HH: As promised, now for a conversation with Ryan Lizza, senior political editor for the New Yorker. His latest article in the current edition of the New Yorker is titled Romney’s Dilemma. I’ve linked it at Hughhewitt.com. You have to pay for it, though, if you want this one. They stuck this one behind the paywall in part. Ryan Lizza, welcome back to the Hugh Hewitt Show.
RL: Hey, thank you, Hugh, for having me. It’s always a pleasure.
HH: It’s always a pleasure. How do they decide when to put one behind the paywall for people like me, and how to, when to make it available for everyone?
RL: I know. It’s sometimes frustrating as a writer, but we basically do one piece from the New Yorker every week for free, and the rest of it, our model is, you’ve got to pay for it. And you know, frankly, it’s a pretty good magazine, so I would encourage your listeners to go and try it out for a little bit, and they might like it.
HH: Actually, I think it’s the, the annual subscription is paid for by the cartoons themselves, and the you throw in Ryan.
RL: (laughing) And we have a great deal. You can read it on you iPad or your other tablet, all for one subscription. So anyway, as you know, a lot of organizations are going through this…are people online going to pay for content or not? And we basically decided that yeah, what we’re doing is worth money, and you’ve got to pay for it.
HH: Now last time you were on, I loved the article you wrote about Obama’s foreign policy, and agreed with much of it. This time, I have some disagreements.
RL: Good. Now that’s better. That’s much more fun.
HH: But let’s start, however, with how did you and the Globe arrive at the same place at the same time, because Brian Mooney over at the Globe…
RL: I know.
HH: …on the same day comes out with a big piece on Romneycare.
RL: Yeah, I don’t know if they got wind of the fact that we were doing it at the same time, and decided to publish yesterday or not. I did know he was working on that piece, to be honest. This piece is not, I’m not, obviously this isn’t the most original idea in the world, right? This is the main question before Mitt Romney, is what he thought, his process for deciding on that health care law, which really was his biggest piece of legislation when he was governor. I doubt that the Globe and the New Yorker will be the last organization to delve into this. To me, it’s the question about his candidacy.
HH: It’s certainly in interesting one. I covered it extensively, and I wrote the book on Romney…
RL: And I read your book about it, and in fact, and I think in an early draft, I may have even quoted from your book. It got cut in the end, but that’s why I want to ask you. I want to know what you think about this.
HH: Well, let’s start with your conclusions.
RL: Because you were very positive in your book about this law.
HH: I am. And I remain very positive about it.
HH: That’s why I want to round a few specifics with you. But I want to start with the reporting.
HH: And the meat of the reporting is you come down to the greatest likenesses and the greatest differences between Massachusettscare and Obamacare. What are the greatest differences, Ryan Lizza?
RL: Well look, the biggest difference, there are some pretty serious differences, right? A national law and a state law couldn’t possibly be identical, right? And for one, Massachusetts did not, had no intention of doing anything about costs, right? It was strictly a coverage bill. It was a bill to expand coverage, whereas the national law, frankly, Obama did a couple of things. He’s got this IPAB board set up that can make recommendations to Congress that’s difficult for Congress to ignore, to cut costs. He did some things on taxes and a few other things to get costs under control. That’s a pretty big difference. And as you know in Massachusetts, one of the big criticisms of the law now is that premiums are going up and costs are going up. When Romney started, health care was about 30% of the budget in Massachusetts. Now, it’s 35%. So cost control, I think, is a big difference. And we’ll see if the Obama cost controls actually work. There are plenty of people who are critical of those. Two, very unique situation in Massachusetts, the way that Romney was able to pay for this, they had this huge chunk of federal money that is the result, I don’t know how much you know about this…
RL: They had this huge chunk of federal money that is essentially the result of a backroom deal between Ted Kennedy and the Clinton administration in 1997. They were getting this money to give to hospitals who were, that was basically for uncompensated care. So when people showed up in the emergency room and couldn’t pay their bills, the state of Massachusetts had a big chunk of money to pay the hospitals to take care of those people. And that money was basically turned into a fund to help fund the Massachusetts law. So Romney didn’t have to really raise taxes to fund this thing, because he had this big pile of money from the federal government. The funding mechanism, of course, in the Obamacare is totally different. He uses some savings from Medicare, and there’s some new taxes in the law to pay for it. That’s another big, big difference.
