The decision by Massachusetts to enact universal health care--or "nearly universal health care," as the papers are calling it--is getting a lot of attention. And deservedly so. If Governor Mitt Romney signs the law, as expected, and it goes into effect, the state will become the first that requires its citizens to buy health insurance.

Such a mandate is essential in any system that truly covers everybody (or nearly everybody). Of course, if you're going to require people to buy insurance you have to make sure that there is actually decent insurance to buy. In other words, it must be affordable, sufficiently comprehensive to cover a large share of medical expenses, and available even to people who have the kind of pre-existing conditions that insurers normally won't cover.

Whether Massachusetts has accomplished this, while avoiding other potential policy snags, remains to be seen. A lot depends not only on the fine print of the legislation but the actions of the government board charged with administering the plan. But in the abstract the general idea seems workable enough. At the very least, as Ezra Klein notes, it looks like an improvement over the status quo.)

That raises one obvious question, which Leif Wellington Hasse addresses here, of whether other states can copy the Massachusetts model. It would seem difficult. The state already has a relatively low number of uninsured, in part because of its booming economy and in part because of its already generous state programs to help people get affordable medical care. In addition, the state faced a unique circumstance in which it stood to lose a chunk of federal money if it didn't expand insurance coverage. That's one reason the state is able, at least on paper, to cover a lot more people for relatively additional investment. Other states won't have that luxury.

Still, Mitt Romney will say this law makes him a worthy candidate for the Republican presidential nomination. And he's right. Politics should reward officials who accomplish something in office. And while it will undoubtedly annoy some progressives who don't love the plan or think he's taking credit for an idea (and favorable circumstances) that fell into his lap, they should be thankful for this development.

Thankful, because nationally the most important impact of this new law may be on politics, not policy. Once Romney starts boasting about how he achieved universal health coverage in Massachusetts, it will become that much harder for conservatives to demonize the very concept as "big government." Oh, they'll try--and they'll have at least some success. But now Democrats will have this retort: If a Republican governor and leading presidential contender with strong conservative credentials thinks universal health care is a good idea, how radical an idea can it be?

On Friday night's Larry King show, Martha Zoller and I sparred with lefty Ed Schultz and radical Rhandi Rhodes over the issues of the day. Here's one exchange on health care of particular interest today:

CALLER: And I would also like to ask the panel if what they thought if this administration or the president, if they're going to make any headway on the whole health care issue, as I'm one of the many that don't have it.

SCHULTZ: Do you want me to -- Larry, this is the number one issue on the minds of all Americans on both sides of the political aisle across the country right now. You cannot expect families to absorb year after year double-digit increases, and the number of people that don't have any health insurance. And the conservatives are sitting there saying, go get a savings account. What! Come on, give me a break....

KING: What do you think?

HEWITT: I think people should look at the states. Massachusetts Governor Mitt Romney has come up with a very, very innovative plan that says to those who are 30 and 40 years old, who are just not buying health insurance because they don't need it, they figure they'll get it later when they get it, you're going to pay in. At the state level, like Massachusetts and the Romney plan, there are many innovative solutions. What we don't need is Canadian health care. What we don't need is what Ed wants....

While Majority Leader Frist, and Senators Allen and McCain are locked in a bloody intra-party battle over illegal immigration, Romney produces an innovative solution --at the state level-- that avoids the worst of Hillarycare and yet moves towards the goal of coverage for all Americans on an equitable basis. Front page coverage in the Washington Post and the New York Times telegraphs the new legislation's importance.

While the plan does impose fees on employers not providing health insurance, it also demands performance from health care providers and begins to address the "free rider" problem in health care.

From a political perspective, it gives Governor Romney a huge advantage heading into 2008, one which all candidates covet: An actual example of concrete achievement that voters will connect to their own lives.

There is no doubt in my mind that the pundits are going to grow very tired of hearing Mitt Romney talk about the "Romney plan which he pushed through a blue state legislature, which extends coverage and controls costs while increasing the quality of health care throughout Massachusetts," but it is a significant achievement for a Republican governor in a very liberal state.

