Mitt Romney pledged to increase funding for the government-run Veterans Health Administration during a town hall at Gilchrist Metal Fabricating, in Hudson, New Hampshire this afternoon. Without specifically mentioning the highly efficient veterans health care system, Romney told an attendee, “I want to be able to support our veterans with the care they deserve. I want to take our savings from waste and inefficiency and care for our veterans and make sure in our hospitals, in our clinics, to make sure they get the care they need. I will not cut our defense budget so we can in part take care of our veterans.” Watch his remarks:

The fully integrated 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 — including private payers and providers (which Romney regularly touts as a better alternative to government programs). 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.”

Romney has previously floated the idea of partially privatizing the veterans health care system, but eventually backed away from the idea. “We have a VA system that needs to be improved and I’ve got no plans to change that other than to make it better and to invest more money in providing for our veterans,” he said.

Rick Santorum regularly highlights his conservative record on health care reform by touting his successful election against former Sen. Harris Wofford (D-PA), a Democratic champion of universal health care reform who campaigned on guaranteeing insurance for all Americans by encouraging employers and employees to share the cost of health benefits. “When I ran for the Senate in 1994, I ran against the man who was the author of Hillarycare in the United States Senate,” Santorum told Charles Krauthammer during an appearance on Fox News in October. “And I ran on a patient-driven, consumer-driven health healthcare system that is consistent with the philosophy of America, which is free markets, build it from the bottom up.” He expanded on the message following his surprising second-place finish in Iowa, “I’ve never been for government-run health care, never,” Santorum said to a crowd in Manchester, New Hampshire on Jan. 5. “Unlike the other two folks who are running here, who have supported individual mandates, who have supported top-down government health care, I never have.”

But as The French Revolution’s Nancy French discovers, Santorum did advocate for an individual requirement to purchase health insurance coverage — not in his general election challenge to Wofford, but in the Republican primary against businessman Joe Watkins. Watkins also backed the provision:

Allentown, PA’s Morning Call from April 7, 1994:

U.S. Rep. Rick Santorum, R-Pittsburgh area, and Joe Watkins, a Philadelphia businessman who worked in the Bush White House, are seeking the Republican Senate nomination, creating the only true Senate primary race….Santorum and Watkins both called for a “comprehensive restructuring” of health care. But they differed sharply on what elements should comprise a basic benefits package.

Watkins would include mental health services, long-term care, prescription drug coverage, dental services and preventive care such as immunizations. Santorum would not. Both reject abortion services. Santorum and Watkins both oppose having businesses provide health care for their employees. Instead, they would require individuals to purchase insurance. Both oppose higher taxes on alcohol or tobacco to help pay for care. They also oppose government-run health care and disagree with controls on doctor or hospital fees. They would cap malpractice awards.

Allentown, PA’s Morning Call from May 2, 1994:

Santorum and Watkins would require individuals to buy health insurance rather than forcing employers to pay for employee benefits. Both oppose abortion services and support limits on malpractice awards. Santorum says non-economic damages should not exceed $ 250,000, adjusted annually for inflation, and lawyers’ contingency fees should be capped at 25 percent. [...]

Santorum introduced the idea of a medical savings account, called Medisave, which has become part of the Gramm bill. Under it, workers would buy major medical insurance and could make tax-free contributions to a Medisave account, from which they would pay for preventive services.

Many Republicans who now argue that the Affordable Care Act’s individual requirement is unconstitutional supported a national mandate as an alternative to then-First Lady Hillary Clinton’s health care proposal. In that sense, Santorum is in very good company. He joins Newt Gingrich, Mitt Romney, Tim Pawlenty, Jon Huntsman, Chuck Grassley, and Orrin Hatch and a growing list of prominent Republicans who came out against the conservative principle of personal responsibility in health care as soon as President Obama endorsed it.

Our guest blogger is Topher Spiro, the managing director for health policy at the Center for American Progress.

Newly released national health expenditures data shows record slow growth in health care costs of only 3.9 percent in 2010. Of course, the severe recession has had a lasting impact on private insurance coverage and consumption. But the actions of the Obama administration also contributed to this slowdown in several ways:

– Growth in Medicare spending slowed significantly, and this can be directly attributed to cuts in payments to private health plans under Medicare. Over the next few years, the Affordable Care Act will cut inefficient subsidies to these plans, slowing Medicare growth even further and leveling the playing field between Medicare and private plans.

– Medicaid spending on prescription drugs slowed significantly from 6.1 percent to 0.3 percent. The Affordable Care Act—which increased the rebates that drug manufacturers must pay, lowering drug prices—contributed to this slowdown.

– Medicare spending on home health care slowed significantly from 11.1 percent to 5.2 percent. The administration’s crackdown on fraudulent billing contributed to this slowdown.

