On April 12, 2006, Governor Mitt Romney, of Massachusetts, signed the most significant bill of his career: a law requiring every citizen in his state to buy health insurance. Romney usually held signing ceremonies in the gold-domed State House, in Boston. But this time his political team, which was preparing for his 2008 Presidential campaign, orchestrated an elaborate ceremony at Faneuil Hall, the site of some of the country’s great pre-Revolutionary War speeches. The brick building was decked in patriotic bunting, and a fife-and-drum corps led Romney inside. Two enormous signs flanked the stage, announcing, in a vaguely eighteenth-century font, “Making History in Health Care.” Aides distributed buttons with the same message. “I want to express appreciation to Cecil B. De Mille for organizing this event,” Romney said as he began his remarks.
Political, academic, and business leaders gathered under a monumental painting of Massachusetts Senator Daniel Webster debating South Carolina Senator Robert Hayne in 1830. The painting, sixteen feet tall and thirty feet wide, depicts a moment from a weeklong colloquy that became one of America’s most historic debates about Federalism, with Hayne arguing that states had the right to nullify federal law, and Webster arguing for a strong federal system. The most famous words from Webster’s final speech served as a backdrop for Romney that day: “Liberty and Union, now and forever.”
Romney had accomplished a longstanding Democratic goal—universal health insurance—by combining three conservative policies. Massachusetts would help the uninsured buy private insurance; it would create a deregulated online marketplace; and it would require that everyone carry insurance. Uninsured citizens no longer would use the emergency room as a primary-care facility and then fail to pay their bills. “It’s a Republican way of reforming the market,” Romney said later that day. “Because, let me tell you, having thirty million people in this country without health insurance and having those people show up when they get sick, and expect someone else to pay, that’s a Democratic approach. That’s the wrong way. The Republican approach is to say, ‘You know what? Everybody should have insurance. They should pay what they can afford to pay. If they need help, we will be there to help them, but no more free ride.’ ”
Although some influential libertarians condemned Romney, most conservatives praised the plan. Robert Moffit, a policy expert at the conservative Heritage Foundation, which helped write parts of the law, spoke at the ceremony. “The real trick is to retain what is best in American health care while correcting its deficiencies and expanding upon its indisputable benefits,” he said. “Massachusetts has done just that.”
Romney signed the bill at a wooden desk using fourteen different pens, which he later distributed to the dignitaries on hand. “It’s law!” he shouted after the final stroke. On cue, the sounds of the fife-and-drum corps filled the hall with Colonial-era music. Behind Romney stood the people most responsible for passing the plan, among them Senator Ted Kennedy and Salvatore DiMasi, the Speaker of the Massachusetts House of Representatives. In one photograph, the Governor is looking over his shoulder at DiMasi, laughing, and Kennedy is smiling at Romney. Kennedy died in 2009, and DiMasi is currently on trial for extortion and corruption and may go to jail. Romney, who did not seek reëlection in 2006, is running for the 2012 Republican Presidential nomination. Early this spring, as his campaign was foundering, a morbid joke about the photo circulated among Massachusetts political insiders: “The funny thing about that picture is that there’s three dead men, but only one is in the ground.”
Mitt Romney, the son of a Republican governor of Michigan, was a successful management consultant at Bain & Company, in Boston, which he joined in 1978 after earning a J.D. and an M.B.A. at Harvard. In 1984, he founded Bain Capital, a private-equity firm. He challenged Ted Kennedy in a 1994 Senate race but lost badly. He returned to Bain Capital but left to serve as C.E.O. of the organizing committee for the 2002 Winter Olympics, in Utah. The job went well, and his revival of the nearly bankrupt and scandal-plagued games gave him the reputation of a non-ideological and data-driven problem-solver. He returned home after the Olympics and was elected governor that year.
Once in office, he saw that health care was one of the biggest data-driven problems that needed solving. It consumed thirty per cent of the state budget, and costs were rising fast. “The Pac-Man of health insurance takes more and more, and every year roads, bridges, schools, higher education have to go down unless you want to keep raising taxes,” Timothy Murphy, the architect of Romney’s policy, said. “That’s why we decided to tackle health care.”
