If you are blessed, or cursed, with a certain kind of sense of humor, the current health care debate offers a rich field for laughs, if only of the sardonic kind. First up is the spectacle of House Freshman Republicans, many of whom owe their seats to the party’s relentless demagoguery on Medicare, whining about the drubbing they’ve been taking from their constituents over the vote they took to undermine Medicare and Medicaid.

But my favorite is the amazing tap dancing of former Governor Mitt Romney as he tried yet again to have it both ways on health care reform in Massachusetts. In his USA Today op-ed and his speech in Michigan, Mr. Romney basically offered up a strange amalgamation of a defense of the Massachusetts law coupled with a rehash of old ideas for national reform that have been analyzed in the past and found to be ineffective and inadequate to address the problems he correctly identifies (the high number of uninsured, high cost and uneven quality).

As for the specifics of the “new” Romney plan: He offers no evidence that the state flexibility he touts will address the problems he identifies. If you look at what states have done (and not done) with their Medicaid programs, you have to conclude that, absent some incentives or requirements to do so, states will not solve these problems on their own. President Obama has already come out in favor of state flexibility as long as states can meet certain minimum benchmarks for the quality of health plans and for reaching the uninsured. Mr. Romney appears to be embracing the idea of state flexibility without any accountability for actually achieving results.

He relies on innuendo and unsupported allegations — e.g. the ACA will harm US economy; the big federal bogey man will get your health care — but he doesn’t actually make an argument or provide evidence to back up his allegations.

Mr. Romney claims he will address the problem of the uninsured with no new taxes, but he also proposes several new federal tax expenditures (which will not be enough to make a real dent in problem of uninsured) with no offset in savings or revenue (unless he is proposing to take it out of the hide of the states with the Medicaid block grant).

He embraces Medicaid block grants that have been shown to shift costs to states and leave them without the resources to maintain current coverage levels, let alone expand coverage.

Romney offers only tepid insurance reforms. For example, insurers couldn’t deny coverage based on pre-existing condition, but he doesn’t say whether they could charge you more based on health status.

He also embraces the sale of insurance across state lines which would produce a race to the bottom that undermines coverage for those who need it most. It would also enormously complicate the job of state regulators who want to provide basic protections, such as requiring insurers to meet reserve requirements, let alone enforce patient rights and quality standards.

Mr. Romney repeats the standard Republican talking point about liability reform. Impartial analysts have concluded that malpractice reform offers a modest opportunity for cost containment but also limits people’s ability to get redress for injuries. Since most wrongfully injured patients are never compensated in any way, any fair malpractice reform proposal would have to address this problem as well.

And of course there are the usual paeans to making health function more like a “normal market.” Never mind that there are so many market failures in health care and they are so fundamental, (Do you really want the same legal and ethical relationship with your doctor that you have with the guy who sells you shoes? No offense meant to shoe salesmen.) that the attempt to make health care more of a market a.) is bound to fail and b.) will have all kinds of negative consequences along the way. Thoughtful people have concluded that in order to make competition work in health care you actually need a very active role for government (e.g. Health Insurance Exchanges, subsidies, universal coverage, etc.).

No matter. It appears that Mr. Romney has concluded that this is what potential donors and Republican primary voters want to hear. He seems to be working overtime NOT to distinguish himself on health care and to repudiate any claim he might justifiably make to leadership on the issue. But judging by the reactions of a number of conservative media outlets and think tanks, it’s not clear that the effort will be successful. If things don’t work out, there is no need to worry. Mr. Romney can always take his tap-dancing act to Dancing with the Stars.

— Michael Miller, Policy Director