Waltham , Massachusetts ( CNN ) -- Mitt Romney has pledged to repeal President Obama 's universal health care law if he is elected president . Critics find his position rather strange , arguing that the plan he helped develop when he was governor of Massachusetts is quite similar in design to the Obama plan . Romney disputes his critics , saying there are important and fundamental differences between the plans . Who is correct ? In actuality , both plans draw extensively from legislation offered by President Nixon in January 1974 . In a book just published , `` Power , Politics , and Universal Health Care , '' David Shactman and I explain how Romney and Obama used the same approach as Nixon to lower the number of uninsured . All three built their system on private , employer-sponsored insurance in which all but the smallest employers had to provide insurance to their workers or pay a penalty . All utilized Medicare to insure the elderly and an expanded Medicaid-type program to insure the poor . All provided subsidies to low-income individuals and small employers . The Romney and Obama plans created state-based private insurance exchanges to make insurance more accessible and affordable to small business and individuals . President Obama has been heavily criticized by conservatives because his plan includes a mandate for all individuals to have insurance or pay a penalty . Romney , too , has joined those criticizing the president , yet his plan in Massachusetts included just such a mandate . This idea was originally proposed by conservative groups as a measure of personal responsibility and an alternative to a single-payer system advocated by many progressive organizations . Romney believes it is alright to have a state require all to have coverage but that it can not be mandated by the federal government . Romney contends the Massachusetts plan required no new funding , whereas the Obama law calls for nearly a trillion dollars in increased taxes and cuts in projected Medicare spending over 10 years . What Romney does n't say is that the Massachusetts plan is partly funded with earmarked federal dollars and partly with state funds generated by a tax increase previously enacted to pay for a universal coverage plan that was never implemented . Unfortunately for Obama , there was no larger entity to support his plan . He had to pay for his plan with new federal monies and cuts in future federal spending . Although the federal government will assume a greater proportion of health spending , total health spending in the United States is projected to increase only 2 % more by 2019 under the Obama plan than it would have otherwise . As with the Nixon proposal , neither Romney nor Obama decided to include significant measures to reduce health care costs . Although both were criticized , I believe that was a sound political decision that allowed all the major health groups to support both plans . President Clinton 's health plan drew strong opposition from many stakeholders because it included a tight spending budget . Under Obama 's plan , hospitals , insurers and drug companies agreed to modest cuts in future revenues or rate increases , because all expected increased revenues from the millions of newly insured Americans . Both Obama and Romney expected that constraining health costs would be necessary in future years . A complete review of the two plans should acknowledge that the Obama plan includes many components not in the Massachusetts legislation . The most controversial are a board appointed to control Medicare spending and a requirement that insurance companies spend a minimum percentage of their revenues on direct patient care . The plan also includes a number of provisions to reform Medicare and Medicaid , and an extensive list of new delivery system approaches to be tested with federal pilot and demonstration programs . Important as these components may be , they are not part of the basic framework of the plan . After comparing the Romney and Obama plans , it is clear that the similarities far outweigh the differences . Romney could argue , however , that Obama did n't use the Massachusetts plan as a model but rather drew on the proposal put forth by Richard Nixon almost 40 years earlier . Romney 's plan worked for Massachusetts , reducing its uninsured rate to the lowest in the country . Although the legislation did not put a brake on rising health care costs , there is some evidence it did reduce its rate of growth compared to other parts of the country . Health insurance premiums have traditionally been higher in Massachusetts than in the rest of the United States . The gap , however , has narrowed somewhat as premium growth between 2006 and 2010 in the United States grew by an average yearly rate of 5.1 % while in Massachusetts the average growth was 4.4 % . The opinions expressed in this commentary are solely those of Stuart Altman .
Romney promises to repeal Obama health care plans , yet critics find links between them . Stuart Altman says both plans had their basis in Richard Nixon 's health care plan . All three plans rely on private , government sponsored health insurance . Romney , Obama plans do n't significantly restrain costs , he says .