Now, The New Yorker just endorsed Obama for president, so that may color your view of its columns. But the ever-excellent economics writer James Surowiecki does lay out with beautiful clarity the stakes of the coming election: “Health care is where the election’s outcome will have the most immediate and powerful impact on how Americans live,” he writes. And he zeroes in on the essence of the difference between the candidates:

“The premise of Obamacare is that healthcare is a collective good, like national defense, something that government has to help provide,” he writes.

In contrast, he writes, what Romney wants…

…”is just to have the government less involved in health care. Insofar as his plans would lower federal health-care spending, it’s not because of the power of the free market; it’s because a Romney administration would simply have the government do less. Romney would eliminate the Obamacare subsidies for health insurance. He would turn Medicaid into a block grant to the states and trim its annual budget, with the result that its funding woudl lag behind the rise in health-care costs. And if he adopts his running mate Paul Ryan’s premium-support plan for Medicare, he would make Medicare recipients pay higher premiums. With these changes, the government would spend less, but only because it would provide less, and Americans would get less. It’s like saving on defense by protecting only two-thirds of the country”

Ultimately, he writes:

“The real issue, come November, isn’t about who has the best ideas for controlling health-care costs. It’s about who has the right idea about what government should do.”

The full piece is very worth a read; it also includes a succinct history of the thinking on why the free market doesn’t work well in health care.

MASS. DEMS DISPATCHED TO TALK UP ‘ROMNEYCARE’ - You know how we said yesterday that no one’s really talking about the flaws in Mitt Romney’s 2006 health care law? We offer our latest exhibit: Two Massachusetts Democrats, at the urging of the Obama campaign, are dropping into Nevada this week to talk up the law that eventually gave rise to the ACA. Massachusetts House Majority Leader Ron Mariano and State Rep. Steven Walsh will visit the Silver State tomorrow and Thursday to contrast Romney’s work on the state law with his promise to repeal “Obamacare” and boost insurers’ involvement in Medicare. The POLITICO Pro story: http://politico.pro/QjVrez

Politico Pro requires a subscription, but Politico’s “Pulse” bulletin offers a bit more free fun: Its staffers write that “we’ve been pondering a health care-themed drinking game for [tonight's] presidential debate. But we also want to make sure there’s a Thursday morning PULSE, so … we’ll take a rain check.”

Hmmm. A health care-themed debate game for tonight?? NBC news has a fascinating analysis here that finds that health care is the biggest issue of the campaign. Should we maybe all do ten sit-ups whenever “care” is used as a suffix to a candidate’s name? Nah, too virtuous. Does anyone have a better suggestion?

It’s not hard to see some political calculus involved in today’s ceremony. Patrick, the AP notes, is a co-chair of Obama’s re-election campaign. Romney, who is increasingly likely to be Obama’s challenger in the general election, has faced some GOP criticism for his support of the Massachusetts law, while also pledging to repeal the national law if elected president.

WBUR’s intrepid political reporter Fred Thys attended the celebration and reports:

Governor Deval Patrick is heaping praise upon former Governor and Republican presidential candidate Mitt Romney for signing Massachusetts’ health care law. Patrick is working to re-elect President Obama, and the remarks help give weight to the fears that many Republicans have about Romney.

It was only yesterday that Mitt Romney finally managed to eliminate his principal rival in the race for the Republican nominaiton, Rick Santorum. Many of the conservative Republicans who supported Santorum distrust Romney because he’s responsible for the requirement that everyone in Massachusetts buy health insurance. This afternoon, speaking through a poor sound system at Faneuil Hall, where Romney signed the Massachusetts health care law 6 years ago, Deval Patrick reminded everyone of that fact.

“It’s a classic insurance concept, which is that you spread the risk as broadly as possible but keep costs down for everybody,” Patrick said. “It’s working here. I know, or at least I sense he’s personally proud of it because there’s a facsimile of it that appears in his official portrait, which is hanging in the Governor’s office and why not be proud of something that has helped so many people?”

