Mission Impossible

Healthcare, the ultimate state budget-buster and our biggest industry, got almost no air time in Mitt Romney's State of the State address last week. But think not that nothing is happening. To the contrary, the governor is thinking big. He is exploring a goal that has eluded many before him: health insurance coverage for every person in Massachusetts, a very Democratic-sounding theme.

The questions are familiar. What would it look like? What would it cost? Who would pay? It is the answers to those familiar questions, now being quietly considered by a small group inside and outside the Republican Romney administration, that are already making people nervous, the state's already stretched-thin hospital industry very much included.

Ron Preston, the state's secretary of health and human services, has been put in charge of studying whether Romney's stated ambition to provide universal healthcare coverage is doable. He calls it a Mission Impossible. "In 30 or 40 years, no state has been able to achieve this. . . . It might be impossible for one state to achieve this," he says. Preston says he does not know the answer, but is working on a tight time line: He hopes to have potential models ready for the governor's consideration no later than early spring.

Massachusetts tried this once. Fifteen years ago, in the midst of his run for the presidency, former governor Michael Dukakis got a universal healthcare law through the Legislature, only to have it collapse under the weight of a sagging economy and rising healthcare costs. The Clinton administration famously made a run at a universal plan and failed.

Since July, Preston has been consulting with a tight group. Among them: Charlie Baker, CEO of Harvard Pilgrim Health Care and a former top official in the Weld administration; Baker's top deputy, Bruce Bullen, who once ran the state's Medicaid operations; Bob Pozen, who recently departed as Romney's top economic adviser; and Jonathan Gruber, an MIT healthcare economist who worked in the Clinton Treasury Department. Many in the healthcare world worry they are being shut out of the discussions. To this Preston says: "The show hasn't even started."

One focus of any universal plan will have to be the state's free-care pool, which pays for the state's 500,000 (and growing) uninsured. The system is widely reviled by most of the state's hospitals, who pay in but get little back, while a few hospitals, mainly in Boston, Cambridge, and Brockton, do relatively well. Any Romney plan would use the $570 million free-care pool to pay for insurance. "If you have a mechanism where everyone has basic insurance, why would you need a free-care pool?" asks Preston.

What would that basic insurance mean? Would it be mainly focused on primary and preventive care, or on catastrophic coverage? "You are way out ahead of us," says Preston. "We haven't had those discussions yet."

Richard T. Moore, Senate chairman of the Legislature's healthcare committee, says he has no details of what the Romney people are working on. Says Moore: "I don't know how they are planning to pay for it." . . .

Neighborhood news: Was it something I said? Last week, on the day of his upbeat State of the City address, Boston Mayor Tom Menino also spoke to Jobs for Massachusetts, a group of the city's business, political, and union leaders who meet regularly in private. Our thin-skinned mayor complained the city's newspapers were too negative and suggested the executives could send the Globe and the Boston Herald a message by withholding ads for a day or two, says one of those at the meeting. There was considerable support, but the mayor's call for a boycott went nowhere in the end. A Menino spokesman declined to comment.

Steve Bailey is a Globe columnist. He can be reached at 617-929-2902 or at bailey@globe.com.