Obamacare, Romneycare and the race for President

As approval of Obamacare and Romneycare falls, healthcare remains one of the most prominent issues o

There will be one glaring issue in the upcoming 2012 presidential election: healthcare reform. According to the latest Real Clear Politics poll - and almost every other poll out there - Mitt Romney will be the one to take on Obama come November 2012, and there couldn't be a more fitting match for such a prevalent issue.

In 2006 Romney achieved the passage of his bill for universal health coverage in Massachusetts while serving as governor. His plan - commonly referred to as Romneycare - included subsidies, an exchange, and a mandate, in its most basic form. Subsidies would be given to the poor and uninsured to enable them to become insured; an exchange would be created to help individuals buy insurance apart from companies and groups; and an individual mandate that everyone buy insurance as a part of their personal responsibility as a citizen of the state was instated.

"It's a Republican way of reforming the market," Romney said after signing his healthcare bill on 12 April 2006. "Because, let me tell you, having 30 million people in this country without health insurance and having those people show up when they get sick, and expect someone else to pay, that's a Democratic approach. That's the wrong way. The Republican approach is to say, 'You know what? Everybody should have insurance. They should pay what they can afford to pay. If they need help, we will be there to help them, but no more free rides.'"

Obama came into office in 2008 with healthcare reform at the top of his agenda. He immediately put his plan into action, working with several of the Democrats from Romney's team, and using the 2006 healthcare bill as a model for the national system.

What was once Romney's most outstanding accomplishment has now become a source of shame to many in the Republican party. To think a Republican's bill laid the blueprints for what has become Obamacare is many conservatives' worst nightmare.

While the bills are similar, there are some fundamental differences. Romney's plan is funded by revenue from the federal government and funds that were being used to reimburse hospitals for giving free care to the uninsured while Obama's will be funded by new taxes and savings from Medicare cuts. Romney's bill is 70 pages and Obama's is 2,000. There have to be a few other things in that extra 1,930 pages.

The biggest - and perhaps the most overlooked - difference is the fact that Romney's plan is for a single state and Obama's includes an entire nation.As Kathleen Parker, a columnist for the Washington Post, put it:

"Just because something works well on the state level doesn't necessarily mean it will work on the federal level. A family of three has different requirements than a family of 300. Or 3,000. Or 3 million. You get the picture."

Romney has defended his bill using the same argument, arguing:

"Our plan was a state solution to a state problem, and [Obama's health law] is a power grab by the federal government to put in a one-size-fits-all plan across the nation."

Scott W. Atlas, a professor at Stanford University Medical Center, gave Real Clear Politics six reasons why this plan for healthcare wouldn't work on the national level. Atlas says Obamacare will result in less access to timely health care, less access to state-of-the-art drugs proven to cure serious diseases, less access to modern medical technology, less choice of doctor and treatment, less choice in health insurance coverage, and less access to leading innovators in health care.

Some of these problems are already surfacing in Massachusetts. A recent Boston Globe article revealed that patients in Massachusetts are facing up to 48 day waits to see a doctor for a "non-urgent medical issue." They also reported that many doctors are no longer accepting new patients. Many believe this is a reflection of the inaccessibility to come on the national level with Obamacare.

According to a recent poll of Massachusetts registered voters conducted by Suffolk University in Boston, Mass., 49 per cent answered "no" when asked if they thought healthcare in Massachusetts was working. When asked if they thought Romney's role in healthcare would help or hurt his presidential campaign, 54 per cent answered "hurt."

Approval for Obamacare is falling as well. According to the latest Rasmussen Reports national telephone survey, 54 per cent of likely US voters favour repeal of Obamacare, while only 35 per cent want it to stay. 46 per cent are confidence that the law will be repealed, while 63 per cent of US citizens consider this issue to be "very important" in their voting decision.

As the election draws closer, platforms may change. Will Obama offer concessions to anti-Obamacare voters, or will repeal only come from the election of a new president? Will Romney continue to defend his state reform while condemning it at the national level, or will he be forced to renounce both in an effort to keep himself in the running for the presidency? Someone will have to step up and address the concerns of the majority. Which of American's two biggest healthcare reformers will it be?

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Has Arlene Foster saved power-sharing in Northern Ireland?

The DUP leader's decision to attend Martin McGuinness' funeral was much more than symbolic. But is Gerry Adams willing to make a deal?

