Mitt Romney’s health problems

The former Massachusetts governor attempts to distance himself from his health-care reforms. But wil

No, he's not the front-runner, but the former Massachusetts governor Mitt Romney is determined to snatch the Republican presidential nomination this time round. This week he managed to raise $1m for his campaign in a single, brief visit to New York, the former president George W Bush helping to pull those big-time Wall Street donors in.

Yesterday, he tried to overcome one of his biggest political obstacles in the GOP heartlands: his record on universal health care.

For though Romney is no liberal, the Massachusetts health-care bill that he helped to design and signed into law is widely credited with inspiring the current president's Obamacare plan.

Yes, that's right, the "socialised medicine" plan that Republicans are up in arms about – the plan that Romney himself described as "an unconscionable abuse of power", the plan that some states are at this very moment trying to prove is against the US constitution – was based on a Republican's idea.

Big Bad Gov

The main part that Republicans are challenging is the part that says citizens will be required by law to have health insurance. It's Big Government gone mad and an intrusion into private lives, say the conservatives. This is a sentiment shared by Romney – even though his Massachusetts law introduced America's first such requirement, making everyone get health coverage or pay a fine.

Yesterday, in a suitably businesslike PowerPoint demonstration in Ann Arbor, Michigan, Romney argued that he wants to "repeal and replace" Obamacare, in the hope that this will lay to rest any idea that he was the man behind the idea in the first place.

Not that he's apologising for the Massachusetts law, as conservative activists would no doubt prefer. An editorial in the Wall Street Journal did not pull any punches: "His failure to explain his own role, or admit any errors, suggests serious flaws both in his candidacy and as a potential president."

There was a sort of rowing back in March when he told supporters that "our experiment wasn't perfect – some things worked, some things didn't, and some things I'd change". Today he'll be tackling the issue head on, riskily choosing to lay out the detail of what he'd like to see instead of Obama's reforms.

And instead of dwelling on details of the past, Romney explained his alternative, claiming that Obamacare tramples all over the rights of states. He said he wants to give states block grants to provide their share of Medicaid and children's health schemes.

Abort, retry, fail

People would get a choice between tax credits to help fund insurance provided by their employer, as happens now, or a new type of tax deduction for those who decide to buy their own plan. He'll allow people to buy insurance across state lines. And he'll keep – but narrow – the rules that currently prevent insurers from refusing to cover people with pre-exisiting conditions. According to one of his advisers, Mike Leavitt: "Government's role is to organise an efficient market, not run the system."

But, for Romney's critics, the role of government is exactly what's at stake. They believe his record on health care means he's fundamentally adrift from the GOP's core principles, which are based on letting the market and competition have their way.

The Democrats, naturally, are making as much as they can out of Romney's dilemma, releasing clips from a 1994 campaign speech where he supported the idea of a federal mandate, saying: "I'm willing to vote for things that I'm not wild with." And they have released their own mock-PowerPoint slides with some of those "missing ideas".

Romney has reinvented himself many times before. When he ran for the nomination in 2008 he depicted his Massachusetts health-care policy as a market-friendly alternative to the failed Bill Clinton plan, which managed to win him the backing of conservative groups such as the Heritage Foundation. Plus there's that well-documented change of heart on abortion. In 2002, he ran as pro-choice. By 2007 he was declaring that his previous views had been wrong.

That led to something of a reputation for being a man who constantly changed his mind. Indeed, there are still websites dedicated to "Mitt Romney flip-flops". As one pundit wrote in the LA Times back in March: "If anything is transparently clear about American politics, it is that Mitt Romney will do or say anything to become president."

The former governor hopes that his detailed argument about the future of health care in the United States will succeed in changing that reputation. Good luck with that, Mitt. Sounds like you'll need it.

Felicity Spector is a deputy programme editor for Channel 4 News.

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There are risks as well as opportunities ahead for George Osborne

The Chancellor is in a tight spot, but expect his political wiles to be on full display, says Spencer Thompson.

The most significant fiscal event of this parliament will take place in late November, when the Chancellor presents the spending review setting out his plans for funding government departments over the next four years. This week, across Whitehall and up and down the country, ministers, lobbyists, advocacy groups and town halls are busily finalising their pitches ahead of Friday’s deadline for submissions to the review

It is difficult to overstate the challenge faced by the Chancellor. Under his current spending forecast and planned protections for the NHS, schools, defence and international aid spending, other areas of government will need to be cut by 16.4 per cent in real terms between 2015/16 and 2019/20. Focusing on services spending outside of protected areas, the cumulative cut will reach 26.5 per cent. Despite this, the Chancellor nonetheless has significant room for manoeuvre.

Firstly, under plans unveiled at the budget, the government intends to expand capital investment significantly in both 2018-19 and 2019-20. Over the last parliament capital spending was cut by around a quarter, but between now and 2019-20 it will grow by almost 20 per cent. How this growth in spending should be distributed across departments and between investment projects should be at the heart of the spending review.

In a paper published on Monday, we highlighted three urgent priorities for any additional capital spending: re-balancing transport investment away from London and the greater South East towards the North of England, a £2bn per year boost in public spending on housebuilding, and £1bn of extra investment per year in energy efficiency improvements for fuel-poor households.

Secondly, despite the tough fiscal environment, the Chancellor has the scope to fund a range of areas of policy in dire need of extra resources. These include social care, where rising costs at a time of falling resources are set to generate a severe funding squeeze for local government, 16-19 education, where many 6th-form and FE colleges are at risk of great financial difficulty, and funding a guaranteed paid job for young people in long-term unemployment. Our paper suggests a range of options for how to put these and other areas of policy on a sustainable funding footing.

There is a political angle to this as well. The Conservatives are keen to be seen as a party representing all working people, as shown by the "blue-collar Conservatism" agenda. In addition, the spending review offers the Conservative party the opportunity to return to ‘Compassionate Conservatism’ as a going concern.  If they are truly serious about being seen in this light, this should be reflected in a social investment agenda pursued through the spending review that promotes employment and secures a future for public services outside the NHS and schools.

This will come at a cost, however. In our paper, we show how the Chancellor could fund our package of proposed policies without increasing the pain on other areas of government, while remaining consistent with the government’s fiscal rules that require him to reach a surplus on overall government borrowing by 2019-20. We do not agree that the Government needs to reach a surplus in that year. But given this target wont be scrapped ahead of the spending review, we suggest that he should target a slightly lower surplus in 2019/20 of £7bn, with the deficit the year before being £2bn higher. In addition, we propose several revenue-raising measures in line with recent government tax policy that together would unlock an additional £5bn of resource for government departments.

Make no mistake, this will be a tough settlement for government departments and for public services. But the Chancellor does have a range of options open as he plans the upcoming spending review. Expect his reputation as a highly political Chancellor to be on full display.

Spencer Thompson is economic analyst at IPPR