Mitt Romney and health care

Let's go through this one more time. In 2006, Mitt Romney, as governor of Massachusetts, guided to passage, signed with a flourish and implemented with fanfare a health care reform law for his state.It was intended to achieve universal health coverage -- a longstanding liberal goal that was not even on the Democrats' national agenda, let alone the Republicans', at the time.

Of the available models, Romney chose one developed in part by the conservative Heritage Foundation. Its central provision was an "individual mandate," requiring everyone to carry health insurance (and subsidizing those who couldn't afford it).

Cut to Washington, 2010. President Obama also chose the individual mandate as his model for health care reform.

As Heritage had argued, it is hard to imagine any other workable alternative to the dreaded "single-payer" (that is, a truly nationalized health-care system, as in Britain).

Obama's people consulted with Romney's in formulating their plan, which passed Congress on a close party-line vote and immediately became an object of vilification for Republicans, who vowed to replace it.

Romney, running for president again after losing in the Republican primaries in 2008, joined in the attack. He promised not just to work for Obamacare's repeal, but also to defund it and allow all 50 states to opt out from his first day in office.

But isn't Obamacare almost exactly like the plan Romney had implemented in Massachusetts? Oh, no, no, no: The two plans are very different.

Furthermore, two out of three Massachusetts residents approve of their plan, according to polls.

What's more, Romney says, if they don't like it, they can change it. That's what's so wonderful about federalism.

This is about as far as the argument has gotten, and Romney may well get away with stopping here now that he's almost sure to get his party's nomination for president.

It will be hard for Obama to make too much of an issue of the resemblance of Romney's plan to his own since he still approves of his own plan.

But Romney shouldn't be allowed to get away with stopping here. This tale makes no sense whatsoever. Here are some remaining questions he needs to answer:

What is it about the people of Massachusetts that makes a health care arrangement suitable for them when it is so unsuitable for all other Americans?

Romney says that it "wouldn't be honest" for him to say now that the Massachusetts plan was "a boneheaded idea." Does this mean he still thinks it is a good plan?

Individual mandate and all? How can that be, if Obamacare, by contrast, is so awful?

Romney has said, correctly, that Obamacare doesn't adequately deal with the issue of controlling costs. He says that, as president, he will do that because it is a national problem.

How does he decide what is a national problem, on which the president must act, and what is a state problem, to which there might be 50 appropriate solutions?

This would create something that doesn't now exist -- a national insurance market -- and dramatically increase competition, thus helping to control costs.

It's a good idea, but, of course, it is exactly the opposite of what he claims to believe is needed in general: Outside competition would make it nearly impossible for states to regulate health insurance, leaving that power and obligation to the federal government.

How does Romney resolve this apparent contradiction?

That is enough, for the moment. It's obvious -- isn't it? -- that Romney is just blowing smoke.

The real story is clear: He wanted to achieve something important and good for the people of his state, namely universal health care.

It's annoying, but more than that, it's disqualifying. To talk such nonsense and count on the hubbub of the campaign to clothe its naked contempt for the voters is an insult to all of us.

Romney radiates this insult. This is what people mean when they talk about how smooth he is.

He will do or say anything to be president. But his ruthlessness is not of the bitter, Nixon sort.

It's the bland impatience of entitlement. It says, "Why are people bothering me with these questions?"