Health care (or healthcare) is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers. It refers to the work done in providing primary care, secondary care and tertiary care, as well as in public health.

Access to health care varies across countries, groups and individuals, largely influenced by social and economic conditions as well as the health policies in place. Countries and jurisdictions have different policies and plans in relation to the personal and population-based health care goals within their societies. Health care systems are organizations established to meet the health needs of target populations. Their exact configuration varies from country to country. In some countries and jurisdictions, health care planning is distributed among market participants, whereas in others planning is made more centrally among governments or other coordinating bodies. In all cases, according to the World Health Organization (WHO), a well-functioning health care system requires a robust financing mechanism; a well-trained and adequately-paid workforce; reliable information on which to base decisions and policies; and well maintained facilities and logistics to deliver quality medicines and technologies.^[1]

Health care can form a significant part of a country's economy. In 2008, the health care industry consumed an average of 9.0 percent of the gross domestic product (GDP) across the most developed OECD countries.^[2] The United States (16.0%), France (11.2%), and Switzerland (10.7%) were the top three spenders.

Health care is conventionally regarded as an important determinant in promoting the general health and well-being of people around the world. An example of this is the worldwide eradication of smallpox in 1980—declared by the WHO as the first disease in human history to be completely eliminated by deliberate health care interventions.^[3]

Health care delivery[link]

Primary care may be provided in community health centres.

The delivery of modern health care depends on groups of trained professionals and paraprofessionals coming together as interdisciplinary teams.^[4][5] This includes professionals in medicine, nursing, dentistry and allied health, plus many others such as public health practitioners, community health workers and assistive personnel, who systematically provide personal and population-based preventive, curative and rehabilitative care services.

While the definitions of the various types of health care vary depending on the different cultural, political, organizational and disciplinary perspectives, there appears to be some consensus that primary care constitutes the first element of a continuing health care process, that may also include the provision of secondary and tertiary levels of care.^[6]

Primary care[link]

Medical train "Therapist Matvei Mudrov" in Khabarovsk, Russia

Primary care is the term for the health care services which play a role in the local community. It refers to the work of health care professionals who act as a first point of consultation for all patients within the health care system.^[6][7] Such a professional would usually be a primary care physician, such as a general practitioner or family physician, or a non-physician primary care provider, such as a physician assistant or nurse practitioner. Depending on the locality, health system organization, and sometimes at the patient's discretion, they may see another health care professional first, such as a pharmacist, a nurse (such as in the United Kingdom), a clinical officer (such as in parts of Africa), or an Ayurvedic or other traditional medicine professional (such as in parts of Asia). Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

Primary care involves the widest scope of health care, including all ages of patients, patients of all socioeconomic and geographic origins, patients seeking to maintain optimal health, and patients with all manner of acute and chronic physical, mental and social health issues, including multiple chronic diseases. Consequently, a primary care practitioner must possess a wide breadth of knowledge in many areas. Continuity is a key characteristic of primary care, as patients usually prefer to consult the same practitioner for routine check-ups and preventive care, health education, and every time they require an initial consultation about a new health problem. The International Classification of Primary Care (ICPC) is a standardized tool for understanding and analyzing information on interventions in primary care by the reason for the patient visit.^[8]

Common chronic illnesses usually treated in primary care may include, for example: hypertension, diabetes, asthma, COPD, depression and anxiety, back pain, arthritis or thyroid dysfunction. Primary care also includes many basic maternal and child health care services, such as family planning services and vaccinations.

In context of global population aging, with increasing numbers of older adults at greater risk of chronic non-communicable diseases, rapidly increasing demand for primary care services is expected around the world, in both developed and developing countries.^[9][10] The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy.^[6]

Secondary care[link]

Secondary care is the health care services provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists.

It includes acute care: necessary treatment for a short period of time for a brief but serious illness, injury or other health condition, such as in a hospital emergency department. It also includes skilled attendance during childbirth, intensive care, and medical imaging services.

The "secondary care" is sometimes used synonymously with "hospital care". However many secondary care providers do not necessarily work in hospitals, such as psychiatrists, clinical psychologists or physiotherapists, and some primary care services are delivered within hospitals. Depending on the organization and policies of the national health system, patients may be required to see a primary care provider for a referral before they can access secondary care.

For example in the United States, which operates under a mixed market health care system, some physicians might voluntarily limit their practice to secondary care by requiring patients to see a primary care provider first, or this restriction may be imposed under the terms of the payment agreements in private/group health insurance plans. In other cases medical specialists may see patients without a referral, and patients may decide whether self-referral is preferred.