But not everyone at the ceremony was willing to give Romney so much credit. Former Senate President Robert Travaglini said it was the Senate that pushed for reform.

“Romney had the political skills and sense to realize that there was a potential victory here, and at the time, he was looking for victories as evidence of his success in a blue state,” said Travaglini.

Travaglini said Romney was not the driving force or even a leader in getting the Massachusetts health care law passed.

WBUR’s Martha Bebinger reports:

BOSTON — Across the national airwaves and on the Republican campaign trail, the Massachusetts coverage law that many now call “Romneycare” is routinely trashed. Here’s Texas Gov. Rick Perry in a debate last October:

“Romneycare has driven the cost of small business insurance premiums up by 14 percent over the national average in Massachusetts.”

And from former Sen. Rick Santorum last month we heard, “it (Romneycare) was the basis of Obamacare and it was an abject failure.”

So you might think this drubbing would rub off on Massachusetts residents, about two-thirds of whom have consistently endorsed the state’s coverage plan since it passed in 2006. Not so. In the latest WBUR poll, 62 percent support the law and 33 percent oppose it.

Read the full WBUR report here.

From insurance exchanges to new rules for insurers and employers and beyond, the two plans really do have a deep twin-like resemblance according to this analysis, if not identical, then at least fraternal. Take a look.

Of course, the political backstory to all this is that Romney has been struggling to highlight the profound differences between the two laws while the Obama administration continues to point out the similarities. Romney and the other GOP presidential candidates debate again tonight, in Jacksonville, Florida, ahead of that state’s primary on Tuesday.

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.

Tonight is going to be all candy, so let’s start the week with a few vegetables, as we sometimes refer to our health policy posts. Not that the above video is lima-bean-like; it’s a lively — though civil — Republican-Democrat debate about whether it’s fair to consider Massachusetts health reform as the “parent” of the federal health overhaul.

As CommonWealth magazine executive editor Michael Jonas introduces it:

We recently launched a new video feature on CommonWealth’s website involving webcam-based discussions between two people. I thought our most recent installment of “Face to Face” might be of interest to you and CommonHealth readers: a discussion of “Romney” and “Obamacare” between two of the people best qualified to chew over the issue that dogs Romney’s campaign perhaps more than any single topic.

Talking over the issue are Tim Murphy, who was Romney’s secretary of health and human services and the administration point-man on the 2006 Massachusetts law, and John McDonough, who was in the thick of the 2006 reform as director of Health Care for All and then went on to serve as senior policy adviser to Ted Kennedy’s Senate Health, Education, Labor and Pensions Committee, where early work on the federal law took place.

The “dead hooker issue” is particularly germane today for two reasons: Romney is scheduled to give a major speech today in Michigan about health care (See today’s sage report by WBUR’s Fred Thys on how the issue is playing in New Hampshire.) And the Massachusetts Medical Society has just put out its latest survey results on how long patients here must wait to see doctors. Opponents of Romneycare-style health reform are spinning the slight lengthening in wait times as further proof that the reform is bad here, and will be worse nationally.

But in The New Republic, senior editor Jonathan Cohn writes here in a piece titled “Defending Romneycare (because Romney won’t do it)” that he sees quite a different spin.

…The report tells a far more complicated story, one that may not have much (if anything) to do with health care reform. And since Romney himself isn’t making this case–I assume he just wishes the whole topic would go away–let me give it a shot.

While the long waits for physician services in Massachusetts seem real enough, the very same survey reveals that the long waits existed before Romney’s law took effect in January, 2007.

He shares some graphs of gastroenterology and internal medicine wait times, and says:

Reported wait times go up and down, year to year, which is precisely the sort of statistical noise you’d expect from a survey that relies on small samples size and the non-scientific testimony from physicians. Evidence of longer waiting times since the introduction of Romney’s plan seems thin, at best.

