RUTHFULLY YOURS

***The exchange began when Rick Santorum scored Mr. Romney for lacking health-care “credibility,” since the 2006 Bay State reform “was the basis for ObamaCare.” If the first claim is for primary voters to decide, no one who knows anything about health policy on the left or right would deny the second: When Democrats wrote the Affordable Care Act in 2009 and 2010, they borrowed liberally from Mr. Romney’s model.

If the plans are not identical in every detail, they share major phenotypes: an individual mandate to buy health insurance or else pay a penalty; large transfer payments to subsidize the middle class; and much more government control over how insurance plans are structured, how medical services are delivered, and how both are priced.

“This is something that was crafted for Massachusetts,” Mr. Romney responded in Las Vegas, repeating his stock answer. “It would be wrong to adopt this as a nation.” The former Governor says Mr. Obama’s plan “must be repealed” and then states can experiment with their own health-care solutions.

Federalism is a virtue, yet Mr. Romney did previously promote his plan as a model until Democrats took his advice. “How much of our health-care plan applies to other states? A lot,” he wrote in these pages in 2006. Mr. Romney repeated those sentiments in the hardcover version of his book “No Apology,” though he cut them from the paperback.

But the larger and more important point is that Mr. Romney continues to defend his Massachusetts plan as a success for precisely the same reasons that President Obama says it should be imposed on all states. In reality, the Massachusetts plan is not a success and its problems are the best refutation of the duo’s arguments.

Here’s Mr. Romney Tuesday night: “What we do is rely on private insurers, and people—93% of our people who are already insured, nothing changed. For the people who didn’t have insurance, they get private insurance, not government insurance.”

Here’s Mr. Obama in his health-care speech to Congress in 2009: “If you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have.” And the uninsured, Mr. Obama continued, would simply receive “affordable choices” from “private insurers.”

Related Video

Grace-Marie Turner on the similarities between ObamaCare and RomneyCare.

The trouble with the Obama-Romney definition of “affordable” is that in practice it means subsidies, and once the government provides “free” health care, the private sector and entitlement state are fungible. Government inevitably dictates choices that used to be left to markets, as Mr. Santorum and Newt Gingrich pointed out. And, sure enough, due to the subsidy gusher that Mr. Romney opened, Massachusetts is now moving to impose price controls on private insurance and tightly regulate the type of care patients can receive.

Mr. Romney did concede on Tuesday that “I didn’t get the job done in Massachusetts in getting the health-care costs down,” and that’s for sure, even as he still endorsed the individual mandate that was supposed to reduce insurance costs. Bay State spending for uncompensated care incurred by “free riders” has increased every year since the plan passed, while a 2010 study coauthored by Mr. Romney’s chief economic adviser, Columbia Business School dean Glenn Hubbard, found that it increased insurance premiums by 6%.

Mr. Gingrich landed a direct hit when he said that such dysfunctions were the result of the “fundamental difference” between market solutions and “one more big government, bureaucratic, high-cost system.” Perhaps that was why Mr. Romney struck back by claiming that “Actually, Newt, we got the idea of an individual mandate from you.”

The individual mandate does have a conservative lineage, though a disputed one. Mr. Romney chided his “libertarian friends” in his 2006 Journal op-ed for opposing the idea, which was backed by the Heritage Foundation and some Clinton-era Republicans. But the mandate’s critics have been vindicated on its failure to control insurance costs, and perhaps next year they will also prevail on its federal unconstitutionality.

***

Mr. Romney has every right to cling to theories that were flawed in conception and have proven false in practice, though the rest of the GOP field has the responsibility to challenge his canned answers. The mental contortions that his health-care record requires need to be dissected—the way Mr. Obama will do if Mr. Romney is the nominee—to give GOP voters a chance to weigh the political liabilities that his candidacy might pose in 2012.

Or, if he is the nominee and if he is elected, to drive him to reject the RomneyCare model in favor of patient-centered, market-driven health-care reform. Mr. Romney laid out such a plan in Ann Arbor in May, even as he now evinces an unaffordable faith that government must pay to reduce the uninsured rate. But the uninsured rate would fall as costs were disciplined through choice and competition in a truly reformed system that Mr. Romney says he favors everywhere except Massachusetts.

Mr. Obama’s unbridled expansion of government means that the election will present the electorate with the largest philosophical choice since 1980: To continue the trend toward a larger and growing government and the ever-higher taxes to pay for it, or to modernize the 20th century’s broken government institutions. Republicans do not want to wake up in 2012 to discover that they have nominated someone who is unprepared, and maybe unwilling, to lead the reform of government that America needs.