In the United Kingdom and Canada, patient self-referral to a medical specialist for secondary care is rare as prior referral from another physician (either a primary care physician or another specialist) is considered necessary, regardless of whether the funding is from private insurance schemes or national health insurance.

Allied health professionals, such as physical therapists, respiratory therapists, occupational therapists, speech therapists, and dietitians, also generally work in secondary care, accessed through either patient self-referral or through physician referral.

Tertiary care[link]

The National Hospital for Neurology and Neurosurgery in London, United Kingdom is a specialist neurological hospital.

Tertiary care is specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.^[11]

Examples of tertiary care services are cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns, advanced neonatology services, palliative, and other complex medical and surgical interventions.^[12]

Quaternary care[link]

The term quaternary care is also used sometimes as an extension of tertiary care in reference to medicine of advanced levels which are highly specialized and not widely accessed. Experimental medicine and some types of uncommon diagnostic or surgical procedures are considered quaternary care. These services are usually only offered in a limited number of regional or national health care centres.^[12][13]

Home and community care[link]

Many types of health care interventions are delivered outside of health facilities. They include many interventions of public health interest, such as food safety surveillance, distribution of condoms and needle-exchange programmes for the prevention of transmissible diseases.

They also include the services of professionals in residential and community settings in support of self care, home care, long-term care, assisted living, treatment for substance use disorders, and other types of health and social care services.

Related sectors[link]

Health care extends beyond the delivery of services to patients, encompassing many related sectors, and set within a bigger picture of financing and governance structures.

Health system[link]

A health system, also sometimes referred to as health care system or healthcare system is the organization of people, institutions, and resources to deliver health care services to meet the health needs of target populations.

Health care industry[link]

A group of Chilean 'Damas de Rojo' volunteering at their local hospital.

The health care industry incorporates several sectors that are dedicated to providing health care services and products. As a basic framework for defining the sector, the United Nations' International Standard Industrial Classification categorizes health care as generally consisting of hospital activities, medical and dental practice activities, and "other human health activities". The last class involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilities, or other allied health professions, e.g. in the field of optometry, hydrotherapy, medical massage, yoga therapy, music therapy, occupational therapy, speech therapy, chiropody, homeopathy, chiropractics, acupuncture, etc.^[14]

In addition, according to industry and market classifications, such as the Global Industry Classification Standard and the Industry Classification Benchmark, health care includes many categories of medical equipment, instruments and services as well as biotechnology, diagnostic laboratories and substances, and drug manufacturing and delivery.

For example, pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States.^[15][16] The United States dominates the biopharmaceutical field, accounting for three-quarters of the world’s biotechnology revenues.^[17][15]

Health care research[link]

The quantity and quality of many health care interventions are improved through the results of science, such as advanced through the medical model of health which focuses on the eradication of illness through diagnosis and effective treatment. Many important advances have been made through health research, including biomedical research and pharmaceutical research. They form the basis of evidence-based medicine and evidence-based practice in health care delivery.

For example, in terms of pharmaceutical research and development spending, Europe spends a little less than the United States (€22.50bn compared to €27.05bn in 2006). The United States accounts for 80% of the world's research and development spending in biotechnology.^[15][17]

In addition, the results of health services research can lead to greater efficiency and equitable delivery of health care interventions, as advanced through the social model of health and disability, which emphasizes the societal changes that can be made to make population healthier.^[18] Results from health services research often form the basis of evidence-based policy in health care systems. Health services research is also aided by initiatives in the field of AI for the development of systems of health assessment that are clinically useful, timely, sensitive to change, culturally sensitive, low burden, low cost, involving for the patient and built into standard procedures.^[19]

Health care financing[link]

There are generally five primary methods of funding health care systems:^[20]

1. general taxation to the state, county or municipality
2. social health insurance
3. voluntary or private health insurance
4. out-of-pocket payments
5. donations to health charities

In most countries, the financing of health care services features a mix of all five models, but the exact distribution varies across countries and over time within countries. In all countries and jurisdictions, there are many topics in the politics and evidence that can influence the decision of a government, private sector business or other group to adopt a specific health policy regarding the financing structure.

For example, social health insurance is where a nation's entire population is eligible for health care coverage, and this coverage and the services provided are regulated. In almost every jurisdiction with a government-funded health care system, a parallel private, and usually for-profit, system is allowed to operate. This is sometimes referred to as two-tier health care or universal health care.

