Newt Gingrich called for an expansion of government health care when he praised the Veterans Health Administration for serving as “a model for modernization and a model of using information technology that’s very impressive” during a veterans issues forum in Iowa on Saturday:

GINGRICH: I think it means an investment in the veterans administration to ensure they’re getting world class help and I have to say the Veterans Administration has been a model of modernization and a model of using information technology that’s very impressive. There are parts of it that still need to be reformed, but in some ways it’s a very impressive institution.

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The fully integrated government-centric veterans’ health care structure of doctors and hospitals actually provides veterans with benefits that are the envy of the rest of the health care system. A study by the RAND Corporation found that “VA patients were more likely to receive recommended care” and “received consistently better care across the board, including screening, diagnosis, treatment and follow up.”

Incidentally, another government health care program, Medicare — which Gingrich seeks to partially privatize — has also served as a model for the rest of the health care system. The program, which “exerts a major influence on the rest of the health care system” and “its reimbursement and coverage policies have been widely adopted by private insurers and other public programs.”

When Rick Perry accused Mitt Romney of advocating for a federal mandate to purchase health care coverage in the hardcover edition of his memoir No Apology during Saturday night’s ABC News debate in Iowa, Romney tried to wager $10,000 that Perry couldn’t prove his point. The moment served to highlight Romney’s vast wealth and played poorly in a state where the average median income “is around $50,000.” But with just three weeks to go to the Iowa caucuses, the wager could proven even more damaging, for it greatly undermined Romney’s claims to consistency on health care and highlighted his greatest political vulnerability: a willingness to change positions and flip flop with the political winds.

To be clear, the hardcover version of Romney’s book No Apology “advocated the Massachusetts model as a strong option for other states” without specifically suggesting that the federal government should adopt the requirement. A later paperback edition even included additional passages that emphasized the changes he would have made to the Massachusetts law and how it’s different from “Obamacare.” What’s important here isn’t Romney book — be it the hardcover or the paperback editions — but rather the way he has evolved his rhetoric about reform from 2006, when he signed the bill into law, to today.

At the signing ceremony in April of 2006, Romney adopted a bipartisan spirit, saying, “This isn’t 100 percent of what anyone in this room wanted. But the differences between us are small.” In news interviews promoting the accomplishment, Romney praised Democrats and Republicans for working together on the measure and even claimed that the law solved “what the Democrats have talked about…which is getting everybody insured…in a Republican way.” He explained that this centered around the mandate by “applying a personal responsibility principle, reforming the market, and allowing people to buy private health care insurance, private insurance that they can take with them from job to job that’s entirely portable.”

During that same round of national media appearances — orchestrated by the governor to sell his accomplishment to the nation ahead of his presidential bid — Romney repeatedly hinted or directly stated that this “ultimate conservative solution” or “the Republican way” of personal responsibility could serve as a model for the nation. It’s a position he first adopted in his challenge to Sen. Ted Kennedy in 1994. At that time, Romney said he would support a mandate on a national level if universal coverage could not be achieved through other means (such as providing tax incentives to purchase care) and explained that he would have voted for the Republican alternative to the Clinton plan offered by then Sen. John Chafee (R-RI), which included a national individual mandate.

By the time he became governor, Romney focused his attention on how Massachusetts and neighboring states could expand coverage, but still advocated for a federal mandate. In December 2007, Romney said that if other states adopted the individual mandate it would be “a terrific idea…we’ll end up with a nation that’s taken a mandate approach” and endorsed the mandate-centric Wyden-Bennett health care proposal. Other select quotes:

– “Let me just note, there are a lot of people who say, ‘you know Governor, I don’t like this idea that people are going to be required to buy insurance. This is America. They should be free.’ Well, they are going to get free health care if they don’t buy insurance. I don’t think it is appropriate to say individuals have a choice of saying I don’t want to buy insurance even though I can afford it and I want to make somebody else pay for it. That’s not American. And that is not the right way, in my view, for us to go.” [Chamber of Commerce, 4/25/2006]

– “I’m proud of what we’ve done. If Massachusetts succeeds in implementing it, then that will be a model for the nation.” [Newsweek, 12/2/2007]

– “I think you’re going to find when it’s all said and done, after all these states that are the laboratories of democracy, get their chance to try their own plans, but those who follow the path that we pursued will find it’s the best path, and we’ll end up with a nation that’s taken a mandate approach.” [NBC, 12/16/2007]

You won’t hear him make a similar case today. The closest Romney comes to discussing his past support for a federal requirement is to say that he borrowed the idea from the Heritage Foundation and Newt Gingrich and applied it to his state. During Saturday’s debate, Romney simply ignored his past support for a federal requirement, saying, “I have not said in that book, first edition or the latest edition, anything about our plan being a national model imposed on the nation. The right course for America — and I’ve said this during the debates last time around; I’ll say it now and time again — is to let individual states — this is a remarkable nation.”

A key consumer benefit of President Obama’s health care reform law is the Medical Loss Ratio — a requirement that insurers spend 80 to 85 percent of premium dollars on health care, rather than administrative spending, and reimburse their customers if they fail to meet that standard. In June, Texas, under Gov. Rick Perry (R), requested a gradual adjustment of the MLR standard to 71 percent, 74 percent, and 77 percent for 2011, 2012, and 2013, arguing that immediate compliance would “likely to stifle competition in the market and constrain many Texans’ access to coverage.”

But 15 Democratic state lawmakers are questioning the need for the delay, since “12 of 35 individual insurance providers in Texas meet the 80/20 medical loss ratio” and a waiver would cost policy holders millions in rebates:

[Texas Department of Insurance] TDI estimates that Texans would receive $160 million in rebates or premium credit from individual insurance carriers in Texas in 2011 if providers are required to direct 80 percent of premiums to medical care and quality improvements. But if the adjustment is approved, and individual insurance carrier are only required to meet a 71/29 medical loss ratio in 2011, Texans would only receive $35.6 million in rebates.

Look:

A recent report from the Government Accountability Office (GAO) has also found that insurers are successfully meeting the MLR requirements by “reducing premiums in 2012,” not applying “for premium increases and are making adjustments to lower premiums as a strategy to increase their MLRs.” Most of the insurers are also reducing brokers’ commissions in an effort to lower administrative spending and meet the MLR benchmarks.

Texas consumers, meanwhile, already pay insurance premiums that are higher than the national average and the state suffers from the highest uninsurance rate in the nation.