HH: Yeah, those two are significant. Now let’s go to the similarities. When you were finished at the end of the article, Ryan Lizza, what do you say is the biggest similarity between MassCare and Obamacare?
RL: Well look, the architecture of the bills, the mechanism by which you expand insurance in both Massachusetts and nationally is the same. And it’s the three-legged stool – subsidies for people who can’t afford to buy insurance on the private markets, you help them out, a mandate, so everyone has to buy insurance, and that way you get the sick and the healthy people in the same pool, so hopefully you keep premiums a little bit lower, and you get more people insured, of course, and these exchanges, basically a health insurance exchange, so you can have buyers and sellers, kind of like e-Bay or Carmax is what the Heritage Foundation compared it to when they were coming up with this policy back in the early 90s. So you have a sort of well-regulated, efficient market. Another comparison is to a stock market, right? So everyone can, so you can help individuals find their own health insurance. So mandates, exchange, subsidies, those three things that were essentially invented in Massachusetts, get adopted nationally.
HH: Now my biggest argument with you, Ryan, is that you’re rather dismissive of the federalism argument.
HH: Now I gave a speech to the Federalist Society in January, I believe, out here at their western convention, about how absolutely vital this is, how crucial it is that conservatives defend the necessity of state innovation as opposed to federal prescription, and how unconstitutional as really a bedrock issue, that Obamacare is unconstitutional, Massachusetts Care is Constitutional.
HH: But you just sweep that aside, and I actually think it’s going to drive the undervote. You folks are expecting Romneycare to drive a lot of the Republican primaries. But a lot of Republican voters, not all, but many, not the libertarian Cato types…
HH: But many simply say yeah, federalism matters.
RL: No, I agree with that, but what is the point of the laboratories of democracy if not to try things out at the state level? If they look like they work, then perhaps try them nationally. I mean, so this is a perfect example of the laboratory of democracy working in Massachusetts. Now you could argue hey, you know what, we should have let a few more years go by before we tried this big experiment nationally, and I certainly could respect that. But I don’t see why, and if your federalism argument, unless you’re talking about the Commerce Clause, why can’t something that works on the national level, excuse me, on the state level be used nationally?
HH: Well, there are lots of reasons. The key is that it’s unconstitutional. I am talking about the Commerce Clause, that if you can in fact do an individual mandate, the Commerce Clause, among we Con Law scholars, just has no limit…
HH: …at which point you can mandate anything. And so it’s an evisceration of the distinction between local and state government.
RL: And you know, you’ve seen this, some courts have weighed in on this.
HH: Yup, yup.
RL: And so far, the balance of the opinions is on the side that this is Constitutional.
HH: It’s up to Anthony Kennedy. It’s going to be a 5-4 debate, and very well analyzed, I think, by the attorney general of Virginia, and it comes down to Anthony Kennedy. He’s confident, I’m not. But I know that for conservatives, it matters.
RL: But the other thing about that is the mandate is, it is important, right? It’s sort of the glue that keeps the law together? But there are some smart policy folks out there that have already come up with ways around the mandate.
HH: Yeah, but I want to go back to the Romney vision of it.
RL: Yeah, the one he proposed. We should talk to your, I’m going to write about this on our website, because I didn’t get it into the piece, but it is an interesting distinction.
HH: And the second one is that you wrote at one point that it’s not entirely unreasonable to praise Massachusetts Care while bashing Obamacare…
HH: …but that Romney’s argument became strained when he asserted that, “individual mandate is the ideal solution at the state level, but tyrannical at the federal level.” Now I spent a lot of time talking to him in ’06, and subsequent, have covered it very extensively. He’s never said it’s the ideal solution. He’s always said what worked in Massachusetts, and he’s always been quick to point out that for states like mine, California, or Texas, with large undocumented populations, where the numbers of uninsured are so much larger, that it might not ever work there. So I think ideal is not fair to Romney.
RL: Well, he certainly thought it was ideal in Massachusetts, and fought very hard for it.
HH: Big difference, though.
RL: But as you know, in Massachusetts, the left wing of this debate was the employer mandate, the right wing of this debate was the individual mandate. And he was the one that had to convince Ted Kennedy to come out with it. Now what you’re saying is that he’s argued that in some states, it’s not ideal?
