Pretty much everyone agrees that Romney’s aggressive performance during last night’s debate is the story of the day. As The New York Times’ Tim Egan put it: “Romney was loaded with the Mormon equivalent of Red Bull, and it showed.” (That aggression may be undermined by the army of fact-checkers questioning some of Romney’s assertions, but that’s another story.)

What it will mean for the nation (and for health care) remains unclear. But here, in an admittedly partisan assessment, is the Harvard School of Public Health’s Nancy Turnbull on, among other things, when she yelled loudest at the TV and when her frustration levels peaked:

My top 5 health care moments in the debate:

1. Most frustrating discussion
President Obama did not effectively counter Governor Romney’s untrue claim that federal health reform is being financed in part by robbing $716 billion from the Medicare Trust Fund (including failing to point out that that the budget plan of Governor Romney’s running mate, Representative Paul Ryan, has the same reductions in future Medicare rates for hospitals, health plans and certain other providers). This one is complicated but the President has to have a comprehensible and effective way to rebut it.

2. Ingenue performance
Governor Romney was coy, to be polite, about his support for a Medicare voucher system, and Jim Lehrer was far too polite in his attempts to get Governor Romney to be more forthright. I wished Martha Bebinger had been moderating.

3. Go Bay State
Massachusetts provided one of the few points of agreement all night: Both candidates said that health coverage reform in Massachusetts has been a great success.

4. Moment when I screamed loudest at the TV
Governor Romney claimed that the Congressional Budget Office estimated that 20 million Americans will lose their health insurance if federal reform is implemented. The CBO estimate is actually that 32 million more Americans will have health insurance.

5. Biggest foreign policy gaffe of the night
Governor Romney’s lack of experience and knowledge in foreign affairs was apparent when he said that “America has the best health care record in the world.”

Here, if you’re still in the mood, is the full debate transcript on ObamaCare, courtesy Kaiser Health News.
Please add your own top moments and we’ll post them throughout the day.

Some sort of Red Scare nightmare? No, I’m just in a state of bafflement after reading “The Socialist Behind Romneycare.” Posted by the right-wing group Accuracy in Academia, it targets Harvard School of Public Health professor John McDonough, who was involved in building both Massachusetts and national health reform and is the author of “Inside National Health Reform.” (Also, these days, the Health Stew blogger for the Boston Globe.) The post reveals that (gasp!) more than thirty years ago, McDonough belonged to the Democratic Socialists of America and chaired its Boston chapter for a couple of years.

The post cites work by blogger and Communist-outer Trevor Loudon: “Loudon’s new report, which is potentially embarrassing to Mitt Romney as he tries to prove his conservative credentials, is headlined, “How DSA Marxists Influenced Health Policies for Both Major Presidential Candidates.”

Now, I know that living in Massachusetts distorts my vision and leaves me insensitive to the realities of national politics, and I know that I should never try to find true logic in political game-playing. But I can’t help asking: Could anybody, anywhere, really care anymore if a politician or a professor — or a health care reformer — once propounded socialism? The Cold War is over, Communism couldn’t be deader, “Are you now, or have you ever been, a member of the Communist party?” has become synonymous with McCarthy-era abuses. And if Mitt Romney praises the Israeli health system, is it some sign of pernicious socialist leanings that in his latest blog post, McDonough praises the French?

The Daily Telegraph has the full yarn here, in advance of Republican presidential candidate Mitt Romney’s trip to England tomorrow.

It has some nice details of the no-frills, moldy-flat life Romney’s third son, Josh, lived in England while he was a Mormon missionary there in 1995. The medical story: A doctor in Sheffield told Josh his stomach problem might be colon cancer. (Though if you read the full story, you might diagnose it as colon blockage caused by eating too much cheap beef.)

Even worse, Mitt Romney later recalled, “the waiting time for a colonoscopy was six weeks – enough time to make an operable, curable cancer become an inoperable terminal condition”.

The family was appalled. “It was scary,” Josh, now a 36-year-old property developer in Utah, told The Daily Telegraph while campaigning with his father in Florida. “I am in favour of you reforming your health care system,” he joked.