And the other would-be successors to W have got to have noticed that when it comes to deliverables, the Romney campaign just took a big jump forward.

Meanwhile, John McCain is teamed with Teddy while also blocking Bush nominees to the federal bench.

Quite a contrast.

More reactions from Webbloggin, Midtopia, ByTheRiver, NationalReview.com --pro, NationalReview.com --con; and Maggie's Farm, which asks "A Home Run for Romney?"

Yes, Maggie, a home run.

Like Aaron Boone's in yesterday's first win of the season for the World Series-bound Indians.

Governor Mitt Romney is financing the early stages of his potential presidential campaign with a novel, multistate fund-raising operation that is allowing him to maximize legal donations, outflank top Republican competitors, and minimize public scrutiny.

Since July 2004, Romney has set up affiliates of his political action committee, the Commonwealth PAC, in five states. By having donors spread their contributions across the various affiliates, Romney has been able to effectively evade the $5,000-per-donor annual contribution limit that applies only to federal committees, which most presidential aspirants set up to build initial support for their candidacies.

The multistate system is helping Romney raise money quickly from relatively few contributors, and foster valuable political relationships around the country. It also is a strategy several potential opponents for the Republican nomination cannot use: Federal office-holders, under new campaign finance rules, are barred from operating such state affiliates.

That means possible 2008 competitors such as Senators John McCain of Arizona and George Allen of Virginia have to rely solely on their federal PACs and thus cannot accept more than $5,000 from any contributor each year.

``I think it's a brilliant strategy," said Rich Bond, a former Republican National Committee chairman and a McCain supporter. ``It's fully compliant with the law, yet allows Romney to deploy political assets in a comprehensive fashion."

A review by the Globe of Commonwealth PAC campaign finance filings indicates that more than 100 donors have given a total of $1.6 million to Romney's various PAC organizations over the past two years. It is a relatively small amount compared to what Romney would need for a presidential campaign -- President Bush raised $273 million in 2004, for example -- but the creation of a fund-raising network will help establish Romney in monied circles that will be crucial if he decides to run for the White House.

A few supporters and their families have given roughly $100,000 or more to Commonwealth PAC, but many donors have made large contributions to several affiliates at a time. On March 30, for example, Florida investment adviser Lee Munder gave $5,000 to Romney's federal PAC, $18,250 to his Iowa affiliate, $18,250 to the one in Michigan, and $3,500 to the one in South Carolina, campaign finance records show.

The Commonwealth PAC is a so-called leadership PAC, which politicians often establish in advance of their official candidacies to finance cross-country travel, maintain a staff, and distribute tactical campaign contributions to local politicians in key states. The money these committees raise is far less than what it takes to mount a formal presidential campaign, but the committees are crucial to building name recognition and a network of donors early on. (Candidates cannot use leadership PAC money to finance their campaigns once they officially declare.)

Romney's multistate strategy, made possible by a campaign finance law that McCain helped write, was crafted by the governor's former advisers Mike Murphy and Trent Wisecup, ``and a smart lawyer or two," according to a person with knowledge of the plans.

One of those lawyers was Benjamin L. Ginsberg, who was a top lawyer for the Bush-Cheney presidential campaigns in 2000 and 2004.

The 2008 presidential election cycle is the first full cycle in which the new campaign finance rules apply, and Romney appears to be taking advantage of them more than other potential candidates. New York Governor George Pataki, a Republican, and former Virginia governor Mark Warner, a Democrat, each have state affiliates of their PACs, but only in one or two places.

``It's been well-documented that being a governor is an ideal office from which to seek the presidency, and the McCain-Feingold law has just magnified that," said FEC chairman Michael Toner, adding that such a system is ``a potential leg up for office-holders such as Governor Romney that their federal counterparts do not have."

Romney has PAC affiliates in Iowa, Michigan, South Carolina, New Hampshire, and, formerly, in Arizona. Particularly beneficial to Romney are the affiliates in Iowa and Michigan, where there are no limits on how much an individual can give. (Donors can give up to $3,500 in South Carolina and up to $5,000 in New Hampshire.)