HH: Well, I’m saying that the Obama people, and there’s a little echo of this in your piece, are out there trying to pin Obamacare on Romney, when Romney campaigned against Obamacare. And one of the reasons is an individual mandate is A) unconstitutional, and second, it doesn’t work with large populations of uninsured, so that it’s far from the ideal that he stood against.
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HH: Before we go back to the meat, Ryan Lizza, I’ve got to tell you my one, I’ve got one twitch here. I like Jon Gruber a lot. He’s been a guest on this show, he’s the friend of some very good friends of mine, he’s very highly esteemed on the left. But not just you, but the Globe, and lots of other reports hold him out as something of an architect of Massachusetts Care and advisor to Romney. My notes indicate, and everything I’ve seen, he met with Romney exactly once in a huge meeting of, like, 20 people. And he’s just not a player in this.
RL: Now I was very careful, and I know the Romney people are very sensitive about Gruber. But I was very careful in how I described him in the piece. But it doesn’t matter how many times he met with Romney. What’s important is that he was the guy hired to do the economic modeling for this plan. And the information, the data that he was feeding through Tim Murphy and Amy Lischko, and Obama’s top policy aides, was crucial in getting Mitt Romney, and convincing Mitt Romney of the case for the individual mandate. So it doesn’t matter. Nobody’s saying that he sat around with Mitt Romney and talked to him, but he was the economist. He built the model. And if you go and look at the Faneuil Hall signing ceremony, where Mitt Romney signs this legislation, he only thanks a bunch of people. One of the people he thanks, by name at the signing ceremony, is Jon Gruber.
HH: Oh, I agree with all that. And he was appointed to the Connector Authority as the health care economist.
RL: And…exactly. Exactly.
HH: Absolutely true. But there’s always this temptation that because someone was standing around at the scene of the car wreck,…
HH: …or as someone was standing around when the kid was saved from the drowning, that they are either the villain or the hero. In fact, Gruber played a somewhat minor role modeling some data, had nothing to do with the policy debates, wasn’t in the politics. And yet because he’s a lefty, he’s quoted not just by you, but by lots of people as an authority.
RL: No, I think you’re wrong. But I think you’re wrong about saying just provided the data. It wasn’t just the data. He provided the economic model that showed if you do it with a mandate, it will cost this much, and you’ll insure this many people. If you don’t, it will cost this much, and you’ll insure this many people.
HH: That to me, Ryan, is just data. But when he shows up and says Romney birthed Obamacare, that’s a left-wing ideologue smuggling his view of the world and his support for Obama into your article.
RL: Here’s my view of this. Romney, like as you were saying before the break, right? I think you can make a principled case for what Romney did in Massachusetts, and against a national law. There’s always going to be enough differences where you could say I don’t like this part or that part. And I think it’s easy enough for conservatives to do that. I disagree, I think as I say in the piece, I think Romney picking out the mandate of all the things is not his strongest argument. But fine, let’s give him that. He thinks he’s got this federalism argument, and he thinks that’s enough. The truth is, none of that matters, Hugh. What matters is not really that Romney took this plan and went and met with Obama and said this is how you do it. But without Romney doing what he did in Massachusetts, we wouldn’t have had the law at the national level, because Jon Gruber and Ted Kennedy, and Kingsdale, who Romney appointed to the exchange to run the implementation process, and all the people who worked on Romneycare, exported their advice and expertise, and came to Washington, and said you know what, guys? We just did this really cool thing in Massachusetts, and you can do it nationally. And that’s really the legacy that Romney cannot live down.
HH: Actually, I couldn’t disagree with you more.
HH: And people will say that’s because I’m a Romney advocate. But I think it is simply this argument, is that what happened in Massachusetts was the product of divided government, a compromise between a center-right governor and advisors, and a left-wing legislature. Obamacare was a one-party solution. They have very little in common in their legitimacy in their expansiveness…
RL: The process. The process was very different.
HH: Everything is different about it. One is a giant assault on American liberty, another is a rather modest state innovation in coverage dynamics for a population of 450,000. That’s what…
RL: But wait, let me stop you there, because you do hear this argument a lot. But what is the attack on liberty that exists at the national level but not the state level?
HH: It’s the unleashing of the federal government to mandate anything. The federal government has always been circumscribed, at least since the Commerce Clause was given new life by the Rehnquist Court, in a time of urgent necessity to keep them from doing things and destroying the states.