His parents, who were raised in the wealthy Michigan enclave of Bloomfield Hills, could not believe John Major’s government would consign Britons to death by maintaining a creaking Soviet-style system – even if it was free for foreign visitors such as their son.
“It made us realise things were different over there,” Josh’s mother, Ann, said after a campaign rally in South Carolina. “He just couldn’t get the answers he needed.”

Not to worry, it all ends well, American-style: Mitt paid cash to send Josh to a private clinic.

Hat-tip to WBUR’s Fred Thys.

On the 6th anniversary of the signing of the Massachusetts health reform law, Gov. Deval Patrick (who also serves as a co-chairman of President Obama’s re-election campaign) took the opportunity to stick it to the likely GOP presidential nominee in remarks at Fanueuil Hall yesterday, The Wall Street Journal reports. There was even talk by national health law advocates of sending Romney (who signed the state health law on April 12, 2006 when he was governor of Massachusetts) a delicious gift to mark to occasion.

“I think he has a lot to be proud of, he contributed ideas, the individual mandate was one of them…why not be proud?” said Gov. Deval Patrick, a co-chair of President Barack Obama’s national re-election committee, referring to Mr. Romney’s support for the state’s requirement that individuals purchase insurance or pay a fee…

The event underscored how Democrats are trying to turn Mr. Romney’s health-insurance expansion into a political liability as he looks toward the general election. Activists who support the federal health law will delivery grocery-store-bought sheet “birthday” cakes with six candles in honor of the Massachusetts health law to two of Mr. Romney’s campaign stops in Pennsylvania on Thursday, said Eddie Vale, a spokesman for the Protect Your Care coalition of campaigners.

To underscore the politics of the day, here’s video from the folks at BarackObama.com:

For a bit more substance, see The Washington Post’s Wonkblog on “Charts: Six Ways RomneyCare Changed Massachusetts.”

Leading Democrats in Massachusetts are pointing to contraception as the latest example of a flip flop from former Governor Mitt Romney.

Contraception, with an exemption for churches, became a required benefit in Massachusetts in 2002, the year before Mitt Romney was sworn in as governor. Phil Johnston, who held top state health care and Democratic party positions, says Mitt Romney never tried to repeal the mandate.  “He never mentioned that it would infringe upon religious freedoms and during the four years that Governor Romney served, he was totally silent on that issue.”

Romney aides say his original health coverage bill proposed eliminating all insurance mandates for individuals and small businesses covered through what would become the Health Connector. Since most large businesses are self-insured, and thus not subject to state mandates, these aides say Romney planned to remove mandates for most residents.

Former Health Care for All director John McDonough echoes Johnston’s recollection that Governor Romney never singled out contraception as an objectionable mandate. “The poster child for bad mandates,” remembers McDonough, “was in vitro fertilization, because it is so expensive.”

The coverage bill that Romney signed into law in April 2006 did not eliminate any state insurance mandates. “In effect,” says McDonough, “it increased contraception coverage because it expanded health insurance that included this benefit to all the newly insured.”

Romney has said many times that he compromised to get a health coverage bill that included most of what he wanted, but I don’t recall him mentioning the mandates among his disappointments.

In response to the critique from Johnston and McDonough, Romney spokesperson Andrea Saul said in a statement, “It’s no surprise that President Obama would dispatch his liberal attack dogs to try and distract from his assault on religious liberty. On his first day in office, Mitt Romney will eliminate the Obama administration rule that compels religious institutions to violate the tenets of their own faith and will begin the process of repealing Obamacare.”

A few hours before the Democratic National Committee hosted the call with Johnston and McDonough for reporters, the Romney campaign issued a statement “on Mitt Romney’s defense of religious liberty” from Ambassador Mary Ann Glendon. She does not address Romney’s record on contraception, but focuses on the Catholic Charities/gay adoptions controversy.

“Mitt Romney has been fighting assaults on religious freedom for a long time, and at moments and in places where it was not popular, to say the least. When Catholic Charities in Massachusetts was being forced out of the adoption business because they were trying to provide adoption services for needy children while staying true to their beliefs, it was Governor Mitt Romney who stood shoulder to shoulder with the Catholic Church and filed a bill to protect religious liberty.”

