I’ve skimmed Mitt Romney’s health care address, and the PowerPoint slides which supported it. The overall structure of the solution was not different than what appeared in his op-ed, which I already discussed. But some other things stand out.

One, Romney did not forswear the mandate that he signed into law in Massachusetts. It’s more that he doubled down on it and defended it, at times pretty strongly, while also saying he would never impose that on the nation because it’s so wrong for America. If you think this makes no sense, you’re probably right. Putting aside the actual benefit of a mandate when the only option is private insurance companies, I don’t know how a strong defense like this will help Romney in a Republican primary. Perhaps there was no disavowing it anyway. But the attempt to thread the needle between his program in Massachusetts and the Affordable Care Act just looked completely absurd.

On the requirement that individuals stay insured, Romney said it was necessary to deal with the “free rider problem,” which left states on the hook for health care costs generated by uninsured patients.

“Ultimately, the bill that we passed was a bill that said 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,” he said, putting a conservative spin on the policy employed by the Affordable Care Act [...]

“We didn’t create a government insurance program or a government policy that people got,” he said. “No, no. We gave people a premium support program where they could buy their own private insurance of their choice and for the poor we helped them with support.”

Those words could just have easily been applied to the Affordable Care Act, which did not include a “government insurance program” after the public option was removed from the final legislation.

Jon Cohn, who was at the speech, has more on this.

But conservatives concerned that Romney will apply the same values he supports on health care from Massachusetts to the rest of the country really shouldn’t worry. In fact, he not only supports the Republican budget with respect to Medicare, but also to Medicaid. On Medicare, Romney said he would release details at a later date, but while he didn’t agree with the exact same approach as the Ryan plan, he “shares many of those objectives.” And on Medicaid he was even more explicit; he prefers block-granting Medicaid so it’s not “an open checkbook” on the federal treasury. This is the plan that would kick 31-44 million Americans off health insurance and send millions of seniors out of nursing homes.

Finally, I think you know exactly where Romney is coming from when you look at slide 16 of his presentation. This slide discusses Part 1 of his five-point health care plan, where he vows to “restore to the states the responsibility and resources to care for their poor, uninsured, and chronically ill.” So what are those resources? Romney said that in Massachusetts he provided premium support to low-income individuals so they could purchase insurance. How does this program deal with the uninsured? It’s up to the states, but he gave some options: exchanges (like the federal plan), a “subsidy for private coverage” (like the federal plan) and then… “charity.”

So the big innovation for covering the uninsured, which to most liberals is the single biggest problem in our broken health care system, is… charity.

That should tell you something about the seriousness of the effort.