While I don't like or support Massachusetts' health care system, and think it was a bad decision on Romney's part, to say that there's no difference between policy made on the federal level and policy made on the state level, even if they're substantially similar, is to completely undermine the notion of federalism - one of the fundamental conceptual and functional components of the republic and a key tenet of conservatism. OTOH, to suggest that a governor who implemented at the state level the same type of behemoth government entitlement that Zero is trying to implement at the federal level will other than that govern conservatively is -at best - very naive.