By NBC/National Journal Reporter
updated 12/14/2007 4:53:58 PM ET 2007-12-14T21:53:58

Think Mitt Romney doesn’t talk about universal health care on the trail? Think again.

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In a Spanish-language debate in Miami on Dec. 9, Romney yet again made the declaration he knows doesn’t sit well with many of the conservatives he’s trying to court: "Well, I think I'm probably the only person on the stage and the only governor that actually stopped talking about getting health care for everybody and actually got the job done."

For a campaign that's become transfixed by the Mike Huckabee boom — leading to attacks focused on spending and immigration — the issue of health care may be one of the only areas where Team Romney has clung to general election-style rhetoric.

"We Republicans can get everybody insured. Let's get it done," he concluded during the debate.

It’s his own brand of compassionate conservatism, and it may be the one area where Romney has stuck somewhat to the center, leaving himself open to a general-election message. Indeed, he tends to remind voters that he’s met with former Republican National Committee Chairman Ken Mehlman, who said health care likely will become the most important issue of next year’s election.

Leading Democratic candidates Hillary Clinton, Barack Obama and John Edwards each introduced their plans on health care coverage to great fanfare from the press, and that caused the trio to argue over which one came out with a plan first, and which one doesn’t guarantee truly universal care — further blowing it up as a key issue. It’s no secret that the party will trumpet health care in the general election in the same way.

Running away from a winning position?
Romney is well aware of that. In early October at a Dover, N.H., "Ask Mitt Anything" town hall meeting, he pivoted to health care coverage from a question on what he would commit to global AIDS funding. After telling the questioner he didn’t have a specific number for her, he said, "I think it’s important to get people insured," adding, "I don’t want to have the Democrats whacking us over the head and saying, ‘Oh, Republicans don’t care.’ We do care. We care about America, we care about people getting health insurance, but we don’t want to raise taxes, and we don’t want government to run health insurance."

But the press hasn’t been buying it. The Washington Post reported in mid-April that in Romney’s quest to garner conservative support, he has tacked away from the plan he signed into law in Massachusetts. Months later, parts of that charge still haven’t gone away.

Time magazine ran a story in early November on Romney and health care. The penultimate sentence reads, "Instead, he rarely discusses the details of his Massachusetts plan and certainly doesn't tout his partnership with Kennedy," who worked closely with him in getting the legislation passed.

In fact, Romney does talk about Democratic Sen. Edward Kennedy and offers a joke that goes something like this: "A lot of people thought that the only way Ted Kennedy and I could agree on something was if one of us wasn’t listening." And when Republican supporters wonder just how Romney would work with a Democratic Congress in such a divisive time for Washington, he boasts the Kennedy health care collaboration and his stewardship in moving the bill through his state’s 85-percent Democratic Legislature.

In Boston and in the states with early primaries, Romney’s camp laments the media’s perception that its candidate is running away from his health care record. Perhaps that’s why in the days preceding and following Thanksgiving, Romney held a series of health care-focused events at hospitals and universities to preview his plan.

Back in October, former Missouri Sen. Jim Talent said in an interview that he believes Romney’s strongest area of domestic policy is health care. Pointing out Romney’s experience in the Bay State, Talent explained, "He became so familiar with so many different facets of that issue ..., that there really isn’t an area that he isn’t at least somewhat familiar with, with regard to health care."

True to form, during several recent tours of medical facilities, Romney’s been prone to chat about various equipment models with the available technicians in a right-brain kind of way that might be lost on voters — or the reporters following him.

Setting the bar
He’s also been fleshing out in greater detail for his audiences the explanation of personal responsibility as applied to health care, so as to take on the standard Republican tone.

And he’s moving the ball forward, too. On Nov. 20 at Des Moines University, he even offered the following time frame: "My estimate that from the time you would put in place this program, pass the legislation necessary to put in place this program, within four years every American would be insured."

So what is the problem? His follow-through.

Romney is often asked about his Massachusetts plan and how that would affect his national agenda. And he always answers that he really likes what was done there but concedes it might not work in every state, explaining that his plan would distribute funding so that the states have the flexibility to create plans that would be best for them. "Other states are free to use our model or come up with something even better," he says.

With that context, however, he hasn’t been able to fully explain how he can guarantee his four-year prediction.

Carrots and sticks
Asked by this reporter how he would see to that claim, he answered: "I would tie incentives, as well as some sticks, to encourage states to deregulate their health insurance markets and to take action to get all their citizens insured." He went on: "And so I would work with the states with the incentive dollars we have ... to get them to deregulate their insurance market, and at the same time, to take action to get citizens insured."

Filling in the blanks is a problem Romney has faced on other issues. On Social Security, he talks about the "four levers that could be pulled" on the issue, including the Democrats' suggestion to raise taxes — which he doesn't like — raising the retirement age and indexing the rate to inflation for the wealthiest sector of the population. He sounds keenest on President Bush's privatization plan that failed in early 2005, but he won't embrace it alone, and instead he says time and again that he favors New Hampshire Sen. Judd Gregg's plan to take a bipartisan group of senators and "lock them in the basement of the White House" until they come up with something workable. It's a function of his management style: Getting different ideas together for compromise, but it means he won't officially take a stand.

Shying away from the M-word
In general, Romney has pushed his rivals into attack mode on health care, and they’ve latched onto the word, "mandate." To the Romney campaign and its opponents, "mandate" has joined the ranks of "liberal" in the category of bad, seven-letter words in politics. Although he may need to impose a mandate to make the four-year mark, he certainly wouldn't say so.

Romney’s defense last Sunday shows that he’s still getting tripped up by the word. "I found a way to do that without requiring raising taxes, without a government mandate, without a government takeover. Instead, I didn't want to have a — when I said government mandate, I meant employer mandate," he said. "Instead, we have personal responsibility. We allowed individuals to buy their own policies."

Still, Romney refuses to employ the term, despite criticisms of the fee imposed on residents who could afford health care in Massachusetts but didn’t sign up for it and what some have claimed is the bureaucracy it created.

Clinton in the cross-hairs
On another front, campaign staff has been exhaustive in their efforts to show how Romney’s plan differs from Sen. Clinton’s. The Romney campaign scheduled a quick trip to New York City on the day Clinton was to unveil her plan in September to host a press conference denouncing it even before Clinton had the chance to make her presentation that morning. And Romney penned an op-ed in the Wall Street Journal in which he felt the need to take on the Democratic front-runner: "Her plan has several weaknesses and should be distinguished from the reforms I led in Massachusetts and the reform plan I have proposed."

He points out that her plan would cost $110 billion and has stuck it to Clinton before on their respective health care plans, saying, "The difference is, mine got passed."

But here’s the kicker: When Romney tried to bring Rudy Giuliani into the mix with an attack late last month at a health care event at the All Children’s Hospital in St. Petersburg, Fla., he got a little twisted in his own words, almost equating his views with Clinton’s: "When Hillary's plan first came out, Rudy Giuliani had nothing but praise for Hillary's plan. Why the change in attitude?" he asked. "When Hillary's plan first came out, he was all roses and petals for Hillary's plan. Now, I'm running for president, he's decided it's not such a good idea."

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