you and spending your money itself, or by forcing you to spend your money how it wants. The latter is what Romney did.  Either way, the government is taking over.

“…and that’s what we did.”

Really? And here I thought the Massachusetts “Connector” bureaucracy explicitly and unanimously decided not to cover 20 percent of the Bay State’s uninsured.

“It relies on personal responsibility….”

Personal responsibility means that you bear the cost of your decisions. But RomneyCare allows people to push the cost of their bad decisions (smoking, poor diabetes prevention and management, etc.) onto others. RomneyCare thus relies on collective responsibility. Romney consistently confuses the two.

“Every Democrat up there’s talking about a form of socialized medicine, government takeover, massive tax increase….”

True enough. But it’s not just the Democrats.

“We get people that were uninsured [covered] with private health insurance….”

Nominally private health insurance, yes. Just like Hillary proposed.

“We have to stand up and say the market works. Personal responsibility works….”

If they work, why abandon them?

“We’re going to have insurance for all of our citizens they can afford, that’s theirs, that’s portable. They never have to worry about losing it….”

Not quite. The only good thing about RomneyCare is that it may give workers more health insurance choices, and let them keep their insurance when they change jobs. The federal tax break associated with job-based coverage traditionally has made that impossible. 

But insurance would not be so portable for those who don’t get another job. In that case, RomneyCare will let you keep your insurance, but the cost could rise 80 percent because you’d lose that tax break. Losing your insurance would be really easy under those circumstances.

Romney’s defenders would say (1) that’s always been the case, and (2) you can’t change that problem at the state level — only Congress can change the federal tax code. But that’s exactly the point. 

The whole premise of RomneyCare and its “Connector” is that a state can undo the damage wrought by federal tax laws. An honest appraisal of RomneyCare belies the folly of that premise. For Massachusetts to mitigate the damage done by federal tax laws — even slightly — required (A) creating a new government bureaucracy, (B) increasing government spending, and (C) imposing new taxes. 

The fundamental flaw of RomneyCare is that conservatives tried to use state law to fix problems created by federal law. The Constitution just doesn’t work that way. RomneyCare is a net minus for freedom because it expanded government at the state level and distracted free-market advocates from pushing for real reform at the federal level. It continues to do so.

I was glad to see that the New York Times’ transcript picked up the comment of an unidentified candidate who responded to Romney’s claim of having covered all the uninsured with: “I’m told that’s not true.  Actually, Wolf, that’s not true.” Watching the debate, I thought it was Rudy Giuliani who said it. That would make sense: he had the soundest approach to health care of all the candidates.