Glendon goes on to mention that Romney received the Canterbury Medal in 2008 from the Becket Fund for Religious Liberty for his support of Catholic Charities.

If you want more on contraception coverage in Massachusetts, the Patrick administration offers this “fact sheet.”

Still, an Indiana law professor, David Fidler, dug up a couple of telling nuggets that give a tiny glimpse into what these guys are all about, or at least what Rick Santorum and Mitt Romney think about overseas aid. In a nutshell: Romney doesn’t think much of it, and Santorum aligns himself with the old-Bush-style compassionate conservatism that supports humanitarian assistance. Fidler writes:

Romney and Santorum perhaps represent two streams in American conservatism that, at the moment, appear to diverge on PEPFAR [the U.S. President's Emergency Plan for AIDS Relief] and global health. Santorum expressly declares in his “10 Steps to Promote Our Interests Around the World“ that the US must “keep and expand” its humanitarian aid efforts, including on HIV/AIDS. Santorum strongly supported PEPFAR when he served in Congress. He also issued a statement on World AIDS Day in December 2011 underscoring PEPFAR’s importance and the “hope that in our lifetime, we may see the end of AIDS.” In Santorum, we see a conservatism embracing global health’s foreign policy importance to American ideals and interests—what Michael Gerson called “Rick Santorum and the return of compassionate conservatism.”

Romney’s official website, as far as I can tell, contains nothing on PEPFAR or global health. Searches on Romney’s website for “PEPFAR,” “HIV/AIDS,” and “global health” yielded no results. Romney’s official foreign policy white paper likewise contains nothing specific to global health. General searching on the Internet revealed some comments indicating reluctance on Romney’s part to commit political capital and fiscal pledges to the US global HIV/AIDS efforts (see, e.g., this Huffington Post item). In fairness, my poking around for Romney’s views on global health was not, shall I say, comprehensive and rigorous. However, my inchoate sampling perhaps suggests in Romney a conservatism imbued with skepticism about global health, including PEPFAR, as important for US foreign policy—a version of a more calculating conservatism less impressed with the alleged benefits of humanitarian assistance for American ideals and interests.

(Hat tip to Kaiser Health News for unearthing this post.)

When facts are in such dispute, who you gonna trust? I don’t know about you, but number one on my list is WBUR’s Martha Bebinger, a longtime, dispassionate and shockingly well-versed observer of the labyrinthine process of the state’s health reform. So it’s a special treat that she’s out today with an authoritative, and surprisingly colorful (who knew that “Animal House” was involved?) version of Mitt Romney’s leadership role in the landmark 2006 health reform.

It’s featured on WBUR.org here, but you can also read it below, and for skimmers, here’s the final paragraph and something of a bottom line:

How much credit Romney deserves for the law that some now call Romneycare is still up for debate. Speaker DiMasi is often seen as the key player in sealing the deal. He’s in prison now for an unrelated conspiracy and fraud conviction. Senate President Travaglini had the first public proposal. Romney was the first to propose key parts of what became law, the Connector, the individual mandate and subsidized insurance. A folder representing the health care law rests on a table next to Romney in his official State House portrait. It remains his signature accomplishment and the best way to evaluate how Romney works as a lawmaker.

By Martha Bebinger
WBUR

BOSTON — The issue that defines Mitt Romney’s years as governor of Massachusetts is health care. It is sometimes a political albatross for the governor as he campaigns for president. But it is also proof, Romney says, that he could bridge party divisions in Washington.

Health care was rising on Governor Romney’s agenda as he moved into the State House corner office in 2003. His friend Tom Stemberg, who founded Staples, had suggested that one of the best things he could do for the people of Massachusetts was to find a way to cover the uninsured. And Romney, in his second month on the job, talked about that interminable state budget buster, health care.

“We’re now seeing health care costs for the poor rising at double digit rates,” Romney said with characteristic intensity. “That’s something that has to be brought in line, in part with people picking up a small share of the cost of providing that service.”