RL: But if I’m a resident of Massachusetts, why do I care about that distinction? My liberty has been curtailed severely by the state of Massachusetts. It doesn’t matter whether the federal government did it or the state government.
HH: Because the social compact is that if you’re closer to the state government, you can much more easily impact how they will be deciding things, and that states mandate all sorts of things. For example, states mandate that you attend public education, private education, or be home schooled. If the federal government got into the business of mandating education, and how it would look, that would be, wouldn’t you agree, Ryan, an enormous assault on liberty?
RL: I just don’t see from the average Massachusetts citizen how you can argue if the mandate itself is the attack on liberty here, I don’t see how, and if that’s, and that’s a fair enough argument if you believe that, but I don’t see then how you can then maintain the distinction that the Massachusetts law itself is okay, and is not an attack on liberty, while the national law is.
HH: Because well-ordered liberty depends upon divided government, especially on federalism, and that if you weaken the states, you are weakening the central undergirding pillar of the entire system.
RL: But wait. But I thought…
HH: I mean, this is Federalist 10.
RL: But I thought the attack itself is the mandate, is the fact that you’re being forced to buy insurance.
HH: No, the attack is that the federal government is taking over the role of the states, and the states divide power with the federal government so they contend equally for the affection and domination of the citizen. That’s, I mean, this is classic political theory, and I think it’s deeply understood by conservatives, and especially the Tea Party, and that’s why, I think, that people are vastly overestimating the kind of political problem that Massachusetts Care is for Romney.
RL: All right, well let me ask you this, because you are a historian of the conservative movement. How did this issue, how did this issue go from the Heritage Foundation in 1990 to the Republicans, like Chafee in 1993 proposing it as the principal alternative to Hillarycare, to Romney doing a state version of it?
HH: That, let me answer, you know, it was very interesting to me in your piece. I did not know about the Chafee innovation. It was simply not on my radar, so that was news to me. But individual mandates have always been a rather conservative view. I saw that you reported accurately that people think at the state level if you drive, you should have insurance, and you ought not to export external costs, and there should not be free riders in a society.
HH: So except for the Cato people…
HH: And they’ve hated it forever.
RL: They attacked Romneycare from Day One.
HH: Yeah, they’ve hated it forever. I don’t see, in fact, during all the Republican debates in 2008, Ryan, do you know that no one ever, not once, did they attack Romney for the mandate?
RL: Exactly. So what has changed since then is what I’m asking you.
HH: Only the liberal media and the Obama team’s decision to try and knock Romney out of the game early by attempting to conflate Obamacare with Massachusettscare.
RL: I see. I disagree. I think what has changed is that Barack Obama adopted the individual mandate as his own, and then it became something that had to be opposed. And frankly, Hugh, if you go back to 2009, what was the principal conservative argument against Obama’s plan? It wasn’t always the mandate. It was the public option.
HH: No, there were many things. Public option was…I did this every day for three hours a day.
RL: But that was the main bogeyman. Come on.
HH: No, I know this thing cold. It was the individual mandate, it was the vast cost, it was cutting seniors by a half trillion dollars, and attempting to take away Medicare Advantage, it was the refusal to adopt tort reform, it was the refusal to adopt an interstate market insurance, it was the massive expansion of government.
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HH: Ryan, let me return to something that I want to stress a little bit, which is that what you call an employer mandate, which is the $295 dollar per employee of businesses of 11 employees or larger who do not insure their workforce, when I did this reporting, that was, A) Romney opposed it and vetoed it…
RL: Yeah, he opposed it. Absolutely.
HH: It ticked off everyone. Number two, it was designed to equalize the treatment between employers who did provide insurance and had to pay a fee, and employers who didn’t provide insurance and had to pay a fee. So it’s got, it’s not really an employer mandate at all. And in fact, Romney, he was against, this whole law came out of opposition to Dukakiscare.