But the multistate setup is not necessarily helpful to voters, who have to hunt down public campaign finance filings in several places to see who has given to the Commonwealth PAC, said Massie Ritsch, communications director for the Center for Responsive Politics, a Washington, D.C., nonprofit that tracks money in politics.

``Setting up individual committees in multiple states makes it hard for the public to learn who's supporting a campaign financially," Ritsch said.

Asked about how Romney's fund-raising strategy differed from those of other potential candidates, Spencer Zwick, who oversees Commonwealth PAC finances, wrote in an e-mail, ``I'm not familiar with how other political leaders structure their political action committees. Furthermore, all of our fund-raising and donation activity, whether it's in connection with a state or the federal PAC, is fully disclosed and available for public inspection."

Romney said last week he was ``very pleased" with how PAC fund-raising was going, but he played down the amount of money he was taking in, saying it pales in comparison to what would be necessary to run for reelection as governor.

``There's no particular reason to raise vast amounts," he said. ``This is being used to support Republican candidates around the country, and it's not something where you're trying to create records or large numbers."

Zwick said he would not discuss fund-raising targets with the media. He said in an earlier e-mail that their focus for the first half of the year was raising money and the focus in the second half will be distributing it.

It is evident Romney has recently been raising money at quite a clip: He hosted at least three PAC fund-raisers last week, in Michigan, Utah, and California, and plans to host another tomorrow in Logan, Utah.

The Globe's review of campaign records offers a glimpse into the early donors Romney is attracting. They come from more than a dozen states -- one met Romney at a cocktail party and has backed him since, another hails from a family that's known his for almost 100 years, and others know him from his days as a venture capitalist.

Kem Gardner is a Utah developer who, along with family members, has given more than $100,000 to the Commonwealth PAC, records show. Gardner said he has known Romney since both lived in Belmont in the 1980s, and that he and many other supporters stand ready to do much more.

``We just hope he gives us an opportunity to work for him," said Gardner, who calls himself ``a good, mainstream Democrat." ``He can count on my support in a big way."

Another leading contributor is Jon M. Huntsman, a fellow Mormon whose father-in-law, David Haight, grew up with Romney's father, George, in Oakley, Idaho. Huntsman and his sons have contributed more than $130,000, records show.

``I've pushed him and encouraged him and done everything that I think our family could to move [him] to the next level and be an actual candidate," said Huntsman, whose son, Jon Jr., is governor of Utah.

Together, Gardner and Huntsman represent two important fund-raising bases for Romney as he eyes the presidency: Utahns and fellow members of the Church of Jesus Christ of Latter-day Saints.

Romney is well known in Utah chiefly because he ran the 2002 Winter Olympics in Salt Lake City, which was widely seen as headed for disaster until he took over. Utah residents have given more than $680,000 to his PAC affiliates, more than any other state. Romney is also one of the best-known members of the Mormon church, which has about 5.7 million members in the United States.

Another Romney donor, Robert Lichfield of Utah, is a controversial figure as the founder of the World Wide Association of Specialty Programs and Schools, which runs boarding schools for struggling teens. At least seven of the organization's schools have closed following allegations of child abuse, the Associated Press reported in October. Lichfield, a frequent Republican contributor, has given Commonwealth PAC $25,000, according to records.

Some political specialists caution that potential presidential candidates cannot be too dependent on a small group of big contributors. That's because once candidates officially declare their intentions, they are permitted to accept only about $2,000 from individuals for the primary cycle and another $2,000 for the general election.

``You can't rely on big donors, because running for president you've got to have a strong network of people around the country who are willing to go out to their friends and neighbors and ask them to join them in the effort," said Jack Oliver, who was finance director for Bush when he first ran for office in 2000.

Romney also recently revamped the Commonwealth PAC website (www.thecommonwealthpac.com) to allow online contributions. Contributors also can print out a document to send in with checks; it asks that donors first give to the federal PAC; then it lists the state affiliates, noting any contribution limits.