Health care administration and regulation[link]

The management and administration of health care is another sector vital to the delivery of health care services. In particular, the practice of health professionals and operation of health care institutions is typically regulated by national or state/provincial authorities through appropriate regulatory bodies for purposes of quality assurance.^[21] Most countries have credentialing staff in regulatory boards or health departments who document the certification or licensing of health workers and their work history.^[22]

Health information technology[link]

Health information technology (HIT) is “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making” (Brailer, & Thompson, 2004). Technology is a broad concept that deals with a species' usage and knowledge of tools and crafts, and how it affects a species' ability to control and adapt to its environment. However, a strict definition is elusive; "technology" can refer to material objects of use to humanity, such as machines, hardware or utensils, but can also encompass broader themes, including systems, methods of organization, and techniques. For HIT, technology represents computers and communications attributes that can be networked to build systems for moving health information. Informatics is yet another integral aspect of HIT.

See also[link]

	Medicine portal
	Health and fitness portal
	Society portal

• Acronyms in healthcare
• Healthcare system / Health care provider
• Health center / Clinic / Hospital / Nursing Home
• Medicine / Doctor's visit / Nursing
• Philosophy of healthcare
  • Social service / Social determinants of health
  • Family medicine / Preventive medicine / Social medicine
  • Community health service / Community health centers in the United States
  • Direct primary care (United States)
• Health policy
  • Health insurance / Insurance /Social health insurance / Subsidies
  • Health care reform / Health care reform in the United States
  • Healthy city / Alliance for Healthy Cities
• Universal health care
  • Health care in the United States as a private system
  • Healthcare in the United Kingdom
  • Healthcare in Cuba as a state owned system
  • Health in Germany as a private system under state controlled insurance
  • Primary Health Organisation (New Zealand)
• Medical classification
  • ATC codes (Anatomical Therapeutic Chemical classification system)
  • Classification of Pharmaco-Therapeutic Referrals (CPR)
  • ICD-10 (International Classification of Diseases)
  • International Classification of Primary Care (ICPC-2) / ICPC-2 PLUS

Notes[link]

External links[link]

Wikimedia Commons has media related to: Health care

• HR3200: America's Affordable Health Choices Act of 2009
• Health Care Policymakers at WhoRunsGov at The Washington Post
• Defining Primary Care from Institute of Medicine IOM—Primary Care: America's Health in a New Era (1996)
• Primary Care Definitions from American Academy of Family Physicians AAFP
• Definition of Primary Care from American Medical Association AMA
• Defining primary health care Department of Health United Kingdom UK
• What is primary health care? Aboriginal Medical Services Alliance Northern Territory (AMSANT) Australia
• Primary Care Diabetes Journal

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Mitt Romney
70th Governor of Massachusetts
In office January 2, 2003 – January 4, 2007
Lieutenant	Kerry Healey
Preceded by	Jane Swift (Acting)
Succeeded by	Deval Patrick
Personal details
Born	Willard Mitt Romney (1947-03-12) March 12, 1947 (age 65) Detroit, Michigan, U.S.
Political party	Republican
Spouse(s)	Ann Romney (m. 1969) «start: (1969)»"Marriage: Ann Romney to Mitt Romney" Location: (linkback:http://en-wiki.pop.wn.com/index.php/Mitt_Romney)
Children	Taggart (b. 1970) Matthew (b. 1971) Joshua (b. 1975) Benjamin (b. 1978) Craig (b. 1981)
Residence	Belmont, Massachusetts Wolfeboro, New Hampshire San Diego, California
Alma mater	Brigham Young University (BA) Harvard University (MBA, JD)
Religion	The Church of Jesus Christ of Latter-day Saints (Mormon)
Positions	Co-founder, Bain Capital (1984–1999) CEO, Bain & Company (1991–1992) CEO, 2002 Winter Olympics Organizing Committee (1999–2002)
Signature
Website	MittRomney.com

	This article is part of a series about Mitt Romney	Mitt Romney
2012 Presidential campaign 2008 Presidential campaign Governor of Massachusetts, 2003–2007 1994 U.S. Senate election Political positions · Electoral history Public image

Willard Mitt Romney (born March 12, 1947) is an American businessman and the presumptive nominee of the Republican Party for President of the United States in the 2012 election. He was the 70th Governor of Massachusetts (2003–07).