After some prevarication, DUP leader Arlene Foster chose to attend the funeral of Martin McGuinness in Derry today. Her decision to do so cannot have been an easy one.

A substantial part of her loyalist base has noisily resisted attempts to memorialise the late deputy first minister as anything other than an inveterate killer. Foster herself notes in today’s Belfast Telegraph that the former IRA commander was responsible for the deaths of “many neighbours and friends”. And in 1979 – aged just eight – she bore witness to the bloody aftermath of an IRA attack in her own home: her father, a reservist police officer, was shot in the head by a gunman later eulogised by McGuinness.

Her attendance at today’s funeral is thus noteworthy and has been the subject of due praise. She was twice applauded by the congregation: as she took her seat, and after Bill Clinton singled her out in his eulogy. It is, however, much more than the symbolic gesture it might appear.

Last month’s election, which saw the DUP lose 10 seats and unionist parties lose their Stormont majority for the first time in nearly a century, proved Foster to be damaged goods. She was – and remains – tarnished by the RHI scandal but also by her crass behaviour towards the nationalist community, particularly on Irish language issues.

Her carelessly won reputation as a truculent bigot will therefore not be easily lost. Her departure remains a red line for Sinn Fein. But with just four days until the deadline for a new devolution settlement, Foster’s presence at McGuinness’ funeral is the clearest indication yet of the DUP’s carefully calculated strategy. It isn’t quite a resignation, but is nonetheless indicative of the new manner in which Foster has carried herself since her party’s chastening collapse.

She has demonstrated some contrition and offered tacit acknowledgement that her election shtick was misjudged and incendiary. Her statement on McGuinness’ death was delicately pitched and made only oblique reference to his IRA past. In the absence of a willingness to allow Foster to step down, the decision instead has been taken to detoxify her brand.

The conciliatory Foster the DUP will nominate for First Minister on Monday will as such at least appear to be apart from the dogwhistling Foster who fought the election – and her attendance today is the superlative indication of that careful transition. There has been talk that this increases the chance of a deal on a new executive. This is premature – not least because the onus is now almost entirely on Sinn Fein.

Theirs is just as much a mandate to reject Stormont as we know it as it is to return and right the DUP’s wrongs. Gerry Adams, the last member of the Armalite generation standing, has made this abundantly clear – and has hardened his line just as Foster has made sure to be seen magnanimously softening hers. He said last night that he would not tolerate any extension of power-sharing talks beyond Monday’s deadline, and called on Dublin to prevent the UK government from re-instating direct rule.

Though Adams also maintained a deal was still possible in the coming days, his statement augurs badly. As the former UUP leader Lord Empey told me on the day McGuinness died, the Sinn Fein president – the ideologue to McGuinness’ Stormont pragmatist – is now entirely without equal within his party. Though he has set the transition to a new generation of female leaders in train, he remains in total control.

The demand for Dublin’s involvement is also telling: as the leader of the third-biggest party in the Dail, his is an all-Ireland long game. Enda Kenny will soon depart, offering Fianna Fail – riding high in the polls – a useful pretext to renegotiate or scrap their confidence and supply arrangement with his minority government. Sinn Fein are on course to make gains, but implementing Brexit and austerity as partners in a Stormont executive would undermine their populist anti-austerity platform.

As such, Empey predicted McGuinness’ death would allow Adams to exert a disruptive influence on the talks to come. “I don’t think it’ll be positive because for all his faults, Martin was actually committed to making the institutions work,” he said. “I don’t think Gerry Adams is as committed – and it was obvious from the latter part of last year that Gerry was reinstating his significant influence in the party. For that reason I think it will make matters more difficult.  I hope I’m wrong, but that’s my sense.”

He is not alone. There was, earlier this week, growing confidence in Westminster that some fudge could be reached on the most contentious issues. It isn't impossible - but Adams’ renewed dominance and rejection of the extended timeframe such negotiations would undoubtedly require suggests a new executive is as unlikely a prospect as it has ever been. With Foster quietly reinventing herself, the DUP could be the big winners come the next election (which could come this year and reinstate a unionist majority) – and the resurgent republicans might well rue the day they squandered their big chance.

Patrick Maguire writes about politics and is the 2016 winner of the Anthony Howard Award.