RL: Oh, absolutely. And look, this was in a sense a victory for Romney in the legislative process, because the debate became the employer mandate versus the individual mandate, and Romney made it clear that he was not going to support an individual mandate, or excuse me, an employer mandate. And the employer mandate the Democrats wanted was much, much higher, and it said the employer mandate becomes this $295 dollar fee. And as you said, he vetoes it and it gets overridden. The breakthrough was Romney, working through this sort of, some influential businesspeople in Massachusetts, basically told the Democrats you guys have to get this bill into a spending bill, into an appropriations bill, because in Massachusetts, an appropriations bill, the governor then has a line item veto, and he can veto individual parts of it. So the deal was you’ve got to get that employer mandate, it has to be turned into something else, and it has to be turned into something that is very, very low. And $295 an employee was pretty low. And then you have to get it into some kind of bill where I can exercise a line item veto.
HH: And the reason I bring it up…
RL: That was essentially the compromise that broke this long logjam.
HH: But the reason I bring it up, the huge contrast between Dukakis, who wanted to hit every employer for $1,680 bucks per employee uninsured, versus the Massachusettscare, which ended up hitting for 11 people firms and larger, a $295 employee fee, is that the best narrative for Romney, I don’t know if he can sell this, is what I thought had happened, which was Dukakis was really the father of Obamacare. He pushed the big government solution, the one payer solution, the universal care solution. Romney and his team built and off-ramp, which was a mandate of individual purchase of insurance, and only that, no cost cutting, no single payer, nothing. That off-ramp, had it been followed in D.C. and other states, would have prevented the leviathan which was Dukakis, which became Obamacare. Your narrative is that he built a bridge to Obamacare. Mine is he built an off-ramp that the election of 2008 negated. And that’s, I think that’s the big difference, Ryan Lizza.
RL: I completely disagree. He, the bridge he built was subsidies, mandates, insurance exchange, and that is the core of Title 1 of the ACA.
HH: No, again, he built it in a state that impacted, this sounds like a debate, but I want to go to the other piece in the Boston Globe, a total of 460,000 Massachusetts residents did not have insurance. So this law was really about those 460,000, 106,000 of whom were already eligible for Medicaid.
RL: Look, I think what…look, I don’t know, maybe the point of agreement here is, and maybe I’m even optimistic about this, but I think what happened was that, and look, the Wall Street Journal said this from day one when they attacked this law, and some other conservatives said it. Romney unleashed forces that he could not control. Now if you look at what Ted Kennedy said on the day that that bill was signed, everyone on that day in Faneuil Hall in Boston was talking about, and joking about how this bill was going to help Mitt Romney in his presidential campaign, and joking about how a campaign was taking off and flying high. And Kennedy kind of ignored all that. And if you read his remarks really closely, what he was saying is I am now going to take what we just did in Massachusetts, and I’m going to bring it to Washington and do this for the rest of the country. And whether Romney wanted, whether Romney likes it or not, that was the effect of what happened in Massachusetts.
HH: But you know, where I have trouble with that, Ryan, is that of course, I wrote my book in ’07…
HH: …before Obama rises, and before Obamacare comes along. So my narrative is rooted in the time, and not in the reconstruction of events.
HH: My narrative was this was the off-ramp. Every Republican loved it. It didn’t get challenged on the debate trail, and indeed, the federalism thing was in fact a feather in his cap, but the campaign wasn’t about health care, but that the narrative has been captured by Obama, who needs to offload blame for this enormously devastating leviathan. And I mean, let’s talk about…
RL: Look, I think what we can agree on is this is a story of unintended consequences. And one of the unintended consequences of what Romney did in Massachusetts is that the very people that were involved in that, Gruber, Kennedy, Kingsdale, they went to Washington and pointed to this, and said this is how you do it.
HH: When we come back from break, we’ll talk about the unintended consequence being about arming the media to tell that story, with the assistance of people like Gruber.
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HH: A couple of stipulations, though, Ryan. Masscare did not cut any benefits, right? Unlike Obamacare which slashed senior care on Medicare, Romneycare did nothing of the sort.
RL: Oh, Romney, in fact, expanded Medicaid so more people would become eligible for it.
HH: Secondly, and I think this is crucial. One of my favorite writers on health care is Gawande, Dr. Gawande, who writes for the New Yorker. He talks about pathway development of health care systems. You noted that when Romneycare came in, Massachusetts was spending about 30% of its budget on health care. It’s now up to 35% of its budget. What would it have been had Romneycare not passed? That’s the key question.
