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GOP2012: Republican debate, October 11th, 2011
The Reality
Fact Check

Mitt Romney Borrowing Ideas from Europe

January 07, 2012 at 10:43 p.m. ET



Romney Touted Switzerland’s Co-Insurance Health Care Model As “Something The States Might Want To Look At.”  “In the interview yesterday, Romney said there are policies of European nations that could be worth considering in the United States. Switzerland, he said, has a health care model where people pay about 20 percent of their medical bills, giving them an incentive to consider cost when making medical decisions. ‘I'm not going to adopt a Swiss health care system, but the power of incentives in a co-insurance model that the Swiss have is something states might want to look at,’ he said. ‘So there are many things, in addition to good food, that we can learn from our European friends. But what I don't want is to adopt a strategy of ever-shrinking government support of the military and ever-increasing support for government programs.’” [Editorial Board Interview With Romney, Concord Monitor, 12/23/11]

Romney Touted The Co-Insurance Model Used By The French And Swiss Where Individuals Are Responsible For 20 Percent Of Their Adding “You Care How Much The Bill Is Because You Aren’t Just Going To Pay The First $1,000, You Pay 20%.” “Believe it or not, the French and the Swiss have some ideas that might be relevant. They have something called co-insurance; you are responsible for 20% of your hospital bill in France. So you care how much the bill is because you aren’t just going to pay the first $1000, you pay 20%. I understand for the poor they don’t charge that 20%, and if its an emergency they don’t charge that 20%, but if you have time to shop around they want you to shop around.” [Portsmouth Herald Editoril Board Interview, 11/3/11]

Romney: “Give People A Stake In What The Cost Of Insurance Is Going To Be, What The Cost Of It Is Going To Be. Co-Insurance, Where People Pay A Share Of The Bill, That Makes A Difference.” [Republican Primary Debate, CNN/Tea Party, 9/12/11]

Romney: “I’d Like To See Us Open Doors For Something Like Coinsurance, Not Copay, Coinsurance.” “And I want to get health care to work more like a market. You’re in the insurance business and you’ll appreciate this. For those of you not, hopefully you’ll get my analogy here. Right now health care insurance is a bit like the following: what would happen if they told you, you could have any car you want, you pay a thousand dollars down, a thousand dollar deductible. You put a thousand dollars in and after that it’s free and the salesman tells you that the car gets a commission based on the more you spend. So think of that, you can have whatever car you want for a thousand dollars down, why you’d all be propping Ferraris, Lincolns, Rolls Royce’s. So that’s a bit of what we have in health care. We really don’t have it working like a market with a consumer and a provider have an incentive to keep costs down. I’d like to see us open doors for something like coinsurance, not copay, coinsurance and try some of these ideas on a state by state level.” [Romney Town Hall, Littleton NH, 8/16/11]


Consumers Union Policy Analyst: “Ten Or 20 Percent May Not Sound Like Much, But 20 Percent Of A $100,000 Surgery Is A Lot Of Money.”  “Because of the confusion involving co-pay and co-insurance, many patients don’t realize just how much it may cost them until they become seriously ill or are hospitalized, said Lynn Quincy, a senior policy analyst at Consumers Union. ‘Ten or 20 percent may not sound like much, but 20 percent of a $100,000 surgery is a lot of money,’ she said.” [New York Times Health, 7/9/10]


2008: Average Cost of A Coronary Artery Bypass Surgery Was $232,600 For Women And $155,571 For Men. [Nevada Compare Care, Report 2008]

  • With Romney’s Coinsurance Plan Coronary Artery Bypass Surgery Would Cost The Average American $46,520 - $31,114.

COST FOR A BACK SURGERY = $20,000 - $33,800

The Direct Cost For A Back Surgery Cost From $100,000 To $169,000. “The costs of back surgeries are among the most expensive, and these costs do not include hospitalization, imaging, drugs or medications: ‘Anterior cervical fusion: $44,000 Cervical fusion: $19,850 Decompression back surgery: $24,000 Lumbar laminectomy: $18,000 Lumbar spinal fusion: $34,500’ Deyo found that the mean hospital costs alone for surgical decompression and complex fusions ranged from $23,724 for the former to $80,888 for the latter. When combined with surgical costs, medications, MRIs, rehab, and disability, every spine surgery case approaches $100,000 or more. The direct costs are astronomical and may reach as high as $169,000 for a lumbar fusion, and for a cervical fusion as high as $112,480.” [J.C. Smith MA, DC, Dynamic Chiropractic, 4/9/11]

  • With Romney’s Coinsurance Plan Back Surgery Would Cost The Average American $20,000 - $33,800.