Many of the people Romney thought could pick up a share of the costs were getting free care at hospitals and clinics. The state was paying the charge: More than a billion dollars a year through a free care pool.

“Romney decided the pool was broken,” recalls Amy Lischko who helped draft Romney’s bill. “This all started with trying to fix the free care pool. Many people forget that.”

Romney filed legislation that would use money from the free care pool to create subsidized insurance. Here was Romney, a Republican governor, floating a major health care overhaul before a legislature that was overwhelmingly Democratic.

“I doubt that my plan will be accepted without any changes,” Romney said at the time. “But I do believe that everyone recognizes that having a half million people who are uninsured isn’t good for them and isn’t good for the rest of our citizens who are paying taxes and paying for health care. We gotta fix this system to get everybody better health care coverage.”

Romney knew the legislature was interested. Several months earlier, Senate President Robert Travaglini had outlined a proposal to cover half the state’s uninsured. House Speaker Sal DiMasi was planning his strategy on the issue. Romney met weekly with DiMasi and Travaglini, but legislators felt like the rest of the members were not worth the governor’s time.

“Governor Romney did not let legislators into his office, you just did not come in.” Patricia Walrath, a Democrat, was the House point person on health care while Romney was governor. She recalls two, maybe three meetings with him. Walrath says the contrast with prior Republican governors was startling.

“He had a whole different understanding as to how government should work,” Walrath says. “He was the CEO and when he said do it, everyone marched in step. It was not finding consensus;  that was not the model that he used at all.”

Romney’s style was to delegate work with legislators to a few top aides. Those aides, not Romney, also handled relations with a broad coalition of health care, union and religious groups that held frequent rallies at the State House. The coalition agreed with Romney’s goal of covering the uninsured, but they opposed the coverage he proposed, calling his plan “Yugo” healthcare. Romney’s strategy was to inform, but not negotiate with these powerful consumer groups, says Tim Murphy, Romney’s Health and Human Services Secretary.

“We were going to do what we were going to do, but we were going to share information,” Murphy says. “We were going to let people know what our vantage points were, we were going to be transparent about that, and we felt that that was a way to build trust in the community.”

Critics argue that Romney only reached out to opponents when it was politically expedient. The governor and the late Senator Ted Kennedy ran against each other in 1994 in a bitter U.S. Senate campaign. Now on the issue of covering the uninsured they formed a critical partnership. Romney needed Kennedy’s help in persuading federal officials to let Massachusetts use hundreds of millions of Medicaid dollars for a health coverage law. He thanked Kennedy publicly, many times.

But in the fall of 2005 the federal government was still threatening to withhold hundreds of millions of dollars. While Romney was in intense negotiations to secure the money, Speaker DiMasi filed a health coverage bill that Romney aides say made the governor’s job much more difficult. DiMasi wanted to tax employers who did not cover their employees. Consumer groups and some economists loved his plan, but Senate President Travaglini did not support the tax and Romney, in private, spoke vigorously against it.

In public, Romney was upbeat in response to DiMasi’s bill: “Let’s not let perfection be the enemy of the good. Let’s get something out there that moves us forward. We’re all speaking from the same book.”

Aides say that while Romney was quick to criticize the legislature on any number of issues, he did not do so with health care. “He intentionally took a different, more positive tone during the health care debate,” recalls an aide who would not identify herself for comment. “He did not want anyone throwing (verbal) bombs.”

DiMasi’s demand that employers pay for health insurance or pay a fine turned into a possible deal breaker that threatened defeat for everyone.

“There was a logjam for weeks and weeks,” says Michael Widmer, president of the Massachusetts Taxpayers Foundation. “There were various options being considered but none of them satisfied both the House and Senate.”

Widmer drafted some of those options and shuttled them across the marble lobby between the offices of the Speaker and Senate President. Governor Romney was not part of the negotiations, but Widmer kept Romney’s Secretary Murphy in the loop.

“They were opposed to having any tax on employers,” Widmer says. “I remember talking to Tim and he said, ‘Do we really have to do this because the administration’s opposed to it.’ I said, do you want a bill or not, essentially, because that’s what it came down to and something was going to have to give.”

