Analysis: Health Care Debate Is Revealing

Question: If government and business leaders do their part to lower the cost of health insurance, should people be required to sign up?

Republican Mitt Romney used to answer yes.

Now he says no.

Democrat Hillary Rodham Clinton says yes or no - or maybe. It depends on the definition of "require."

The way these and other 2008 presidential candidates answer the "individual mandate" question says as much about their characters, their strategies and the tricky politics of health care reform as it does about the actual policies.

"Individual mandate" is the jargon politicians use to describe health care plans that assume every citizen will enroll in health insurance, often with subsidies and under threat of penalty.

Clinton's position, still a work in progress, shows how careful the New York senator is to not upset anybody with her new health care plan after her confrontational, secretive approach in 1993 ended in political disaster.

Romney's yes-and-no positions are further reminder that he has a habit of taking both sides of an issue - often based on what's politically expedient at the time.

As governor of Massachusetts, Romney pushed a plan that requires state residents to get health insurance or face tax penalties. The law includes a new bureaucracy to implement it, government subsidies for the poor and guidelines for health insurance companies.

The effort broke new ground by sharing responsibility between government, business and individuals.

As a presidential candidate, Romney opposes a national individual mandate. Balancing his belief in personal responsibility against his support of states' rights, Romney came down on the side of federalism.

"Far be it from me ... to stomp on all 50 states and say, "Here's Mitt Romney's plan. You must all adopt my plan,"' he said during a recent interview with The Associated Press. "No, let people try their own plans but do what the federal government did for us, which is give us the flexibility to create our own plan."

He led as governor. Is Romney copping out as a presidential candidate? He says no.

"From the very beginning, I was asked, 'Is this the model for all states?' I said no - some parts of this may be, but states have very different populations," Romney said.

He said Massachusetts has a relatively low rate of uninsured and older residents, which allowed state leaders to seek universal health care without raising taxes.

"But I wouldn't go to Texas and say, 'All Texans must have insurance. Oh, too bad there's not enough money, so you're going to have to raise taxes."'

Not as a GOP presidential candidate, anyway.

Rather than claim credit for pushing Clinton and others into a responsible middle ground on health care, which he credibly could do, Romney seems content to resort to 1990s-style attacks. He said her plan was inspired by European bureaucracies and that Clinton herself "doesn't believe in the American people," offering no proof of either charge.

Thirteen years after her singular leadership position ended in failure, Clinton proposed a $110 billion a year program that builds on the existing employer-based system of coverage.

It is nowhere near as complicated or ambitious as the plan she engineered for her husband, then-President Clinton.

The new plan claims to require citizens to get insurance as part of a "shared responsibility," but it has no teeth. In an interview Tuesday, Clinton said she doesn't support punishing people who don't get insurance, though she could envision a day when a person would need to show proof of insurance to an employer, "like when your kid goes to school and has to show proof of vaccination."

Details would be left to Congress.

It is one of the lessons she learned from the failure of her 1993 plan: Work well with Congress and business leaders.

"I have a track record of working to find common ground with people on the other side of the aisle," she told the AP.

That is not the record her rivals recall.

"The real key to passing any health care reform is the ability to bring people together in an open, transparent process that builds a broad consensus for change," said rival Democrat Barack Obama.

Fellow Democrat John Edwards accused Clinton of courting the same insurance companies, drug manufacturers and HMOs that helped kill her 1990s plan.

"The lesson Senator Clinton seems to have learned from her experience with health care is, 'If you can't beat 'em, join 'em,"' the former North Carolina senator said.

Edwards, who opposed universal health care during his 2004 presidential campaign, now supports it and an individual mandate. If elected, he vows to seek to cut off health care coverage to the president, his Cabinet and Congress on July 20, 2009, unless universal health care coverage passes by then.

Call it a political mandate on Washington: Fix the problem, finally, or lose your own insurance.
By Ron Fournier