On Meet the Press on Sunday, Mitt Romney announced  what sounded like a major shift in policy. He is running a pledge to repeal the Affordable Care Act. Asked whether that means he will actually toss young people and people with prior conditions off of their health insurance, Romney displayed his characteristic cowardice and dishonesty. Instead of admitting that is what he intends to do, he said:
I’m not getting rid of all of healthcare reform. Of course, there are a number of things that I like in healthcare reform that I’m going to put in place. One is to make sure that those with pre-existing conditions can get coverage. Two is to assure that the marketplace allows for individuals to have policies that cover their family up to whatever age they might like. I also want individuals to be able to buy insurance, health insurance, on their own as opposed to only being able to get it on a tax-advantaged basis through their company.
Some conservatives reacted with predictable apoplexy. Bryan Fischer, director of issues analysis at the American Family Association, sent a series of tweets  on the subject: “Oh man. Romney says will keep the good parts of ObamaCare. Good grief. There are no good parts… Oof. Romney says will use RomneyCare as his model for what to keep from ObamaCare… Conservatives to Romney on ObamaCare: END IT, DON'T AMEND IT.”
FreedomWorks, the fiscally conservative advocacy group, took a more measured tone, saying  that the only objectionable feature of what Romney promised is his pledge to allow children to be covered by their parent’s insurance.
That’s because FreedomWorks understands that Romney has offered no plan to actually insure people with pre-existing conditions. That policy, known as guaranteed issue, requires insurance companies to sell insurance to anyone who can pay for it, regardless of their medical history. Romney’s campaign platform proposes only preventing exclusions of people with prior conditions who already have insurance.
If you took Romney’s Meet the Press statement at face value, it would imply that Romney does not understand the insurance market. You cannot simply force insurance companies to cover people who are already sick. If they do, their outlays for treatment will increase, and so will the price of insurance. Healthy people will then be even less likely to buy insurance and the price will go up even further in a negative feedback loop. (This is sometimes a “death spiral.”) Fischer was correct when he tweeted that Romney’s proposal, “will mean the end of private health insurance.”
The solution to this conundrum, as Romney well knows because he enacted it in Massachusetts, is to mandate that healthy individuals also buy insurance. Insurers can then afford to cover the sick. Having the healthy participate in a social pool to help cover the sick is how a decent society functions.
But Romney is pretending to be an ideological conservative who believes the healthy should be allowed to abandon the sick to die from lack of health insurance. So he opposes the individual mandate. But rather than having the courage of his supposed convictions, Romney wants credit for protecting the vulnerable.
But conservatives should rest assured: if Romney is president, people with prior conditions will be unable to obtain health insurance. Romney has no actual plan to do otherwise.