The data also show that Medicare is better at containing costs than private health plans. Medicare continues to have lower growth in costs per enrollee than plans in the private sector. This is because private plans pay higher rates to health care providers and have significantly higher administrative costs.

Finally, the data show why the Affordable Care Act is so needed. The administrative costs and profits of health insurance companies grew at 8.4 percent in 2010—the fastest growing spending category. But starting in 2011, the Affordable Care Act required public review of unreasonable premium increases and put limits on insurance company administrative costs and profits. Once the Affordable Care Act is fully implemented, it will continue to slow the growth in health care costs. That’s because the ACA included an array of reforms to the way health care is paid for and delivered. These reforms reward the value and quality of care, and not just the quantity of care:

— Reducing payments to hospitals with high rates of preventable readmissions and hospital-acquired infections

– Creating pilot programs to bundle payments together for multiple providers as an alternative to paying a fee for each service

– Creating accountable care organizations—teams of providers accountable for all of a patient’s care—that will coordinate care and share the savings

– Linking payments for hospitals and physicians to performance on quality measures—so-called value-based purchasing

– Creating an independent payment advisory board to recommend additional proposals to slow Medicare spending and improve the quality of care

– Creating a patient-centered outcomes research institute to identify what works best to improve the quality of care and outcomes

– Creating an innovation center to develop and expand innovative payment models to improve the quality of care and reduce costs

Such reforms to the payment and delivery system are essential to reducing health care costs over the long term — and the ACA made a substantial down payment.

Speaking at the Nashua Chamber of Commerce this morning, Mitt Romney said, “If you don’t like what [insurance companies] do, you can fire them. I like being able to fire people who provide services to me.” Romney was making the case for increasing the availability of individual health insurance plans with higher deductibles and cost sharing. “I want individuals to have their own insurance,” the former Massachusetts governor said, arguing that Americans who pay more for their own health care insurance plans will spend less on unnecessary services:

ROMNEY: That’s the system we have in health care, everyone just keeps piling on because it’s free…In some places overseas, they have this idea of co-insurance, where people are responsible for a percent of their bill. Let’s say 10 percent. In Switzerland, you’re responsible for, I think 20 percent of your hospital bill. So, if you’re going to have a knee replacement you shop around to see who is going to have the best record and who is reasonably priced…We’re going to have to bring into health care the dynamics of a consumer market so that people have an incentive to look at the cost.

Watch it:

Conservatives have long claimed that giving Americans more “skin in the game” — that is, increasing their sensitivity to prices — would encourage individuals and families to make more informed health care choices, avoid costly treatments and eventually lower health care costs. But there is very little evidence to suggest that asking people to pay more out of pocket would actually reduce health care costs, particularly since most of the spending is concentrated among the sickest Americans (those who suffer from multiple chronic conditions and cannot choose to forgo care).

As Yale professors Theodore Marmor and Jerry Mashaw pointed out in the Philadelphia Inquirer last year, “if free medical care led to more reckless overuse, countries like Canada and Germany, where patient costs are either zero or minimal, would suffer disproportionate inflation in expenditures or severe access pressures. They don’t.” Indeed, the theory doesn’t even hold up in the American health care system, where individuals with higher cost sharing in the employer based system with higher cost sharing don’t seem to spend less than Medicare enrollees with smaller cost sharing.

Ron Paul told a town hall audience in New Hampshire that uninsured Americans should rely on charity for health care and said the modern health system “is overly corporate and not much better than a socialized healthcare system.” The Concord Monitor reports:

He said reducing the size and cost of government would give more people the financial ability to make charitable donations and support the sick and indigent in their communities. “There was a time in the ’50s and early ’60s, people were not lying out in the street not getting medical care. Charities and hospitals stepped up,” he said, pointing to President Lyndon Johnson’s introduction of Medicare and Medicaid as ruining health care and replacing it with “corporate medicine.” “It’s not socialized medicine, but it’s not a whole lot better,” he said.

One man said his daughter is sick and will soon not be covered on her parents’ health insurance. “Will she have to wait in line at a charity hospital?” he asked Paul.

“She’ll have to wait in line under Obamacare, that’s for sure,” he answered, before drifting into a long, twisting answer about how a completely free market-based health care solution would improve the system.

The charity care line is gaining popularity as an alternative to the Affordable Care Act in the GOP presidential primary, as both Newt Gingrich and former presidential candidate Michele Bachmann have suggested that charities should be responsible for providing health care to those who can’t afford it. While the organizations served as important safety net in the era before Medicare and Medicaid, they would have little capacity to address the needs of today’s 50 million uninsured — and would certainly do very little to reduce health care costs or minimize the cost-shifts that result from uncompensated care.

In fact, for any politician to argue that government should outsource the task of keeping Americans healthy to charities is like saying that people should be punished with death if they are unfortunate enough to be poor or are priced out of insurance due to a pre-existing health condition.