Mitt Romney's Health Care Advantage?

The hope (the never-before-tried idea) was that the newly-insured Bay Staters would start making health care decisions more like their previously-insured neighbors. Once covered, it was thought, people like Brian would make better use of primary care physicians and place a lesser burden on costly emergency rooms.

Has it worked? Yes and no. The plan has absolutely worked to increase health insurance coverage. Massachusetts has by far the lowest rate of uninsured citizens in the country. At the same time, however, patients still go to the emergency room too often, and Massachusetts still struggles with health care costs. Yet those costs have hardly spiraled out of control. The idea (spread in some circles) that the individual mandate has bankrupted the state or led to uncontrolled cost growth is simply a "myth." The Massachusetts Taxpayer Foundation has calculated the additional financial impact as roughly 1.2 percent of the state budget. The increased cost is not good, but it's hardly backbreaking.

Now, let's contrast Mitt Romney's approach with President Obama's.

First, the President took an approach (the individual mandate) that had previously been tried only in one of America's wealthiest states with a relatively low percentage of uninsured and imposed it on the entire country.

Compare this chart, showing relative state median income, with this chart, showing percentages of uninsured by state. See any differences? Arkansas is relatively poor ($37,823 median income, 48th in the country), with a high percentage of uninsured (19.2 percent in 2009). California has high income ($58,931) and a high percentage of uninsured (20 percent). Then there's Massachusetts, with high income ($64,081) and a low number of uninsured (4.4 percent). With higher percentages of uninsured come much, much higher costs in an individual mandate.

In fact, one of the prime reasons for initial cost concerns with RomneyCare was that so many people signed up for subsidized insurance so quickly that policymakers were concerned that they'd undercounted the uninsured (the numbers eventually leveled off). Start imposing the mandate on states with uninsured percentages three, four, or five times greater than Massachusetts, and costs will rise astronomically—to the point where either the budget breaks or cost controls become so draconian that the quality of care suffers and real rationing ensues.

Second, President Obama's individual mandate represents a dramatic change in the concept of federal power—a change so momentous that the Supreme Court is quite likely to strike it down. The Constitution entrusts the states with the so-called "police power," a generalized power to enact laws and regulate behavior, limited of course by state and federal constitutional constraints. The federal government, by contrast, is limited to "enumerated powers," having only those powers specifically granted by the Constitution.

Why the difference? America's founders had experienced both the centralized authority of the British Empire and the near-chaos of the Articles of Confederation. They chose a middle way that granted authority to the states but also created a federal government strong enough to defend and unify a vast and diverse country. Their wisdom echoes to this day, as the one-size-fits all approach of ObamaCare has not only been rejected by the 26 states who've filed suit against the law, but even by the Obama administration itself, which has granted, at last count, nearly 1,400 waivers from the law's requirements.

Finally, it's also critical to note that Mitt Romney turned his attention to health care only after transforming a projected $3 billion state deficit when he entered office into a $600 million surplus by 2006, the year he signed his health reform legislation. Romney fixed an economic crisis before he reformed health care. Did President Obama do this? Did he first deal with our deficit and high unemployment? Our financial reality speaks for itself.