The Annual Cost Dialysis For People With Kidney Disease Reaches To $75,000 To $100,000 Per Patient. “About 400,000 Americans undergo dialysis, with the annual cost of treating end-stage kidney disease sufferers reaching $75,000 to $100,000 per patient, Chertow said. The study was reported today at the American Society of Nephrology meeting in Denver. More sessions may be costlier and inconvenient for patients, and spur companies led by DaVita Inc., the biggest U.S. dialysis provider, and Renal Advantage Inc., to expand.  [Bloomberg, 11/20/10]

  • With Romney’s Coinsurance Plan Dialysis Would Cost The Average American $15,000 - $20,000 Annually.


Cost Of Breast Cancer Treatment Within Two Years Of Diagnosis Ranged From $22,343 To $117,033 Dependant On Local, Regional And Distant Brest Cancers. “Administrative data from the North Carolina Medicaid program linked with cancer registry data were analyzed to derive monthly Medicaid costs for cancer patients and the incremental costs of breast cancer treatment at 6, 12, and 24 months from diagnosis. We compared 848 beneficiaries diagnosed with cancer during the years 2002 to 2004 with 1696 comparison cases matched on age. With the exception of in situ cancers, the cost of cancer care continued to increase beyond the initial 6-month period. The incremental costs at 6 months after diagnosis are $14,341, $24,002, and $34,469 for those with local, regional, and distant breast cancers, respectively; and these costs increased to $22,343, $41,005, and $117,033 at 24 months.” [Subramanian et al, RTI International Study, January 2011]

  • With Romney’s Coinsurance Plan Two Years Of Breast Cancer Treatment Would Cost The Average American $4,468 - $23,406.


“In The 1960s Only The Poor Could Not Afford Coinsurance. Today, Only The Wealthy Can Afford It.” “In the 1960s, only the poor could not afford coinsurance. Today, only the wealthy can afford it. Public discussion of the introduction of coinsurance for tier 4 drugs has centered thus far on the sticker shock experienced by individual patients whose costs for essential treatments have skyrocketed.” [Lee & Emanuel, New England Journal of Medicine, 7/24/08]

Coinsurance Out-Of-Pocket Expenses Usually Far Exceed What Patients Who Rely On The Insurance Can Bear. “‘Coinsurance’ is a different animal. Instead of a fixed amount, patients are charged a percentage — often 20 to 33% — of the overall costs of ‘tier 4’ medications such as biologic agents. Patients who require these drugs are unlucky to begin with, and the out-of-pocket expenses usually far exceed what their budgets can bear.” [Lee & Emanuel, New England Journal of Medicine, 7/24/08]

Health Care Specialist: With Coinsurance “Costs Could Quickly Climb For More Expensive Visits And Procedures.” “One big change, [healthcare specialist in the Stamford, Conn., office of the benefits consulting firm Watson Wyatt, Thomas] Billet says, is that many more employers have changed their coverage so that instead of a co-pay (say, $20 for an office visit) one now has to pay a percentage of the cost (a ‘coinsurance model’). At 20% coinsurance -- a typical rate -- a patient's share of a $150 doctor's office visit would go up to $30 from $20. But costs could quickly climb for more expensive visits and procedures.” [Los Angeles Times, 10/12/09]

A Move To Coinsurance Could Leave People Owing Hundreds Of Dollars The Day Of Their Visit To The Doctor. “A move by a growing number of physicians to ask patients to pay their full share of an office visit (the co-pay, the deductible if still not met, and any coinsurance) on the day of the appointment could catch many consumers by surprise. Say the coinsurance is 20%; an office visit with a $75 strep test could cost an extra $15 on top of a $20 co-pay. It could cost the full $95 if the deductible hasn't been met. Similarly, having a complete physical before a deductible is paid up could make you responsible for hundreds of dollars on the day of the visit.” [Los Angeles Times, 2/2/09]


