If Obamacare penalty is a tax, Romney is a huge tax-raiser

Mitt Romney never met a flip that he didn't soon flop.

The guy has no spine. He bends to whatever his right-wing Tea Party masters want him to say and do. Not a great leadership quality for a would-be president of the United States.

Latest case in point: at first he and his campaign argued that the Affordable Health Care penalty for not having health insurance wasn't a tax, contrary to the Supreme Court majority opinion. Probably this was because the penalty in Massachusetts under "Romneycare," which "Obamacare" essentially copied, also was handled by the tax collection folks, so if the penalty is a tax, Romney increased taxes.

But today… the flip has flopped.

Under pressure, Romney now says the Affordable Care Act penalty is a tax, while the same penalty in Massachusetts is just a penalty. Doesn't make any sense. Like most of Romney's pandering political positions.

Why the switch? As he has on so many issues, Mr. Romney caved to Republican conservatives who want him to campaign on the falsehood that the mandate is a vast tax increase on the middle class. The Supreme Court’s decision that the law is constitutional was disastrous to their cause, so they distorted its basic reasoning. Chief Justice John Roberts Jr. wrote that the mandate is legal under the Congressional taxing power, which Republicans took a step further, saying the mandate must now be a tax. And not just a tax, but a huge, oppressive tax, one of the largest in history.

It is, of course, no such thing. How many “oppressive taxes” are entirely optional? Anyone who does the smart thing and gets health insurance won’t have to pay it. It is, as Mr. Romney himself described it in 2006, a fee to promote “personal responsibility” and prevent healthy people from freeloading. (Among those who won’t be able to comply with the law are poor people living in states where Republican governors refuse to expand their Medicaid programs using federal dollars — though most of those people don’t make enough to have to pay the penalty.)

So what is Romney's solution to 30 million people uninsured, rapidly rising costs, wasteful administrative overhead, poor health outcomes in this country relative to other nations with universal health care?

Trust in the free market.

Which is the same free market, only more so, that's responsible for all of the problems our health care non-system faces today. Again, doesn't make sense. Fareed Zakaria's column, "Curbing the Cost of Health Care," explains why.

To understand the issue better, I spoke with Daniel Vasella, the chairman (and former chief executive) of Novartis and a physician by training. He is also frankly pro-market and pro-American, both of which have made him a target for some criticism in Europe.

Vasella emphasized that there is no single model that works best, but he explained that France and Britain are better at tackling diabetes and lung disease because they take a systemic approach that gives all health-care providers incentive to focus on early detection and cost-effective treatment and that makes wellness the goal. “In America,” he said, “no one has incentives to make quality and cost-effective outcomes the goal. There are so many stakeholders and they each want to protect themselves. Someone needs to ask, ‘What are the critical elements to increase quality?’ That’s what we’re going to pay for, nothing else.”

I asked him whether the lesson he has drawn is that only the government can produce system-wide improvements. “It pains me to say this as a free-market advocate, but you have to have [the] government act in this case. Health care is very complex. Only at a systemic level can you figure out what works best based on the evidence, and what procedures and treatments are not worth the money,” he said.

Paul Krugman also explains why the free market doesn't work in health care.

There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either — they’re not in business for their health, or yours.

…The second thing about health care is that it’s complicated, and you can’t rely on experience or comparison shopping. (“I hear they’ve got a real deal on stents over at St. Mary’s!”) That’s why doctors are supposed to follow an ethical code, why we expect more from them than from bakers or grocery store owners.

You could rely on a health maintenance organization to make the hard choices and do the cost management, and to some extent we do. But HMOs have been highly limited in their ability to achieve cost-effectiveness because people don’t trust them — they’re profit-making institutions, and your treatment is their cost.

Between those two factors, health care just doesn’t work as a standard market story.