Elsewhere, it appears that primary care physicians (although not specialists) are becoming less likely to see new patients. And that’s certainly worrisome. But that decay was also underway before the Massachusetts reforms: It doesn’t appear to have accelerated starting in 2007.

His bottom line:

…My strong hunch is that the real story in Massachusetts is an old one that’s plagued the entire country for some time now: We don’t have nearly enough primary care providers. As Nancy Turnbull, a longtime state official who now lectures at Harvard, told the Boston Globe after last year’s ER report, “I don’t think the increase has anything to do with health care reform. It’s much more reflective of [primary care] access problems.’’

Solving that will likely require increasing the supply of pediatricians, family doctors, and geriatric physicians, as well as nurse practitioners and others who can handle primary care duties. The Affordable Care Act actually addresses that problem, by boosting primary care reimbursements. It may not be enough, but it would seem to be a step in the right direction–particularly since, whatever its modest effect on physician availability, it will provide financial protection to tens of millions of people.

The post opens:

WASHINGTON — Five years after Mitt Romney signed a landmark health care law that paved the way for President Obama’s controversial national reform, an unscientific survey of Massachusetts HuffPost readers found widespread satisfaction with the state’s health insurance coverage.

Responses from more than 50 current or former Massachusetts residents asked by HuffPost about their experiences confirms a recent poll that shows a large majority of Bay State residents like “RomneyCare.”

The piece gets it salt from Romney’s recent attempts to publicly distance himself from the landmark 2006 Massachusetts health reform that he helped bring in. But I found most interesting the plethora of vignettes it gathered from Massachusetts residents of all stripes, most of them praising the effects of the reform but several pointing out its shortcomings. There’s more of the same in the hundreds of comments, too, including a patient who went bankrupt because of a major operation here. An excerpt:

“The Massachusetts health plan was life-saving in many ways and we were, and are, exceedingly grateful for it. We couldn’t believe a Republican designed it!” she wrote. “It enabled my husband to have many years (of) overdue blood work, and also hearing aids that have changed his life. This is not even a benefit on most so-called standard health plans. It also enabled me to receive dental care at much reduced costs.” (Huffington Post)

Some notable salvos already this week: We posted Monday here about factcheck.org’s reality check on various claims about Massachusetts health reform. Dennis Byron, our highly numerate reader and a health statistics blogger in his own right, responded that factcheck.org itself needs some fact-checking:

I found 30 errors and they all seem to be in favor of the proponents of Romneycare. When you add that to the fact that the so-called “non-partisan” author from factcheck.org only talked to proponents and only cites proponents and did not talk to people at Cato, or Sally Pipes, or Trudy Liemberman, etc., it’s hard to call this a non-partisan look at the facts and falsehoods of Romneycare.

Among my list of 30 errors, the one that needs constant correcting is the statement that

“The truth about premiums is that they’ve gone down for those who buy their own insurance (in what had been the so-called “individual market’)… “as much as 40%.”

As Politifacts says, “pants on fire” not true (I like that line even though Politifacts is as lefty as factchecks.org).

And more on health reform history: The Washington Post’s “Right Turn” blog ran an interview with MIT’s Jon Gruber on the origins of RomneyCare. Blogger Jennifer Rubin begins:

It is “sad,” says MIT professor Jonathan Gruber, that presidential candidate Mitt Romney is running away from his Massachusetts health care plan, a plan that Gruber says “gave birth to one of the greatest pieces of social legislation in our history,” namely President Obama’s 2010 health-care reform legislation. Aside from Romney, Gruber is the man most responsible for the Massachusetts plan. And given how important the debate is over the ‘Cares — RomneyCare and ObamaCare, as they’re often dubbed — I decided to go to the man who perhaps knows more than anyone about the development of both.

In a candid phone interview, Gruber explained how RomneyCare came about, where he thinks the critics have it wrong and whether potential “defenses” against his own plan by the Republican 2012 frontrunner hold up to scrutiny.