RL: That’s a very good question, and that’s the thing we can’t answer, just like we can’t answer, a lot of people are attacking what he did in Massachusetts as a broken system and not working, and they’re pointing to increases in premiums. And my response to that is the same one. What’s happening in other states where they don’t have this? You’re also seeing increases in premiums. And what would have happened if this law didn’t go into effect? So I think we agree. Do you agree that in Massachusetts, the law was, is generally a success?
HH: Oh, yes. In fact, the more I read about it, the more I think that it will be, if Romney is the nominee, a great asset to him, because he’ll be able to argue that Obamacare was a needless tragedy and wrecking of a system that could have been improved on. But I also think that…
RL: I don’t necessarily disagree with that. I think you’re right. These things, just as this was once an asset for him, it could one day again be an asset for him.
HH: And what’s interesting is Deval Patrick. Now Deval’s a classmate of mine. I don’t like to be too hard on him. He’s the only Democrat I ever contributed money to in my life, and so I have to own that before this audience. But Deval took that money that was supposed to subsidize health care, and reduced the cost. He continued to spend it on the hospital. He still has a half billion dollar slush fund sitting there, Ryan.
RL: Yeah, now I hope I got this right, but my understanding is that at the very end of the legislative process, there was, I’ve got to check this, but Romney might get some blame for this, because my understanding was that at the end of the legislative process, people that wanted to protect those hospitals did add some funding for the hospitals through the back end.
HH: Yeah, through Deval Patrick. And they just…
RL: No, but I thought it was at the end of the Romneycare legislative process?
HH: If my understanding’s right, it was supposed to be spent to zero over the course of three years, and that it’s been maintained, and they kept it up.
RL: They kept it up.
HH: And that’s why health care’s gone from 30 to 35% in part, is because he’s not used the money available to him to reduce…he continues to spend money on hospitals that were supposed to get out of the business of subsidy once the individual mandate came in.
RL: Well, I mean, this is one of the ways in which Massachusetts is very unique, right?
RL: Like every state, the hospitals in Massachusetts, they have very good hospitals, but they’re also very politically powerful. When they were first cutting this deal in ’97, and this is a great story, Republican Governor Weld, he wanted to get a Medicaid waiver to have some flexibility in how the state administered Medicaid. He went to the federal government, to the Clinton administration to get this. And they said sure, no problem, we’ll give that to you, but we also want you to take this extra money for the hospitals. And the state, the Massachusetts representatives who were on the other side of the table said wow, this is really weird, we’ve never seen the federal government ask us to take extra money for these special hospitals. It turns out the reason they did that was because Ted Kennedy had lobbied the Clinton administration and asked that that happened. So that is the other unique thing in Massachusetts. The pot of money that Romney used to pay for his bill was, its birth was in a backroom deal between the Kennedys and the Clintons.
HH: Very interesting, very interesting reporting. Now I want to finish, though, by going back to where we started, which is federalism, because I think this is so important, because I don’t think many people in the Manhattan-Beltway kind of media elite really believe this federalism stuff. Now do you get me when I say…
RL: No, my view of federalism is that liberals and conservatives are always hypocritical on federalism. And neither side is 100% consistent on this. And just look at what Romney said in his speech the other day in Ann Arbor. He made an argument about insurance across state lines, and he wanted to equalize this, right? And he made a basically, he argued that, gosh, I’m getting the details…
HH: National markets are not an assault on federalism.
HH: But he…
RL: But he made an argument for a less federalist system when it comes to one thing, while arguing for a more federalist system when it came to something else in the same speech.
HH: But you know, Ryan, that’s what’s interesting. That is the way the Constitution set it up. The Constitution reserved the general police power to the states, but they gave enumerated powers to the federal government, for fear that the federal government would grow too large, remote and onerous. Therefore, to argue for a national market in commerce of insurance products is very federalists. It’s like opening up the road traffic that the anti-federalists wanted to keep to themselves, but that mandating things from the federal government, I mean, it comes down to the commerce power. But I think you don’t take, I don’t really think you care about that.
RL: But if you, let me ask you this, if the mandate was ruled unconstitutional, and there was a way to do Obamacare without a mandate, would that please conservatives?
HH: No, it certainly wouldn’t. I think conservatives want a national market in insurance products, they want tort reform, and they want the states to innovate with cost controls.
RL: Well look, tort reform is, you could still get tort reform. I mean, that’s not, you can still get tort reform, and still have the system that Obama signed into law.