LEBANON -- Republican presidential hopeful Mitt Romney said Thursday he believes the nation eventually will adopt mandatory health insurance similar to reforms he signed into law as governor of Massachusetts.
"I can't guarantee my state will get it right every single step, but one state out there is going to get it right, and when we see it's working in one of the states, we'll be able to adopt it nationally," he told health professionals at Dartmouth-Hitchcock Medical Center.
A new law in Massachusetts requires all uninsured residents with incomes more than three times the federal poverty level to buy private insurance by July 1 or face tax penalties. Those making less have access to state-subsidized plans or free care.
Romney, who left office last month after not seeking re-election, said the mandates will eliminate what he calls the "doom-loop of bad behavior incentivizing other bad behavior": people without insurance waiting until they have a medical crisis before seeking expensive hospital care, driving up the cost for everyone else.
"I know there may be some who think a single-payer system is the way to go -- let the government pay for this -- but our experience as a nation has been that free enterprise and the free market can work to get better quality and better cost management," he said.
"If you have government take over health care, they're going to find that it's very expensive," he said. "They're going to start rationing and saying you really don't need an MRI for certain conditions."
The Massachusetts Association of Health Plans estimates 200,000 Massachusetts residents who already have health insurance through the state's five largest insurers would be forced to buy additional coverage to meet the proposed minimum standards under the law.
Those standards still are under review by a state board, which postponed its decision last week because of concern about of the basic plans, an average of $380 a month, nearly twice the amount Romney cited before signing the law.
Romney acknowledged the law isn't perfect but said it is better than the alternatives.
"Let's get everyone in the system," he said. "We'll make all sorts of mistakes, we'll see all sorts of things that don't work as we planned and then we'll make adjustments. In the private sector, you do that all the time."
He answered a question about whether the voices of frail, elderly Americans would get lost in a consumer-and employer-driven system by explaining efforts in Massachusetts to expand at-home care for the elderly.
While at-home care costs less than nursing home care in the short term, Romney said, it adds to overall costs because the elderly live longer if they can remain at home. In that case, higher costs make sense, he said.
"What Americans want to see is that we're not wasting money," he said. "We're not putting people in settings where they don't get good care."
Dr. Ira Byock, who asked the question, said later he found Romney's answer "thoughtful and substantive," and that he plans to ask all the candidates about what he calls a public health crisis surrounding the way Americans are cared for as they age and die.
Byock, director of palliative medicine at Dartmouth-Hitchcock, is leading an initiative called "Reclaiming the End," which seeks to use the New Hampshire primary to focus attention on the issue. Members will hold forums around the state, distribute questionnaires to candidates and question them at public appearances.
The group won't endorse a candidate, and Byock declined to comment on his own political leanings.
"I'm an issue-orientated guy," he said. "This is one crisis that is really affecting virtually every American family."
Meanwhile, Romney named former Missouri Sen. Jim Talent, a Republican who narrowly lost his bid for re-election last year, to serve as domestic policy task force chairman for Romney's presidential exploratory committee.
Romney is among 10 Republicans seeking their party's presidential nomination for 2008.
Along with Sen. John McCain of Arizona and former New York City Mayor Rudy Giuliani, he is one of the best-known and best-funded.