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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Junior doctors’ strikes: the greatest union failure in a generation

The first wave of junior doctor contract impositions began this week. Here’s how the BMA union failed junior doctors.

In Robert Tressell’s novel, The Ragged-Trousered Philanthropists, the author ridicules the notion of work as a virtuous end per se:

“And when you are all dragging out a miserable existence, gasping for breath or dying for want of air, if one of your number suggests smashing a hole in the side of one of the gasometers, you will all fall upon him in the name of law and order.”

Tressell’s characters are subdued and eroded by the daily disgraces of working life; casualised labour, poor working conditions, debt and poverty.

Although the Junior Doctors’ dispute is a far cry from the Edwardian working-poor, the eruption of fervour from Junior Doctors during the dispute channelled similar overtones of dire working standards, systemic abuse, and a spiralling accrual of discontent at the notion of “noble” work as a reward in itself. 

While the days of union activity precipitating governmental collapse are long over, the BMA (British Medical Association) mandate for industrial action occurred in a favourable context that the trade union movement has not witnessed in decades. 

Not only did members vote overwhelmingly for industrial action with the confidence of a wider public, but as a representative of an ostensibly middle-class profession with an irreplaceable skillset, the BMA had the necessary cultural capital to make its case regularly in media print and TV – a privilege routinely denied to almost all other striking workers.

Even the Labour party, which displays parliamentary reluctance in supporting outright strike action, had key members of the leadership join protests in a spectacle inconceivable just a few years earlier under the leadership of “Red Ed”.

Despite these advantageous circumstances, the first wave of contract impositions began this week. The great failures of the BMA are entirely self-inflicted: its deference to conservative narratives, an overestimation of its own method, and woeful ignorance of the difference between a trade dispute and moralising conundrums.

These right-wing discourses have assumed various metamorphoses, but at their core rest charges of immorality and betrayal – to themselves, to the profession, and ultimately to the country. These narratives have been successfully deployed since as far back as the First World War to delegitimise strikes as immoral and “un-British” – something that has remarkably haunted mainstream left-wing and union politics for over 100 years.

Unfortunately, the BMA has inherited this doubt and suspicion. Tellingly, a direct missive from the state machinery that the BMA was “trying to topple the government” helped reinforce the same historic fears of betrayal and unpatriotic behaviour that somehow crossed a sentient threshold.

Often this led to abstract and cynical theorising such as whether doctors would return to work in the face of fantastical terrorist attacks, distracting the BMA from the trade dispute at hand.

In time, with much complicity from the BMA, direct action is slowly substituted for direct inaction with no real purpose and focus ever-shifting from the contract. The health service is superficially lamented as under-resourced and underfunded, yes, but certainly no serious plan or comment on how political factors and ideologies have contributed to its present condition.

There is little to be said by the BMA for how responsibility for welfare provision lay with government rather than individual doctors; virtually nothing on the role of austerity policies; and total silence on how neoliberal policies act as a system of corporate welfare, eliciting government action when in the direct interests of corporatism.

In place of safeguards demanded by the grassroots, there are instead vague quick-fixes. Indeed, there can be no protections for whistleblowers without recourse to definable and tested legal safeguards. There are limited incentives for compliance by employers because of atomised union representation and there can be no exposure of a failing system when workers are treated as passive objects requiring ever-greater regulation.

In many ways, the BMA exists as the archetypal “union for a union’s sake”, whose material and functional interest is largely self-intuitive. The preservation of the union as an entity is an end in itself.

Addressing conflict in a manner consistent with corporate and business frameworks, there remains at all times overarching emphasis on stability (“the BMA is the only union for doctors”), controlled compromise (“this is the best deal we can get”) and appeasement to “greater” interests (“think of the patients”). These are reiterated even when diametrically opposed to its own members or irrelevant to the trade dispute.

With great chutzpah, the BMA often moves from one impasse to the next, framing defeats as somehow in the interests of the membership. Channels of communication between hierarchy and members remain opaque, allowing decisions such as revocation of the democratic mandate for industrial action to be made with frightening informality.

Pointedly, although the BMA often appears to be doing nothing, the hierarchy is in fact continually defining the scope of choice available to members – silence equals facilitation and de facto acceptance of imposition. You don’t get a sense of cumulative unionism ready to inspire its members towards a swift and decisive victory.

The BMA has woefully wasted the potential for direct action. It has encouraged a passive and pessimistic malaise among its remaining membership and presided over the most spectacular failure of union representation in a generation.

Ahmed Wakas Khan is a junior doctor, freelance journalist and editorials lead at The Platform. He tweets @SireAhmed.