The son of Lenore and George W. Romney (Governor of Michigan, 1963–69), he was raised in Bloomfield Hills, Michigan. In 1966, after one year at Stanford University, he left the United States to spend thirty months in France as a Mormon missionary. In 1969, he married Ann Davies, and the couple had five children together. In 1971, he earned a Bachelor of Arts degree in English from Brigham Young University and, in 1975, a joint Juris Doctor and Master of Business Administration from Harvard University as a Baker Scholar. He entered the management consulting industry, which in 1977, led to a position at Bain & Company. Later serving as Chief Executive Officer, he helped bring the company out of financial crisis. In 1984, he co-founded the spin-off Bain Capital, a private equity investment firm that became highly profitable and one of the largest such firms in the nation. His net worth is estimated at $190–250 million, wealth that has helped fund his political campaigns. Active in The Church of Jesus Christ of Latter-day Saints, he served as Ward Bishop and later Stake President in his area near Boston. He ran as the Republican candidate in the 1994 U.S. Senate election in Massachusetts, losing to long-time incumbent Ted Kennedy. In 1999, he was hired as President and CEO of the Salt Lake Organizing Committee for the 2002 Winter Olympics and Paralympics; and he helped turn the fiscally troubled games into a success.

He was elected Governor of Massachusetts in 2002 but did not seek re-election in 2006. During his term he presided over a series of spending cuts and increases in fees that eliminated a projected $1.5 billion deficit. He also signed into law the Massachusetts health care reform legislation, the first of its kind in the nation, which provided near-universal health insurance access via state-level subsidies and individual mandates.

Romney ran for the Republican nomination in the 2008 U.S. presidential election, winning several primaries and caucuses but losing the nomination to John McCain. In the following years, he gave speeches and raised campaign funds on behalf of his fellow Republicans. In June 2011, he announced that he would seek the 2012 Republican presidential nomination; as of May 2012, he has won enough caucuses and primaries to become the party's presumptive nominee.

Early life and education[link]

Heritage and youth[link]

Willard Mitt Romney^[1] was born at Harper Hospital in Detroit, Michigan,^[2] the youngest child of George W. Romney, a self-made man who by 1948 had become an automobile executive, and Lenore Romney (née LaFount), an aspiring actress turned homemaker.^[3][4][5] His mother was a native of Logan, Utah, and his father was born in a Mormon colony in Chihuahua, Mexico, to American parents.^[6][7] He is of primarily English descent, and also has more distant Scottish and German ancestry.^[8][9][10] He is a fifth-generation member of The Church of Jesus Christ of Latter-day Saints (LDS Church).^[11][12] A great-great-grandfather, Miles Romney, converted to the faith in its first decade, and another great-great-grandfather, Parley P. Pratt, was an early leader in the church during the same time.^[13]

He was preceded in birth by three siblings: Margo Lynn, Jane LaFount, and G. Scott. Mitt followed after a gap of nearly six years. He was named after family friend, hotel magnate J. Willard Marriott, and his father's cousin Milton "Mitt" Romney, a former quarterback for the Chicago Bears.^{[14][nb 1]} In 1953, the family moved from Detroit to the affluent suburb of Bloomfield Hills.^[16] In 1954, his father became the chairmen and CEO of American Motors, a company he helped avoid bankruptcy, and return to profitability.^[16] By the time Mitt was twelve, his father had become a nationally known figure in print and on television,^[17] and Mitt idolized him.^[18]

Mitt Romney began attending Cranbrook School in the seventh grade.

He attended public elementary schools^[15] until the seventh grade, when he began commuting to Cranbrook School in Bloomfield Hills, a traditional private boys' preparatory school where he was one of only a few Mormons and where many students came from backgrounds even more privileged than he.^[19][20] He was not particularly athletic and at first did not excel academically.^[18] During his sophomore year he participated in the 1962 campaign in which his father was elected Governor of Michigan.^{[nb 2]} When his parents moved to the state capitol as part of George Romney taking office, Mitt took up residence at Cranbrook's Stevens Hall.^[19] George Romney was re-elected twice; Mitt worked for him as an intern in the governor's office, and was present at the 1964 Republican National Convention when his moderate father battled conservative party nominee Barry Goldwater over issues of civil rights and ideological extremism.^[18][22] During these years, Romney had a steady set of chores and summer jobs, including working as a security guard at a Chrysler plant.^[23]