Before joining Romney, Murphy, a graduate of Harvard’s Kennedy School of Government, was an investment banker at J. P. Morgan. Like the rest of Romney’s health-care team, he was not an ideological conservative. “I wouldn’t go to the Kennedy School if I thought government was evil,” he told me recently at a café in Boston’s South End. “If government was evil, the Pilgrims wouldn’t have come and written the Mayflower Compact. That’s how societies work. If societies were just disaggregations of people roaming around, you wouldn’t have that street.” He pointed out the window at the road outside. “Mitt’s more in that vein. How can you run for President and be anti-government?”
The Romney administration also hired Jonathan Gruber, an M.I.T. economist who is the country’s foremost authority on modelling the effects of health-care policy. Romney never asked Gruber, who is a Democrat, about his political views. “It wasn’t an issue at all,” Gruber told me. Another Romney aide, Amy Lischko, of the state’s Division of Health Care Finance and Policy, had long studied the composition of the uninsured in Massachusetts. She was impressed by how much attention Romney gave to her number crunching. “He’s a real data wonk,” she said. “It’s just exciting that somebody wanted to have empirical data to base their policy on.” The three Romney advisers—Murphy, the pro-government Republican; Gruber, the liberal academic; and Lischko, the state employee—started to work.
In 2004, Lischko presented Romney with a detailed description of Massachusetts’s uninsured. About twenty per cent were eligible for Medicaid, but they hadn’t enrolled. It would be easy to find them and get them into the program. Forty per cent made too much money to qualify for Medicaid but not enough to afford insurance. They were generally in jobs—perhaps working half time for two companies—with no benefits. The remaining forty per cent, many of them young and healthy, could afford insurance but hadn’t bought it, perhaps because they didn’t think they were at risk. The state was paying about a billion dollars a year to compensate hospitals for treating uninsured patients who didn’t pay their bills. Conservative health-care experts wanted to use that money to subsidize the poor in buying insurance plans on the private market. Romney immediately adopted the idea.
There also needed to be a simpler way for individuals to buy insurance. “The types of insurance products we were offering sucked,” Murphy told me. “And it’s because the state had overregulated the markets.” The market was so confusing—and so geared to selling group policies to institutions—that only fifty thousand people, in a state of 6.4 million, bought policies that weren’t provided by their employers.
Moffit and his colleagues at the Heritage Foundation had promoted the idea of an exchange to help people buy insurance. As CarMax had done for automobiles and as eBay had done for old furniture in the attic, the online exchange could consolidate the splintered health-insurance market. Creating such an exchange would also help accomplish another long-term conservative policy goal: transforming health insurance from a responsibility for employers to a responsibility for individuals. Romney loved this idea, too.
Romney often argues that his plan resulted from the unique circumstances of the state, and in many ways this is true. When he became governor, only eleven per cent of Massachusetts residents were uninsured, a relatively low figure compared with other states. But the most idiosyncratic feature of Romney’s plan was how it was funded.
Starting in 1997, Massachusetts had operated its Medicaid program under an arrangement worked out between Ted Kennedy, Republican Governor William Weld, and the Clinton Administration. Like a few other states, Massachusetts received a waiver that allowed it some flexibility in how it administered the program. In addition, Massachusetts was given a special pot of money, which was secured with Kennedy’s influence, designated primarily for the politically powerful Cambridge Health Alliance and Boston Medical Center.
In the first year of the deal, the federal government gave Massachusetts approximately a hundred million dollars for the hospitals. In 2002, the deal expired, and Kennedy, who had just worked with the White House to pass George W. Bush’s new education law, persuaded the Administration to continue the arrangement for three more years. By 2004, the special fund had grown to three hundred and eighty-five million dollars annually. But that fall Romney received a warning from the Bush Administration. It would extend the waiver for Medicaid for another three years, but the extra money would be cut off in 2005.
Romney called Kennedy, and they agreed to approach the Bush Administration and present the outlines of Romney’s embryonic health-care plan. If the Administration would allow Massachusetts to continue to receive the extra money, Romney would achieve universal health care in his state. If the strategy worked, Mitt Romney and George W. Bush could both take credit for reforming health care by using market-based ideas and without raising taxes.
Before Romney could pitch his full plan to the Bush Administration, he needed to make a major decision: Would he favor an individual mandate? Was it enough to create an exchange and offer subsidies, or did he need to require people to buy insurance?