In addition to opposing the employer tax, Romney’s aides say he didn’t think the state needed any new revenue to fund a coverage law. But in January, during his State of the State, Romney said he realized, “Some of you have your doubts about that. I know that the uncertainty could stall our progress or even end it and for that reason I put aside $200 million dollars in a reserve account to fund our health care initiative.”

The money did not persuade DiMasi to give up the employer tax and strained relations between all three leaders continued. Romney grew increasingly frustrated. In late January, he made a rare personal appeal. Tim Murphy was out walking on a Saturday when his Blackberry went off.

“It was an email from Mitt,” says Murphy. It said, “I’m going to write this letter and this is what I want it to say and I want to go and deliver it and I just want you to check a few things.”

Romney delivered letters the next day, a Sunday, to Travaglini and DiMasi at home. The wrinkle free governor found Travaglini in sweat pants. DiMasi was not in to greet Romney. The letter, recalls Murphy, said let’s get going, we can’t have an employer tax but think about all the things that we could achieve.

“It was just one of those moments in time where he felt the need to personally intercede,” says Murphy. “That was not Mitt’s style. He did not walk down the hallways stopping in at offices, so when he does something like that, it has a little bit more weight to it.”

Romney’s letters did not end the stand-off between Travaglini and DiMasi. Jack Connors, the powerful chairman of Partners HealthCare, visited DiMasi’s office with a copy of Animal House and played the “nothing is over til we decide it’s over” scene. Travaglini and DiMasi finally started talking about an employer compromise after a dinner arranged by their wives. The final deal, drafted by a small group of business leaders, was a modest fine on employers (with 11 or more employees) who don’t offer health insurance. The bill sailed through the House and Senate.

At a well-orchestrated bill signing ceremony, ushers handed out programs and buttons while Governor Romney took the stage at Faneuil Hall.

“Massachusetts, once again, is taking a giant leap forward.” Romney told the audience of health care and business leaders. “And it’s our faith in you that gives us the confidence to do just that.”

Legislators were all smiles during the ceremony but minutes after, their mood soured. Romney aides told the press the governor would veto eight sections of the bill, including the legislature’s carefully crafted compromise on that modest employer fine. Legislators had become increasingly wary of Romney’s motivations around the health care bill. Senator Richard Moore suspected Romney vetoed the employer penalty because he knew it wouldn’t play well if he ran for president.

“This bill should have been based on what was best for the CommonHealth,” said Senator Moore, “not what would play well on a national stage. Those vetoes are just political vetoes.”

But Romney aide Tim Murphy argues that the governor was genuinely interested in covering the uninsured and that legislators knew Romney would not support the employer penalty. Murphy says Romney can claim, based on the health care law, that he knows how to work with bi-partisan groups to fix complicated policy problems.

“I look at Massachusetts health care reform and say, ‘This is your textbook example of how to do it effectively,’ and it really reveals, to me, the type of leader that Mitt is.”

Former Health Care for All director John McDonough, who pushed for many changes to Romney’s bill, gives him credit for compromising on a version that was more generous than the one Romney proposed.

“It indicates a keen sense of political reality and that he is willing to adjust on policy details to achieve his overarching policy goal,” says McDonough. “We can see this in his willingness to compromise on the health care reform law and on his willingness to separate himself from key parts of that law in his quest now for the Republican nomination.”

How much credit Romney deserves for the law that some now call Romneycare is still up for debate. Speaker DiMasi is often seen as the key player in sealing the deal. He’s in prison now for an unrelated conspiracy and fraud conviction. Senate President Travaglini had the first public proposal. Romney was the first to propose key parts of what became law, the Connector, the individual mandate and subsidized insurance. A folder representing the health care law rests on a table next to Romney in his official State House portrait. It remains his signature accomplishment and the best way to evaluate how Romney works as a lawmaker.

David Brooks, in The New York Times this week, wrote of “settling into the idea that Romney might well be president.” A Gallup poll out yesterday found half of Americans say Obama and Congress are doing a worse job than their predecessors.

