Rick Santorum calls Massachusetts health law top-down and government-run

It’s like a new cover of an old song.

During a Republican primary debate on Jan. 26, 2012, Rick Santorum said that the health care legislation Mitt Romney signed as governor of Massachusetts is "a top-down, government-run health care system."

The former Pennsylvania senator called the issue one of "fundamental freedom" and criticized Romney for enacting a law similar to the one that passed nationally in 2010.

And the beat goes on.

PolitiFact has explored the Massachusetts health program extensively, considering its similarities to the federal law and examining what role the government really plays in it.

Here are a few important points:

• Individual mandate to buy health insurance. Everyone in Massachusetts must purchase health insurance or pay a penalty.
   
• Employer responsibilities for offering health insurance. Companies with more than 10 employees must offer health insurance or pay a penalty.
   
• Health insurance exchanges. The plan involves the use of voluntary "exchanges" through which individuals and small businesses may purchase private-sector health insurance. These exchanges are designed to offer a range of plans with different benefits and premium levels.
   
• Affordability subsidies. Lower-income individuals and families receive government subsidies to help pay their health insurance premiums. Subsidies are allotted on a sliding scale up to 300 percent of the federal poverty level.
   
• Expansion of Medicaid. The plan expands Medicaid to all children whose families earn up to 300 percent of the federal poverty level.
   
• Insurance market regulation. In Massachusetts, dependents up to age 25 may be covered on their parents' plan.
   
We think Santorum’s use of the label "top-down" reflects his political opposition to both the Massachusetts plan and the national plan modeled after it. Given that opposition, a person could consider an individual mandate a "top-down" approach to health care, although others would disagree.

But "government-run?" That characterization is simply wrong.

We asked Jonathan Oberlander, a professor of health policy at the University of North Carolina-Chapel Hill, to explain:

"The Massachusetts plan leaves private health insurance intact, and under the Massachusetts plan, health care delivery remains predominantly in private hands, as it was before the law was enacted," he wrote in an email.

"The role of government is expanded, but that is not the same as saying the government ‘runs’ the health system. The Massachusetts plan expanded Medicaid, but at the same time it expanded uninsured residents’ access to private insurance (through subsidies to buy coverage and the connector)."

What does an actual government-run system look like? Oberlander pointed to the truly socialized system of Great Britain -- as well as to one in our own backyard.

"The Massachusetts plan ... looks NOTHING like a true ‘government-run health care system...  the VA’s health system where the government owns the hospitals and employs doctors directly," he said.

Our ruling

Santorum called Romney’s health law "a top-down, government-run health care system."

  The individual mandate and the requirement that employers offer health insurance might be considered top-down, though it is still a system that relies heavily on private insurance and private medical providers. But there’s no case to for calling it "government-run."  A real government-run system has doctors on the payroll. Massachusetts does not. We rate Santorum’s claim Mostly False.

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