According to Murphy, Lischko, and Gruber, Romney believed that the logic in favor of a mandate was impeccable. Federal law requires emergency rooms to treat patients regardless of their ability to pay. “This is not Calcutta,” Murphy said. “We don’t let people go and die in the street. And then the question is, Who bears that cost? Those costs get paid by increased premiums for the people who do buy insurance, or they get paid for through socialized costs and claim our tax revenues and come at the expense of other things that people might want to do, like building roads and bridges. And in the Republican Party that I grew up in—go back to the welfare debate, it’s about personal responsibility—that seems pretty reasonable.”
Republicans had been discussing the idea for years. In 1990, the Heritage Foundation made the individual mandate a linchpin of its health-care plan, arguing that it should be part of “a two-way commitment between government and citizen.” The government would help individuals buy insurance, and, “in return, government would require, by law, every head of household to acquire at least a basic health plan for his or her family.” The head of the family would make the decisions.
In 1993, Republican Senator John Chafee, of Rhode Island, adopted much of this plan, and his bill became the main G.O.P. alternative to Bill Clinton’s health-care proposal. The concept of a mandate also won support from Representative Newt Gingrich, among others. One of Chafee’s health-policy aides, Christine Ferguson, later became Romney’s Commissioner of Public Health, and she reminded his policy team of the Heritage and Chafee proposals. “We got the idea from Christy Ferguson,” Lischko told me. “At one of our early meetings, she brought up the idea of the individual mandate and said, ‘We need to look at that. Don’t assume that because he’s a Republican governor he’s not going to want an individual mandate.’ ”
Romney and his aides had a lengthy debate about the merits of the mandate, which evolved into a broader philosophical discussion. Personal responsibility was important, some aides argued, but what about the libertarian view that the government had no business requiring people to buy something? It was one thing to ask drivers to buy car insurance. Owning a car is a choice. But the health-insurance mandate demanded the purchase of a product just for being alive.
Philosophically, Romney sympathized with the personal-responsibility argument and not with the libertarians. The pressure of satisfying the Bush Administration was also acute. Gruber, the M.I.T. economist, may have sealed the case with a model showing that, without a mandate, Romney would insure a third of the people at two-thirds of the cost of doing it with a mandate. “All the sick guys sign up,” Gruber said. “So you’d be silly not to have the mandate.” Gruber says he attended a meeting where the discussion of the mandate turned into a debate between Romney and his political advisers. Romney argued passionately for it; his advisers argued against it.
“My recollection of that meeting is Romney convincing his staff that this was a good thing to do,” Gruber said. He was inspired by Romney’s stand in favor of the plan. “He was just a champ,” Gruber said. “ ‘We’ve gotta stop these free riders! We can cover all the uninsured without spending any new money! This is the right thing to do!’ ”
Romney doesn’t appear to have had many doubts. “I don’t think the Governor was opposed to it at all,” said Lischko, who was present at the key meetings where Romney and his team discussed the mandate. “We thought this was going to be the hardest thing. And, actually, getting it through the liberal legislature was harder than getting it past the Governor.”
On January 14, 2005, Kennedy and Romney met in Washington to make their case to the Bush Administration. They had little time left. The federal money would dry up in six months. They arrived at the Department of Health and Human Services, a giant cinder-block building that stands close to the United States Capitol, and found the mood on the sixth floor rather festive. It was Secretary Tommy Thompson’s last day on the job, and as they explained the details of Romney’s universal health-care plan—subsidies, an exchange, and a mandate—they could hear music from Thompson’s going-away party in another room. By the end of a two-hour meeting, Thompson had agreed to a deal: if Massachusetts passed the plan, the federal government would keep the money flowing, though it would go to subsidize people buying insurance, and not to politically powerful hospitals. Romney and Kennedy had until June 30, 2006. The three men retired to the party and celebrated the agreement. Kennedy gave such a poignant farewell toast to Thompson that H.H.S. staffers wondered what Thompson had done to get Kennedy to speak so stirringly.
Once Romney had submitted his plan to the Democratic-dominated legislature, he stepped away from the process. Murphy told me that the Governor often refrained from intervening with legislation, fearing his actions could backfire. Months of debate through 2005 led to a consensus that there should be an individual mandate, but there was a stalemate around what was called the “employer mandate”: whether employers should be required to pay a penalty if they didn’t offer insurance to their employees. The House and liberal health-care advocacy groups favored it; the Senate and Romney, who was certain that it would be seen as a tax increase that would strangle his Presidential ambitions, opposed it.
