Two of the smartest writers on health care issues, the Wall Street Journal's Laura Meckler and consultant Robert Laszewski, raise a really good question about Mitt Romney's ability to serve as John McCain's running mate.

As you may recall, when Romney was governor, he signed into law a bill that is designed, eventually, to make sure every resident of Massachusetts has health insurance. It is, in other words, an act designed to achieve universal health care. And, at least in its broad design, it looks more than a little like the plan Barack Obama has proposed to implement nationally. Specifically, it sets up what amounts to a govenrment-regulated purchasing cooperative, through which private insurers make coverage available at community rates (that is, the same price for all customers) and without exclusions for pre-existing conditions. To help people afford this coverage, Massachusetts also offers subsidies to lower-income residents.

The similaries pretty much end there. Relative to Romney, Obama would spend more money helping to subisdize low- and middle-income people who can't afford coverage; he'd probably call for all insurers to offer more benefits as part of their standard package; and he'd create a new public insurance plan, something that looked a bit like Medicare, into which anybody could enroll. But in one crucial sense, Obama might not go as far as Romney's plan did: Massachusetts now requires all adults to get insurance, although it has initially exempted part of the population (mostly because the subsidies aren't as generous as they need to be). Obama wouldn't do that, at least right away.

Still, the schemes are parallel enough that it would seem to create a serious political problem. One of McCain's main line of attacks against the Obama plan is that it's too much "big government." But, all things considered, Obama's plan doens't involve that much more govenrment than Romney's plan. If McCain picks Romney, wouldn't the McCain-Romney ticket have to abandon its line of attack on Obama's health plan?

It would if Romney cared about intellectual honesty. Fortunately--or unfortunately, I suppose--he doesn't. During the primaries, Romney himself constantly attacked his Democratic counterparts for proposing a "government takeover," likening their proposed schemes to something Karl Marx would think up. Critics repeatedly pointed out the absudrity of the charge, given the similarities to what Romney had signed in Massachusetts, but he went right on attacking the Democratic plans anyway.

It's a safe bet Romney would have no compunction about picking up those attacks again as McCain's running mate. And while those of us who follow this issue would do our best to point out the hypocrisy, it's also a safe bet a lot of voters simply wouldn't notice it. 

--Jonathan Cohn

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