Governor Mitt Romney's oratory style is not charismatic.  He does not connect to average people.  This week, the Romney campaign missed an opportunity to attack President Obama after the Supreme Court ruling concerning the individual mandate.  He finally called the mandate a tax.  This misstep is a concern about his campaign.

Romney's campaign should reassess the effectiveness of subordinates and surrogates.  How can Governor Romney, who signed the 2006 Massachusetts Health Care Reform law, explain the differences between his 70-page law and the 2,700-page bill from Washington?  The governor and his advisors must distinguish the two laws from each other in a simple and consistent way.  Romney has to reach people without the media's help.  The electorate grows weary of the health care reform fight, and the press turns to other issues.  Still, one third of the people do not understand how the Court ruled.  Romney must communicate without the enthusiastic support of many conservatives who distrust him.  Romney needs to attack each issue with a simple, memorable slogan and not allow opponents to define him.

Governor Romney disappoints supporters because of his modesty.  His biography is compelling.  His family would be a model in any storybook tale.  His success in business; his tenure as governor in liberal Massachusetts, as the head of the 2002 Salt Lake City Olympic Games, and as a philanthropic supporter of the Mormon Church; his stint as a Mormon missionary in France; and his support of his wife Ann during her health battles demonstrate his skills at navigating difficult conditions.  During the primaries, he showed personal resolve to win the nomination of the Republican Party.  Romney has demonstrated an ability to raise campaign funds, and he may raise more money than President Obama -- a first against an incumbent.  Yet he allows the Obama campaign to create his public narrative by labeling him a job-exporter while at Bain Capital, a wealthy person who does not pay his fair share of taxes, aloof and out of touch.

In light of the health care laws Governor Romney and President Obama signed, Romney has allowed others to equate his plan to Obama.  There are differences between the federal and state laws.  Romney should distinguish Massachusetts' law from the national law.  Likewise, he should provide a concise explanation of his national plan.  His plan is rooted in capitalism.  Opponents favor the federally regulated program with its "one size fits all states" approach.  The president has stated that he seeks a single-payer system.  Federalism allows the states to be the theaters for political experimentation.  The mandate is popular in liberal Massachusetts.  The president enunciates his ideas regardless of consensus.

RomneyCare was structured to limit regulations and tangential taxes, and to solve problems in the health care delivery system created by numerous and contradictory federal laws.  The state law has resulted in significant improvements: emergency room visits are down over 4%; more employees receive health insurance (68% compared  to 64% previously); there has been an increase in doctor visits and dental treatment ; 400,000 additional citizens have been covered by health insurance (amounting to 98% of the state's population); there has been an increase in cancer screenings, a decrease of 150,000 smokers, and an increase in prenatal care; and there has been a significant drop (67,000 in 2007 compared to 44,000 in 2010) in the number of mandate-required penalty assessments on state tax returns  as additional residents have secured health insurance.  The governor can state that Massachusetts' experiment has had successes.  There are concerns, as cost increases to the state are about $100 million per year.  The legislature recently reduced health care costs by up to $150 million.  The Massachusetts law depends upon securing additional federal money through increased Medicaid funding.  This works well for this state, but an expansion throughout the country will threaten the federal coffers. 

Similarities exist between the two laws:  the individual mandate with tax penalties for those who do not purchase insurance, an employer mandate (which Romney vetoed along with seven other provisions, but he was overridden by the Democratic-controlled legislature), medical review panels, insurance exchanges,  coverage through parents for those up to age 26 (though RomneyCare allows two years), elimination of pre-existing conditions (though RomneyCare allows a six-month exception), increased preventive care requirements, contraceptive coverage, subsidies offered to increase participation, elimination of caps on coverage, and the creation of online insurance premium comparison.  The provisions to end pre-existing condition limits and insurance to age 26 under family coverage are popular nationally.

The Patient Protection and Affordable Care Act of 2010,by its size and reach, cannot be mistaken for RomneyCare.  The two laws differ in subtle and nuanced ways: Romney wanted a private-oriented solution to encourage participation, control costs, and improve services.  The federal law will force participation in a federal system when insurance plans change or do not follow federal regulations.  ObamaCare adds many new taxes, while RomneyCare did not.  The bill in Massachusetts was bipartisan and popular, unlike the federal bill.  RomneyCare was openly debated for months, while the federal bill was passed without transparency.  Questionable procedures were employed after the election of Senator Brown.  The federal bill grants great authority to the secretary of health and human services, which threatens the people's due process rights.  The state law set minimal standards for coverage, while the federal system details coverage.  The state system consolidated other laws and reduced regulations, while the federal system increased rules.

Governor Romney inherited a state in debt.  He balanced the budget and improved the state's fiscal health before the plan was enacted.  In contrast, the federal debt grows, and health care reform will exacerbate this problem.  Medicare reductions in the federal bill total $500 billion over ten years and are controlled by the Independent Payment Advisory Board. 

Over 20 tax increases in the federal law include: a surcharge of 3.8% on investment incomes for wealthier household, a surcharge on higher Medicare wages, a tax penalty on individuals and employers without health insurance, excise tax on insurance companies, excise tax on Cadillac insurance plans, tax on certain bio-fuels, tax on innovative drug companies, tax on medical device manufacturers, increases the floor on medical deductions to 10%, reduces use of Flexible Spending Accounts, reduces Health Savings Account usage and increase penalties on over usage, taxes employer help with Medicare Part D (drug), tax on tanning salons, penalties for high income executives, penalties to the Blue Cross/Blue Shield companies, taxes on charitable hospitals that fail certain tests, and impose reporting by employers and individuals regarding health insurance.  The total is between $500-750 billion over ten years.  This law is the largest tax increase in history and will affect the middle class in contrast to the president's promises.

It is not enough for Romney to say he will repeal ObamaCare.  He must articulate a positive alternative that provides greater individual freedom to choose care while controlling costs.  He has to communicate a plan that will allay fears that a devastating illness will bankrupt middle-class families.  His plan for federal reform includes block-granting Medicaid to the states, minimizing federal regulations upon insurers and states, increasing flexibility for patients, encouraging insurance pools for expand risk and reduce premiums, preventing discrimination against those with pre-existing conditions, allowing individuals greater use of Health Savings Accounts, allowing insurance purchases across state lines, providing tax benefits for individual purchase of health insurance, and reducing litigation to resolve disputes.  He has yet to provide a concise and aplan for affordable health care that citizens can rally around.