In ways, Clinton healthcare plan resembles Romney's Mass. solution

Key elements of Hillary Clinton's healthcare proposal are strikingly similar to the tenets of the health overhaul that Mitt Romney signed into law in Massachusetts last year. But you would never guess it from the broadsides he hurled yesterday against what he called "Hillarycare 2.0" and described as "a European-style socialized medicine plan."

"In her plan, we have government insurance instead of private insurance," he said at a press conference in New York, held before Clinton had even unveiled her proposal. "In her plan, it's crafted by Washington; it should be crafted by the states. In her plan, we have government Washington-managed healthcare. Instead, we should rely on private markets to guide healthcare. And in her plan, you see increased taxes. The burden should not be raised on the American people."

But the central premise of Clinton's plan - an "individual mandate" requiring that every American have health insurance - is precisely what Romney proposed in the Bay State, in what was seen as a bold approach to attaining universal coverage. The idea became a pillar of the law, which he signed in April 2006.

Clinton's plan and the Massachusetts law also share a guiding principle: Build on the existing employer-based private healthcare system, instead of replacing it with a government-run system.

"What Hillary proposed is in many ways the Massachusetts plan gone national, and I think that's great," said MIT economics professor Jonathan Gruber, an early adviser to Romney on the healthcare reform law who has consulted with all the major Democratic presidential candidates. "We are the shot fired around the world again - there's a whole new movement in healthcare started by what we did here. And rather than claiming credit for it, Romney's running away from it."

While the law is Romney's signature achievement as governor, on the campaign trail he has soft-pedaled or avoided mentioning elements of the law that might trouble conservative audiences, such as the extent of state government's involvement.

There are a few differences between Clinton's plan and the law Romney signed. Even though Romney said Clinton's plan is inspired by "European bureaucracies," it does not open any new government agency, according to the campaign, unlike the Massachusetts law, which created the Health Connector to help uninsured people obtain insurance. Massachusetts also does not provide subsidies to small employers to help them provide insurance, as Clinton's plan would.

Romney yesterday pointed out that Clinton's plan depends on tax hikes; to pay for her proposal, she would end some of the Bush tax cuts for those who earn more than $250,000 a year. The Massachusetts plan did not rely on increased state taxes; instead, it redirected federal dollars, fees on hospitals, and other money that had been subsidizing care for the uninsured.

He also contended that Clinton's plan would expand government by allowing the uninsured to buy into Medicare or one of the private plans available to federal employees.

But Massachusetts also used existing government programs to cut the number of uninsured, expanding some eligibility guidelines for the state's Medicaid program, as well as stepping up efforts to enroll those already eligible, adding tens of thousands to the rolls, said Michael Doonan, executive director of the nonpartisan Massachusetts Health Policy Forum at Brandeis University and a member of Clinton's healthcare task force in the early 1990s.

Romney's own healthcare plan, which he announced in August, would use federal incentives and subsidies to help states design their own systems, and would also seek to lower premiums by urging states to deregulate their insurance markets to encourage competition.

Romney called his press conference to assail Clinton's plan in front of St. Vincent's Hospital Manhattan; he did not realize he was speaking in front of a trauma center named for a rival, former New York Mayor Rudy Giuliani, who, along with his wife, Judith, raised millions for the hospital.

The hospital scolded Romney for speaking there without its permission.

"We find it unfortunate that Mr. Romney misappropriated the image and good will of St. Vincent's Hospital to further a political agenda," the hospital said in a statement.

Lisa Wangsness can be reached at lwangsness@globe.com.