Romney leads the GOP field on health care — at least in the real world

What makes Mitt Romney’s health-care troubles particularly perverse is that, by all rights, he’s the one candidate in the Republican field who’s really accomplished something on the issue. This graph uses data from the Kaiser Family Foundation to chart the number of uninsured in each Republican contender’s home state. In states where there are two likely Republicans — say, Minnesota, where both Tim Pawlenty and Michele Bachmann receive their mail, or Texas, which elected both Ron Paul and Rick Perry — I’ve grouped them together. Look who comes out ahead. And not by a little:

Moreover, Donald Trump can’t be blamed for New York’s rate of uninsurance. Tim Pawlenty hasn’t done much to change Minnesota’s health-care system one way or the other. But Massachusetts’s leadership on this graph is substantially due to decisions Romney made as governor. Romney doesn’t look good because the Dukakis administration did the work for him, though the Dukakis administration did pass some important health-care reforms. Romney looks good because he achieved something important.

Romney’s record looks worse, it should be said, if you focus on costs. Massachusetts had the highest per-person costs when Romney took office and it has the highest per-person costs now. His reforms largely dodged the cost issue, arguing that access was a necessary precondition for cost control, and so it needed to be done first. In the individual and small-group markets where his reforms focused, however, insurance has become, on net, more affordable.

To his credit, though, the theory that expanding access can align the political incentives toward cost control is largely working out. The reforms gave the Massachusetts political establishment something to protect, and so they’ve begun focusing seriously on the sort of real cost controls needed to make near-universal coverage sustainable. The Patrick administration has proposed one of the most far-reaching cost control efforts ever seen on the state level, and the state’s largest health insurer is carrying out the most promising payment experiment we’ve seen in some time. Romney has a lot to be proud of, even if he’s not supposed to say so.