NPR logo

Obama, Romney On Health Care: So Close, Yet So Far

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript
Obama, Romney On Health Care: So Close, Yet So Far

Obama, Romney On Health Care: So Close, Yet So Far

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel. Barack Obama and Mitt Romney have many things in common - Harvard degrees, strong marriages; cerebral, slightly aloof personalities. But they also have another unbreakable bond. Both signed health care reform laws based on an individual mandate. NPR national political correspondent Mara Liasson has the latest entry in our presidential campaign series Parallel Lives.

MARA LIASSON, BYLINE: Healthcare has become one of the starkest contrasts between President Obama and Governor Romney in the 2012 campaign. And that's surprising, given that once upon a time they both came up with similar plans to fix it. Stuart Altman, a professor of health policy at Brandeis University, says on health care the two men once occupied the same political space.

STUART ALTMAN: I would define Obama as a moderate liberal and Romney as a moderate conservative. Both of them came to the same conclusion that what was needed was built on the existing health insurance system.

LIASSON: Both men embraced what was considered to be mainstream health care policy thinking: maintain the employer-provided system, but get everyone covered through an individual mandate. Governor Romney went first in 2006. And when he talked about the Massachusetts mandate, it was in decidedly nonideological terms.

MITT ROMNEY: We're going to say, folks, if you can afford health care, then gosh, you'd better go get it; otherwise you're just passing on your expenses to someone else. That's not Republican, that's not Democratic, that's not Libertarian, that's just wrong.

LIASSON: Getting rid of free riders was a moral issue for Romney and many Republicans back then, says Jonathan Gruber, an MIT economist who helped the Romney and Obama administrations design the individual mandate. Gruber says he could tell that health reform had a particular appeal for Romney, a businessman who specialized in turning around troubled companies.

JONATHAN GRUBER: Mitt Romney was a management consultant. And what management consultants are is they're sort of like engineers. They go in, they see a problem, they solve it. I saw a lot of excitement, this passion to say, wow, we can move this piece around, add the mandate, rededicate the money, put it together and we can solve this important problem. Isn't that really neat?

LIASSON: Just as passing a national health care law was supposed to be the legacy achievement for President Obama, Gruber says back in 2006, as Governor Romney got ready to run for president, the Massachusetts law also looked like a surefire political winner.

GRUBER: You can understand his thinking, right? I mean, he thought, look, I can run for president by saying I solved this intractable problem by bringing conservative principles to bear - individual responsibility, the health insurance exchange. I mean, there was a guy from the freaking Heritage Institute on the stage with Romney at the bill signing. This was a victory for Republican ideals, a victory for using market forces to solve an intractable problem, and I think that Romney probably thought, isn't this a great thing I can run on as a Republican? I would have thought so, too.

LIASSON: Over time, President Obama and Mitt Romney have had a mirror-image relationship with the linchpin of their health care laws. Mitt Romney was for the mandate before he was against it. Barack Obama was against the mandate before he was for it.

ALTMAN: The irony is even worse than that.

LIASSON: Stuart Altman.

ALTMAN: I worked for Obama during the election and he was adamantly opposed to the individual mandate. I was on his advisory group, and we said, but you know, you really do need an individual mandate to make this all work together. He said, I won't support that because you're asking, you know, not wealthy people to buy expensive insurance. We got to get the cost down.

LIASSON: During the 2008 Democratic primary, the mandate was the single biggest policy divide between Mr. Obama and Hillary Clinton. In a debate, candidate Obama blasted Clinton's plan for an individual mandate by citing the experience in Massachusetts.

PRESIDENT BARACK OBAMA: Now, Massachusetts has a mandate right now. They have exempted 20 percent of the uninsured because they've concluded that that 20 percent can't afford it. In some cases there are people who are paying fines and still can't afford it, so now they're worse off than they were. They don't have health insurance and they're paying a fine.


LIASSON: And, says Stuart Altman, Mitt Romney and President Obama have something else in common. They were both victims of the same political sea change. The Republican Party got a lot more conservative.

ALTMAN: Obama campaigned that he was going to be a different kind of a president. He was going to get things done. He was going to compromise. And when he got to Washington, he realized that the Washington that he thought was there wasn't there anymore. So the movement of the Republicans to the right hurt Obama and really put Romney in a bind.

LIASSON: Romney's bind was apparent in the GOP primaries, when conservatives questioned his ability to attack the president on a plan so similar to his own. But now, with the nomination in hand, Romney is making health care the heart of his argument against the president.

ROMNEY: Now, the president's plan assumes an endless expansion of government, with rising costs and, of course, with the spread of Obamacare. I will halt the expansion of government, and I will repeal Obamacare.


LIASSON: What was once a common bond is now a deep divide.

OBAMA: I will not go back to the days when insurance companies had unchecked power to cancel your policy, or deny your coverage, or charge women differently from men. We're not going back there. We're going forward.

LIASSON: There is no overlap at all in the two men's current approaches to health care. If Romney is elected, he'll get rid of the law that was based on his own plan. If the president wins a second term, he'll fight to keep what he can. Mara Liasson, NPR News, the White House.

Copyright © 2012 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.