Possible opponents such as McCain and Allen have their advantages, too. Both have already raised money for federal office that they could transfer to a presidential campaign. In McCain's case, he has broad name recognition from his presidential run in 2000.

Craig Goldman, executive director of McCain's PAC, Straight Talk America, said that while his group is aware of Romney's multistate strategy, McCain's PAC has raised $4 million by soliciting checks from $5 to $5,000.

``We're very happy where we are fund-raising," he said.

Allen's campaign manager, Dick Wadhams, said Allen has been focused on his reelection to the Senate this year and has not devoted that much attention to his leadership PAC, Good Government for America. Told of Romney's strategy, Wadhams said, ``Wow. Well, that's pretty creative, no doubt about it."

WASHINGTON -- John Breaux, the former senator from Louisiana known for his deal-making in Congress, has hooked up with American University to sponsor a series of Washington forums where political opposites, such as Hillary Clinton and Newt Gingrich, are challenged to explore possible areas of agreement on solving the nation's health care crisis.

On April 17, Breaux brought together Tommy Thompson, the secretary of health and human services in the first term of President Bush, and Donna Shalala, who held the same job throughout Bill Clinton's tenure. Republican Thompson and Democrat Shalala quickly agreed on one thing: The most interesting and potentially promising innovation in health policy in recent years is the law enacted by the Democratic legislature in Massachusetts and signed this month by Republican Gov. Mitt Romney. That law aims at requiring every Massachusetts resident to have health insurance by mid-2007 and provides subsidies for those who need help paying the premiums.
Romney was in Washington last week and, after defending his handiwork against critics of "big government" at a session with conservative pundits and a meeting of the U.S. Chamber of Commerce, I found him primed for verbal battle when we met for lunch. What I learned convinces me that Thompson and Shalala are right.

The banner headline on Romney's plan is the ambition to make his state the pioneer in universal coverage -- an obvious breakthrough in a nation where millions are uninsured and their numbers continue to grow.

Underlying Romney's promise is a plan for radically restructuring the health care financing system. One piece is taking the billion dollars a year the state now uses to reimburse hospitals for treating the uninsured and instead allocating those funds to subsidize low-income families' purchase of private health insurance. Romney's defense against the "big government" charge from conservatives who see the insurance mandate as an infringement on individual freedom is that "making the individual responsible for his own health coverage is a lot more conservative than a permanent program of government handouts to hospitals."

That idea came from Romney and his health and welfare commissioner, Timothy Murphy. The other big outside-the-box idea was given to him by the Heritage Foundation's Edmund Haislmaier. He proposed creation of a new organization he called an insurance exchange, which Romney renamed the Connector. In essence, it's a type of public bank that will collect the premiums from individuals and pass them on to their chosen insurers. By creating that entity, it becomes possible under federal tax laws for individuals to buy health insurance with pretax dollars, just as employers now do in company plans. Romney estimates that this innovation will save 30 percent to 35 percent and keep the cost of a basic policy to about $200 a month per person.

This is a rare and exotic political hybrid, with a basis in a conservative think tank and the blessing of a Democratic legislature and Sen. Ted Kennedy. The passage of such a program with overwhelming bipartisan support is a notable achievement in a time of polarized, partisan politics. But it is still just an idea. It remains to be seen how many uninsured people actually order policies, what the sign-up difficulties may be, how high the deductibles and co-pays have to be set to keep the price to $200, and whether there are sufficient economies and cost controls to make it affordable in the future.

Romney remarked, "I wish I were going to be governor the next five years to see it through," but he has made the decision to step down at the end of this year and is preparing to seek the presidency.
But he knows the real challenges lie ahead for him, just as they do for his health plan. One special test involves the public reaction to his Mormon faith. He thinks it won't ultimately be a barrier, but says, "At some point, I know, I will have to face all the questions about its tenets. . . . But I think tolerance will prevail again."
Meantime, his health plan gives him a unique calling card -- and provides the country with an important opportunity to test one possible solution to a vexing problem.