But wait, might the national health law save the day for the president by sinking the GOP frontrunner?

Here’s The Wall Street Journal politics blog suggesting that the White House is going all out to evoke Romney’s fraught connection with the health law whenever possible. (This issue, overall, is bad for Romney, who has a love-hate relationship with its central tenet: He supports the individual mandate at the core of the Massachusetts health law, but says the national health law, which is modeled on the state law, should be repealed.)

Here’s the WSJ, citing an example of the administration’s gentle reminder to health-law hating Republicans that Romney supported an earlier version of a similar law:

Then the president’s top spokesman zinged Mr. Romney, quoting from the GOP candidate’s interview on Sean Hannity’s radio show.

“A former governor of Massachusetts just said the other day: ‘The idea for a health care plan in Massachusetts was not mine alone. The Heritage Foundation, a great conservative think tank, helped on that. I’m told that Newt Gingrich, one of the very first people who came up with the idea of an individual mandate, did that years and years ago. It was seen as a conservative idea to say, you know what? People have a responsibility for caring for themselves if they can. We’ll help people who can’t care for themselves. But if you can care for yourself, you’ve got to take care of yourself and pay your own bills.’”

“That’s a former governor of Massachusetts describing the individual mandate and why it’s smart policy, and we certainly agree,” Mr. Carney said.

Suddenly, the administration’s surprise decision this week to ask the Supreme Court for a fast ruling on the health law becomes clearer.

What is the political calculus here? Will a high court ruling on the national health law keep the issue hot through the elections and undermine Romney? Will someone smarter than me weigh in on this please?

Five years ago, in Boston, Romney signed into law Massachusetts’ landmark health reform legislation requiring every citizen in the state buy health insurance. And that, as we’ve heard, is both his signature achievement and, potentially, his most devastating political baggage.

In its inimitable way, The New Yorker lays out Romney’s conundrum better than anyone else. In the current issue, Ryan Lizza opens his story with a familiar scene: Romney at an elaborate bill-signing ceremony at Faneuil Hall. But he embellishes the portrait of the Governor with perfect detail. (The full story is behind a pay wall now, but here’s a taste):

Romney signed the bill at a wooden desk using fourteen different pens, which he later distributed to the dignitaries on hand. “It’s law!” he shouted after the final stroke. On cue, the sounds of the fife-and-drum corps filled the hall with Colonial-era music. Behind Romney stood the people most responsible for passing the plan, among them Senator Ted Kennedy and Salvatore DiMasi, the Speaker of the Massachusetts House of Representatives. In one photograph, the Governor is looking over his shoulder at DiMasi, laughing, and Kennedy is smiling at Romney. Kennedy died in 2009, and DiMasi is currently on trial for extortion and corruption and may go to jail. Romney, who did not seek reelection in 2006, is running for the 2012 Republican Presidential nomination. Early this spring, as his campaign was foundering, a morbid joke about the photo circulated among Massachusetts political insiders: “The funny thing about that picture is that there’s three dead men, but only one is in the ground.”

]]> 2011-06-02T08:46:13-04:00 http://commonhealth.wbur.org/2011/05/mitt-romney-live http://commonhealth.wbur.org/2011/05/mitt-romney-live#comments Thu, 12 May 2011 17:39:24 +0000 http://commonhealth.wbur.org/?p=10500

New England Cable News just aired Mitt Romney’s speech on health care live, and we live-streamed the NECN feed. If you watched, what did you think? Please share the inimitably intelligent comments characteristic of CommonHealth readers below. Here’s my pick for strongest quote:

“I’m proud of the fact that in our state, when we faced real challenges, we didn’t just say, ‘Well, it’s a problem that no one can solve.’ We said, ‘We’ve got a job to do. We need to help people, we need to do our best.’ By the way, what we did wasn’t perfect… but overall, am I proud of the fact that we did our best for our people and we got people insured? Absolutely!”

Here’s the Washington Post’s Ezra Klein on Romney’s plan. And here’s The Wall Street Journal from this morning, writing about “the failure of the ObamaCare model that began in Massachusetts.”

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