After a long period of legislative inaction, Romney resorted to a publicity stunt. On the afternoon of January 29, 2006, a Sunday, he visited the homes of the Senate president and the House Speaker. Neither was there, but Romney left handwritten messages urging them to finish their job. More privately, he came up with a politically nimble way through the deadlock. In Massachusetts, the governor can exercise a line-item veto, but only for spending bills. Romney thought that if the tax on employers was modest and if he could veto it—a veto that would surely be overturned—then he would sign the bill. The plan worked: the Democrats agreed to a small penalty on employers who didn’t provide coverage and then rolled the whole health-care plan into a spending bill. Romney made a show of vetoing the employer mandate and a few other sections, and the vetoes were overturned. Soon afterward, the Bush Administration sent Murphy a letter praising the passage of the new law.
At the Faneuil Hall signing ceremony, there were many jokes about how Romney’s plan had turned him into a national star and how it might lead him to the Presidency. “The last time I was at this altitude, I needed oxygen,” Robert Travaglini, the president of the Senate, said after ascending an elevated speaker’s platform that Romney’s aides had set up. “A campaign is taking off and flying high, and there’s a reason for that: the bill that stands in front of us this morning.” It was Ted Kennedy, though, who articulated the true long-term consequences of what the Heritage Foundation, the Bush Administration, and Romney had accomplished. The new law, Kennedy said, might have a major impact on passing universal health care nationally. “This is a moment to savor,” Kennedy said, “of hope and promise and achievement for all the people of our Commonwealth—and perhaps for the rest of America, too. And we intend to make the most of it.”
During the 2008 Presidential campaign, Barack Obama did not support a mandate as part of his health-care plan, and that decision caused one of the most fiery exchanges of his primary contest with Hillary Clinton. Obama ran a television ad in which he criticized Clinton’s proposal for a mandate on the ground that “it forces everyone to buy insurance, even if you can’t afford it.” Clinton retaliated at a press conference in Cincinnati. “Shame on you, Barack Obama!” she said, in one of the more memorable moments of the primary campaign. “Meet me in Ohio. Let’s have a debate about your tactics and your behavior in this campaign.”
Obama’s position on the mandate contradicted that of most other Democrats and that of many of the interest groups essential to passing a law. In 2008, Kennedy, determined to make good on his promise at Faneuil Hall, hired John McDonough, who had run Massachusetts’s leading advocacy group for universal health care during Romney’s governorship. That October, McDonough and other Senate staffers convened about twenty of the most influential leaders and lobbyists from hospital associations, the pharmaceutical industry, the insurance industry, the labor movement, and universal-health-care advocacy groups. Many of them became the key brokers of the final health-care deal, in 2010. McDonough, who is now writing a book about health-care reform, laid out three potential policies for the next President: “Constitution Avenue,” a single-payer system that would replace most private health insurance with a government system; “Independence Avenue,” an incremental expansion that would not achieve universal coverage; and “Massachusetts Avenue,” based on Romney’s three-part plan. Fifteen of the twenty people raised their hands in support of the Massachusetts option and nobody raised a hand in support of the others. But there was still one very important policymaker who was not convinced of the virtues of a mandate, and a few weeks later he was elected President.
On April 21, 2009, Obama’s top health-care adviser, Nancy-Ann DeParle, sent the new President a seven-page memo with the subject line “Health Reform Decisions.” In 2009, Obama faced a political situation similar to Romney’s in 2003: a budget squeezed by exploding health-care costs and an activist community led by Ted Kennedy intent on passing a universal insurance plan. By the spring, the issue had become Obama’s top priority, and Congress was starting the process of writing legislation. DeParle indicated that it was time for Obama to get more specific about what he would and wouldn’t support in a bill, and the first issue addressed in her memo was the individual mandate. She had some delicate news to deliver to the President: he needed to reverse his position. “The Congressional Budget Office will likely take the position that without an individual responsibility requirement, half of the uninsured will be left uncovered,” she wrote.
DeParle added that excluding the mandate from his plan would reduce the over-all cost by two hundred and seventy billion dollars over ten years, but it would also leave twenty-eight million Americans uninsured. It was exactly the argument that Romney had encountered when he made his decision on the mandate a few years earlier. The Obama Administration even contracted with Romney’s economist, Jonathan Gruber, whom Romney had appointed to the board that implemented the law in Massachusetts, to do the economic modelling for Obama’s national plan. Gruber made clear that Obama could double the coverage by adding only about a quarter of the price.
