In Mitt Romney's private imagination, the perfect scenario would be this: He wins the presidency but weakened Democrats in Congress are still barely strong enough to prevent repeal of Obamacare.
Yes, Romney has vowed over and over to get Congress to repeal the Affordable Care Act — every jot and tittle of it — but you know that he never really wanted that to happen. That was just for Tea Party consumption. If he succeeded, he would begin his presidency facing not only the debt and jobs crises that he hopes are taking Barack Obama down and a new Middle East war that Romney has been egging on but also a health-care crisis suddenly become catastrophic.
I was about to expose Romney's secret hopes when he decided this week to do it himself, on NBC's Meet the Press.
"I'm not getting rid of all of health-care reform," Romney ventured. "There are a number of things that I like in health care reform that I'm going to put in place. One is to make sure that those with pre-existing conditions can get coverage." Another feature of Obamacare that he would keep is allowing young people to stay on their parents' insurance — not just until they are 27 but forever, as far as he is concerned. Romney implied there might be other aspects of Obamacare that he would keep, though apparently not the one he didn't mention and that he fathered himself — the mandate that people buy a health policy.
He was letting it be known that he is a health-care reformer like Obama. Never mind that his campaign took nearly all of it back later in the day in an "explanation" of his comments.
The campaign's small "explanation" was that rather than protect people from losing their coverage owing to pre-existing conditions as Obamacare will do in January 2014, Romney would not protect them.
The media reported Romney's soft stand on Obamacare and some genial remarks about the president as Romney's long-awaited pivot away from the right-wing dogma that sewed up the nomination to the old moderate Romney who can claim the confidence of enough independents to win. Every successful candidate plays to the base in the nominating season and moves to the middle in the general election. It's proving harder for Romney because he had to very specifically repudiate virtually his entire public record to mollify the far right.
But on health care Romney has to be thinking also about governing in January on the chance that he is elected. He needs the Affordable Care Act to remain virtually intact while being seen as keeping his promise to try to repeal it. He said this week that he would try to repeal it and, if he succeeds, offer his bill, which would include barring insurance companies from canceling policies for the chronically ill and some other things in Obamacare he agrees with.
If Obamacare were to be repealed, the new president would suddenly face millions of angry people with chronic health conditions who can't buy health insurance at reasonable rates and who are expecting to receive coverage again in 2014; newly exploding Medicare expenses and a wider deficit after the savings in Obamacare are canceled; policyholders who would no longer be reimbursed for excessive premiums; tens of millions of Medicare beneficiaries whose drug costs would rise when the "doughnut hole" is opened again; an insurance industry that would face new pressures on their profits because they must insure the chronically sick at everyone else's premium rates (if Romney keeps his Meet the Press promise); and all the nation's policyholders, corporate and individual, whose premiums will rise to cover the insurance industry's new losses. Repeal would also dash hopes for capping medical inflation and improving care. As a New York Times article suggested last week, the insurance and health industries are watching Arkansas's experiment with one of the Obamacare options, bundled care, to see if offers a feasible way out of the world's most expensive and wasteful health-care system.
Romney seems not to have grasped the complexity of the problem when he cheerily answered Gregory's question about Obamacare. Guaranteeing coverage for people with pre-existing conditions is not feasible without the mandate that healthy people who can afford it buy insurance rather than rely on emergency rooms and the uncompensated care of physicians and clinics. Insurers would have to jack up everyone's premiums to cover the losses.
Back in the campaign offices, the staff must have heard from insurance industry backers. Thus the explanation that what Romney meant was that the new federal version of Romneycare would guarantee coverage only for people who have enjoyed "continuous" coverage. If you had never had an interruption in coverage even for a week, the insurer couldn't cancel your coverage when you got sick.
That would leave out about 89 million Americans, who have had some interruption in their coverage, maybe when they lost or switched jobs.
Romney's clarified promise is meaningless because people with continuous coverage have been protected since 1996, when Republicans and Democrats came together to pass the Kennedy-Kassebaum bill, the Health Insurance Portability and Accountability Act, after both Bill Clinton's and the Republicans' health-insurance reforms crashed. The Republican bill that had crashed, by the way, is what eventually became the core of Obamacare and Massachusetts' Romneycare.
Have you noticed? When Romney talks about health care, his fingers are always crossed, metaphorically anyway.