As the Republican field for the 2012 presidential election takes shape, it seems clear the most significant policy issue defining the potential candidates is their approach to health care and entitlement reform. How they respond to these challenging issues is likely to define the next several months’ debates.
The current consensus frontrunner according to most polls is Mitt Romney, the former governor of Massachusetts whose 2006 Romneycare reform is credited by the White House and others as bearing more than a passing resemblance to Obamacare. Romney has repeatedly refused to disavow his 2006 individual mandate-based system, claiming instead that his good ideas were warped after the fact by flawed implementation carried out by Massachusetts Democrats. This message largely has fallen on deaf ears, and Romney’s current suggestions about health policy amount to little more than a list of poll-tested bullet points.
Tim Pawlenty, the former governor of Minnesota who achieved some positive health care reforms in his state, revealed his federal health care proposal last week. While saying he would be willing as president to sign House Budget Committee Chairman Paul Ryan’s Path to Prosperity reform, Pawlenty stressed he would prefer a Medicare reform more like the proposal put forth by fmr. OMB Dir. Alice Rivlin, a Democrat, and fmr. New Mexico Sen. Pete Domenici, a Republican, in which Medicare enrollees, current and future, would be given a choice of staying in their current plan or picking a private plan. Fmr. House Speaker Newt Gingrich also has expressed support for this idea, and he will be unveiling his own plans for reform soon.
Although keeping traditional Medicare voluntary makes sense as a politically defensive posture—Ryan himself has said this is an idea worth considering. The problem is that Pawlenty and Gingrich probably would be walking into a trap. By retaining a government program that competes with the privately-run marketplace in a nationwide exchange, they miss out on one major advantage of Ryan’s reform: eliminating the ability of Congress to rig the game to protect traditional Medicare at the expense of the consumer and the marketplace.
Jon Huntsman, former governor of Utah and ambassador to China, has his own health policy albatross. He followed Romney in being the second governor to design and pass a health care exchange, although it (fortunately) passed without the individual mandate Huntsman had endorsed. Though just a pilot program, his plan was fraught with problems: few businesses, and fewer individuals, signed up. The exchange had to be redesigned before opening it to the broader marketplace last year, after Huntsman was long gone, and it has yet to bear fruit as a consumer-empowering force. Huntsman has endorsed bipartisan approaches to the politically safer issue of Medicaid reform, but he has avoided giving fuller thoughts about Medicare reform, while endorsing the uncontroversial idea that some reform needs to happen.
New to national politics is a tea party favorite Herman Cain, whose passionate following has elevated the Georgia businessman in early polls, to the surprise of Washington insiders and the media. Cain can trace his first political activity to the arena of health care—he was thrust into national prominence after confronting President Bill Clinton at a town hall meeting and telling the him how Hillarycare would hurt small businesses. Cain’s the only current candidate who has adopted Ryan’s plan wholesale, without caveat. Calling his support for it “100 percent”, he has accused those “backing away from Ryan’s plan” of “lacking courage” because the plan may be difficult to sell to the American people.
How much these and the other candidates choose to say about their plans, and how they react to Ryan’s proposal, will define that matter of courage, as well as their seriousness about budget reform. Whoever can put forward a solution the Republican base supports, and make the case for it in a convincing way, is probably the likeliest to win the chance to pit that solution against President Barack Obama in a general election.
Benjamin Domenech ([email protected]) is a research fellow at The Heartland Institute and managing editor of Health Care News.