To satisfy Obama’s concerns about affordability, DeParle recommended that he adopt a mandate like the one Romney signed into law, which included a hardship exemption for those who still couldn’t afford insurance. “Because of concerns about the impact of the individual requirement on middle income families,” she wrote, “we have explored coupling an individual requirement with an exemption process for those for whom coverage remains unaffordable. In Massachusetts, taxpayers are exempt from the mandate-associated penalties if the lowest premiums available to them exceed a certain fraction of income.” She went on to explain in some detail how the Massachusetts mandate worked. A few weeks later, Obama sent a letter to congressional leaders saying that he would support an individual mandate for every American to buy health insurance.
If it were not for Mitt Romney, with assistance from the Heritage Foundation and George W. Bush, it is extremely unlikely that Obama would have passed his universal health-care law last year. Bob Kocher worked on health care in the Obama White House and recently returned to McKinsey, his previous employer. “We asked the question ‘What plan can you invent that would cover a lot of people and not change anything?’ ” he told me. “We want them to buy private insurance, and so you end up wanting an exchange. You know you have to provide subsidies because some people can’t afford to buy private insurance. And you don’t really want to go from an uninsurance rate of sixteen per cent down to ten per cent, because it just doesn’t seem like you’ve accomplished that much, so then you say, ‘I need to add on a mandate.’ And then you add in the mandate and then suddenly you end up with a mandate, an exchange, subsidies. And that’s Massachusetts.”
The two laws do differ in important ways. Romney funded his largely with revenue from the federal government; Obama used a mixture of new taxes and savings from changes to Medicare. Romney’s law was strictly about expanding coverage to the uninsured; Obama’s includes mechanisms to help control health-care costs. But the basic architecture is the same. The Obama Administration and Congress drew on the expertise of many of the policymakers in Massachusetts who had several years of experience making their law work. Aside from Gruber and McDonough, the White House consulted regularly with Jon Kingsdale, a former insurance executive whom Romney hired to run the implementation process in the state. “The policy in Massachusetts was real,” Kingsdale told me. “We were very, very influential. I testified a lot. The congressional staffers would constantly ask, ‘Well, how do you handle this? How do you handle that?’ We were the go-to people.”
Romney initially thought that his health-care plan would help him politically. George Bush had risen in the Republican Party after the failure of anti-government conservatives who took power in Washington after the 1994 election. Bush fought the libertarian wing by criticizing House leaders who he said had tried to “balance their budget on the backs of the poor,” and by pointing to his bipartisan achievements in Texas on education and tax reform. His victory in 2000 seemed to offer a template for other ambitious Republican governors, and Romney’s crucial choices—refusing to raise taxes and focussing more on personal responsibility than on personal liberty—were consistent with the reigning ideology of his party. Although Romney’s plan did not reduce the state’s over-all health-care costs, which continue to rise, he did succeed in bringing insurance to nearly a hundred per cent of Massachusetts residents. Even in his first Presidential campaign, Romney’s health-care plan was an asset. South Carolina Senator James DeMint, the Senate’s most conservative Republican, cited it, in January, 2007, as a principal reason for endorsing Romney. “He has demonstrated, when he stepped into government in a very difficult state, that he could work in a difficult partisan environment, take some good conservative ideas, like private health insurance, and apply them to the need to have everyone insured,” DeMint said. The following month, during a speech in Baltimore, Romney boasted, “I’m proud of what we’ve done. If Massachusetts succeeds in implementing it, then that will be a model for the nation.” But John McCain won the nomination, and chose Sarah Palin, not Romney, as his Vice-Presidential running mate. Within a few months, the financial markets crashed, the Bush Administration bailed out the banks, and Barack Obama won the Presidency. He bailed out more financial institutions, as well as the auto industry; pushed through a nearly eight-hundred-billion-dollar stimulus; and sought a health-care bill expected to cost a trillion dollars.
