Mitt Romney's Health-Care Mandate Problem

On the fifth anniversary of the enactment of sweeping health-care reforms in Massachusetts, Mitt Romney, the governor who signed them into law, has a problem.

It's not just that Democrats love to talk up those reforms as the underlying framework for the eventual federal health-care overhaul under Obama, thereby tying the GOP presidential aspirant to what conservatives call "Obamacare." Nor is it that Democrats so enjoy taunting Romney for making the reforms he now avoids mentioning, praising them in terms certain to raise the hackles of GOP primary voters. Take this example, from NECN.com in Boston:

The state of Massachusetts threw a birthday party Monday, complete with candles and a cake, for the fifth anniversary of the landmark universal healthcare law. State and healthcare officials gathered at the Dorchester House community health center in Boston to tout the success of the law....
Five years ago, a Democratic legislature passed the law and a Republican governor, Mitt Romney, signed it. Romney was invited to Monday's birthday celebration, but didn't attend, something the current governor doesn't understand.
"I can't understand why anybody who was so central to moving a transformative piece of legislation like this wouldn't be proud of it," said Governor Deval Patrick, (D) Massachusetts.

Or this thank you video, from the Massachusetts Democrats, timed to the anniversary:

The real problem for Romney is that it would be political malpractice if his GOP primary opponents did not take video clips like the below, released in March 2010 by the Democratic National Committee, and turn them into campaign ads. Pay attention in particular to Romney's remarks (at the 0:44 mark) at the January 2008 ABC News-Facebook-WMUR Republican presidential primary candidate debate in New Hampshire.

"I like mandates. The mandates work... Let me tell you what kind of mandates I like, Fred," Romney said, addressing former senator Fred Thompson (R-Tenn.) at the debate.

"Here's my view: if somebody, if somebody can afford insurance and decides not to buy it and then they get sick they ought to pay their own way... If you can afford to buy insurance, then buy it. You don't have to, if you don't want to buy it. But then you gotta to put enough money aside that you can pay your own way," Romney said.

It used to be that making the conservative case for health-care reform involved talking about "personal responsibility" versus "free riders"; today, apparently (and according to Paul Ryan's budget plan), it's about ending Medicare as a fee-for-service program and turning it into a subsidy for older people to buy private insurance.

An even bigger problem for Romney looms with the Supreme Court ruling on the individual mandate question, expected early next year. If it is ruled unconstitutional in mid-February or earlier, it is very difficult to see how Romney survives the politics of that during the heat of the Iowa-New Hampshire-South Carolina period of the primary season, even if the legal argument against an individual mandate to purchase health insurance by the federal government is not directly applicable to whether or not an individual state can implement such a mandate.

About the Author

Garance Franke-Ruta is a former senior editor covering national politics at The Atlantic.

The world has many coming-of-age traditions: sweet sixteens, bar mitzvahs, quinceañeras. But in one African country, 'initiation' is endangering the health of girls and boys.

CHIRADZULU, Malawi — A slight frame gives her the appearance of a child, but the hardened look Grace Mwase wears makes her seem older than her 14 years. In many villages across Malawi, a largely agrarian sliver of a country in southern Africa, custom dictates that both boys and girls as young as eight attend a rite of passage known as “initiation,” after which they are no longer seen as children. The practice is most entrenched in the country's south, where Mwase's Golden Village is located.

Mwase was just 10 when she was led, along with about a dozen other girls, to remote huts outside her village during winter vacation from school in August. The girls were accompanied by older women from their village in Chiradzulu district, near the border with Mozambique. The women, known as anamkungwi, or “key leaders,” told them that when they returned to their villages they should cook and clean—and have sex. According to Mwase, most of the two weeks she spent at the initiation camp were dedicated to learning how to engage in sexual acts. She had been excited for this time with friends away from home, but that feeling quickly gave way to dread as she learned the true purpose of initiation.