New York Times: High Co-Insurance And Other Out-Of-Pocket Costs Can Sometimes Discourage Patients From Receiving The Treatment They Need. “High co-insurance and other out-of-pocket costs, including insurance premiums, can sometimes discourage patients from receiving the treatment they need.” [New York Times Health, 7/9/10]

Enirqueta Dickens Saw Her Coinsurance Costs Rise Wildly For Diabetes Check-Ups To $100 Out-Of-Pocket And Decided “She Would Simply Stop Getting Checkups.” “Enriqueta Dickens, 70, a legal immigrant from Honduras, described how she lost a portion of her coverage and saw her coinsurance costs rise wildly for diabetes check-ups: $100, out of pocket, to get her blood tested at a teaching hospital. She had a made a decision that felt coldly rational: She would simply stop getting checkups. `I don't worry about it anymore,' Dickens told the group. `I'm gonna die from something, so . . . ' She threw up her hands.” [Boston Globe, 11/21/10]

Coinsurance And High Deductibles Effectively Serves To Ration Health Care By Income Class. Uwe Reinhardt, Professor of political economy, Princeton University wrote in an op-ed: “Therefore, the solution policymakers will adopt is a wholesale undoing of health insurance through health insurance policies with very high deductibles and coinsurance, which effectively serve to ration health care by income class. It will be fascinating to watch Americans squirm and whine under this new, new thing when it really begins to bite.” [Uwe Reinhardt Op-ed, Chicago Tribune, 9/9/06]


Romney Said He Could Support A Value-Added Tax As A Replacement For Part Of The Tax Code. “Since Mr. Romney mentioned a consumption tax, would he rule out a value-added tax? He says he doesn't ‘like the idea’ of layering a VAT onto the current income tax system. But he adds that, philosophically speaking, a VAT might work as a replacement for some part of the tax code, ‘particularly at the corporate level,’ as Paul Ryan proposed several years ago. What he doesn't do is rule a VAT out.” [Interview, Wall Street Journal Editorial Board, 12/24/11]

Cato Institute’s Daniel J. Mitchell Criticized Romney For Considering A Value-Added Tax, Saying A VAT-Supporter “Should Not Be Allowed Anywhere Near The White House.” Mitchell: “Simply stated, this is an awful tax. If it ever gets implemented in the United States, the battle will be over. America will descend to European-style stagnation, eventually leading to fiscal crisis. Any politician that supports a VAT (or even hints at supporting a VAT) should not be allowed anywhere near the White House. That applies to Mitt Romney.” [Forbes, 12/24/11]

Cato Institute’s Daniel J. Mitchell: “Mitt Romney Won't Rule Out The Possibility Of Imposing A Tax That's The Fast Track To A European Welfare State.” [Mitchell Op-Ed, Wall Street Journal, 1/4/12]

  • Cato Institute’s Daniel J. Mitchell Warned That If Romney, “A VAT Sympathizer,” Wins And Institutes A Value-Added Tax, It Would Be “A Terrible Deal For Taxpayers.” Mitchell: “But what if a VAT sympathizer like Mr. Romney wins next November and decides that his plan for a lower corporate tax rate is only possible if accompanied by a VAT? There will be quite a few Republicans who like that idea because they want to do something nice for their lobbyist friends in the business community. And there will be many Democrats drawn to the plan because they realize that they need this new source of revenue to enable bigger government. That's a win-win deal for politicians and a terrible deal for taxpayers.” [Mitchell Op-Ed, Wall Street Journal, 1/4/12]
  • Cato Institute’s Daniel J. Mitchell Warned Of Romney’s Support For A Value-Added Tax, Saying Some Republicans Would Be Attracted To A Lower Corporate Tax Rate Accompanied By A VAT Because It Would Be “Nice For Their Lobbyist Friends In The Business Community.” Mitchell: “But what if a VAT sympathizer like Mr. Romney wins next November and decides that his plan for a lower corporate tax rate is only possible if accompanied by a VAT? There will be quite a few Republicans who like that idea because they want to do something nice for their lobbyist friends in the business community.” [Mitchell Op-Ed, Wall Street Journal, 1/4/12]
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