In response, the Republican Party swung back dramatically toward the libertarians. By the summer of 2009, the debate among conservative intellectuals about a health-care mandate was over, and the libertarians had won. Even the Heritage Foundation turned against it. Robert Moffit, the wonk who spoke at Faneuil Hall in 2006 and spent the years afterward defending Romney’s plan, declared that he now believed the individual mandate was an affront to American values. “Requiring everyone to buy government-specified health insurance, whether they need it or not, is an unacceptable violation of personal liberty,” he wrote in August, 2009. Gingrich, who has announced that he is running for President, recently recanted his support for the mandate. Meanwhile, in courts across the country, conservative legal groups have challenged the constitutionality of the federal mandate. Twenty-eight states have filed to overturn it. Three federal courts have dismissed such cases, but two federal judges have declared the mandate unconstitutional, which means that the Supreme Court may well decide the issue. In an echo of the Hayne-Webster debate, bills have been introduced in at least eleven states to nullify the federal law.
The two other most credible Republican candidates for President in 2012—former Utah Governor Jon Huntsman and former Minnesota Governor Tim Pawlenty—also face versions of Romney’s problem, and the phenomenon of a party that has shifted dramatically to the right in a very short time. Huntsman seems to have been sympathetic to the mandate, and he and Pawlenty both supported regional plans for addressing carbon pollution that were virtually identical to Obama’s national cap-and-trade plan. Like the individual mandate, cap-and-trade, which also was popularized by conservative think tanks, is now considered a heretical idea among almost all Republicans. In response, Pawlenty and Huntsman have simply renounced their support for cap-and-trade.
Romney, in contrast, has not followed a policy of total renunciation. Instead, he has tried to maintain support for his greatest achievement, a health-care plan that has been successful and popular in Massachusetts, while arguing that it bears no resemblance to Obama’s national program. (Perhaps appropriately, Romney’s most recent book is titled “No Apology.”) The Onion memorably captured his dilemma in April with the headline “MITT ROMNEY HAUNTED BY PAST OF TRYING TO HELP UNINSURED SICK PEOPLE.”
On May 12, 2011, Romney gave a speech about health care, in Ann Arbor, Michigan. He wore a dark-blue jacket and an open collar, and commanded the room with his baritone voice and six-foot-two-inch frame; for all the talk about how his health-care record may have killed his campaign, he still looks the part of a Presidential candidate, and, indeed, he’s leading in the polls. Aided by a PowerPoint presentation projected on a wide screen in an auditorium at the University of Michigan’s Cardiovascular Center, he painstakingly reviewed the logical chain of facts that had led him to conclude that an individual mandate was the best way to insure almost every person in Massachusetts at the lowest cost to taxpayers. He summed up the policy more succinctly than most Democrats have: “Either have insurance or we’re going to charge you for the cost of the fact that the state is going to have to cover you if you get seriously ill.”
Romney shifted to explaining why he would repeal Obama’s law, and the Bain consultant seemed to be replaced by a Tea Party activist: the presentation lost its logical rigor, as Romney resorted to platitudes and anti-government outrage, and to facile arguments about federalism. One slide presented a comparison between “Obamacare,” which was described as “a government takeover of health care,” and “Mass-care,” which was simply devised to “help people get and keep their health insurance.” Romney said, “Our plan was a state solution to a state problem and his is a power grab by the federal government to put in place a one-size-fits-all plan across the nation.”
It’s not entirely unreasonable to praise Mass-care while bashing Obamacare. Obama’s law, the Affordable Care Act, is more sweeping than Romney’s, and even though they use the same mechanisms to expand insurance, it’s possible to argue that the national law costs too much or raises taxes or includes additional provisions that are unacceptable to principled conservatives. Romney’s argument, however, became strained when he asserted that the individual mandate is the ideal solution at the state level but tyrannical when imposed at the federal level.
Still, this debate is no longer really about such details. Romney could give his PowerPoint presentation in every living room in Iowa and New Hampshire until every Republican understood the technical differences between the two plans, and it would not change the core of his dilemma. Romney’s real problem is not just that he supported a mandate, which Republicans have seized on as the most anti-American feature of Obama’s health-care plan, but that he showed Democrats the political and procedural path to passing a universal-health-care bill in America. Aside from Obama, Romney may be the man most responsible for the national law.
That honor is not one that Romney is entirely happy with. As the Boston Phoenix pointed out, when “No Apology” was issued in paperback, in February, Romney made a notable change from the original version. In the hardcover, published in early 2010, Romney, after reviewing the success of health care in Massachusetts, wrote, “We can accomplish the same thing for everyone in the country.” In the paperback, the line had been deleted. ♦