At Cranbrook he was a manager for the ice hockey team and a member of the pep squad,^[19] and during his final year joined the cross country running team.^[15] He belonged to eleven school organizations and school clubs, and started the Blue Key Club boosters group.^[19] During his final year at Cranbook, Romney improved academically, but was still not a star pupil.^[18][20] He won an award for those "whose contributions to school life are often not fully recognized through already existing channels".^[20] Romney was involved in many pranks.^{[nb 3]}

In March of his senior year, he began dating Ann Davies, two years his younger, whom he had first met in elementary school; she attended the private Kingswood School, the sister school to Cranbrook.^[27][20] The two informally agreed to marriage around the time of his June 1965 graduation.^[18]

University, France mission, marriage and children: 1965–1975[link]

Romney attended Stanford University for a year,^{[18][nb 4]} where he worked as a night security guard in order to pay for trips home to see Ann.^[28] Although the campus was becoming radicalized with the beginnings of 1960s social and political movements, he kept a well-groomed appearance and participated in pre-Big Game actions designed to protect the Stanford Axe.^[18] In May 1966, he was part of a counter-protest against a group staging a sit-in in the university administration building in opposition to draft status tests.^[18][29]

In July 1966, he left for a thirty-month stay in France as a Mormon missionary,^[18][31] a traditional rite of passage that his father and many other relatives had volunteered for.^{[nb 5]} He arrived in Le Havre with ideas about how to change and promote the French Mission, while facing physical and economic deprivation in their cramped quarters.^[33][13] Rules against drinking, smoking, and dating were strictly enforced.^[13] Most individual Mormon missionaries do not gain many converts,^[35] and Romney was no exception:^[33] he later estimated ten to twenty for his entire mission.^[36] The nominally Catholic but secular, wine-loving French people were especially resistant to a religion that prohibits alcohol.^[18][13][30] He became demoralized, and later recalled it as the only time when "most of what I was trying to do was rejected."^[33] In Nantes, he suffered a bruised jaw while defending two female missionaries who were being bothered by a group of local rugby players.^[13] He continued to work hard; having grown up in Michigan rather than the more insular Utah world, Romney was better able to interact with the French than other missionaries.^[37][13] He was promoted to zone leader in Bordeaux in early 1968, then in the spring of that year became assistant to the mission president in Paris, the highest position for a missionary.^[33][13][38] In the Mission Home in Paris he enjoyed palace-like accommodations.^[38] Romney's support for the U.S. role in the Vietnam War was only reinforced when the French greeted him with hostility over the matter and he debated them in return.^[13][33] He witnessed the May 1968 general strike and student uprisings and was upset by the breakdown in social order.^[39]

In June 1968, an automobile he was driving in southern France was hit by another vehicle, seriously injuring him and killing one of his passengers, the wife of the mission president.^{[nb 6]} Romney, who was not at fault in the accident,^{[nb 6]} became co-acting president of a mission demoralized and disorganized by the May civil disturbances and by the car accident.^[37] He rallied and motivated the others and they met an ambitious goal of 200 baptisms for the year, the most for the mission in a decade.^[37] By the end of his stint in December 1968, he was overseeing the work of 175 fellow members.^[33][40] Romney developed a lifelong affection for France and its people, and speaks French.^[42] The experience in the country instilled in him a belief that life is fragile and that he needed seriousness of purpose.^[18][37][13] It also represented a crucible, after having been an indifferent Mormon growing up: "On a mission, your faith in Jesus Christ either evaporates or it becomes much deeper ... For me it became much deeper."^[33]

While he was away, Ann Davies had converted to the Mormon faith, guided by George Romney, and had begun attending Brigham Young University (BYU).^[18] Mitt was nervous that she had been wooed by others while he was away, and she had indeed started dating popular campus figure Kim S. Cameron and had sent Romney in France a "Dear John letter", greatly upsetting him; he wrote to her to in an attempt to win her back.^[43][15] At their first meeting following Romney's return they reconnected, and decided to get married immediately but agreed to wait three months to appease their parents.^[44] At Ann's request, Romney began attending Brigham Young too, in February 1969.^{[43][nb 4]} The couple were married on March 21, 1969, in a civil ceremony at Ann's family's home in Bloomfield Hills that was presided over by a church elder.^[46][47][48] The following day, the couple flew to Utah for a wedding ceremony at the Salt Lake Temple.^[46][47]

While Mitt attended Harvard, his father George W. Romney (pictured here with Richard M. Nixon) served as United States Secretary of Housing and Urban Development.

Romney had missed much of the tumultuous American anti-Vietnam War movement while away, and was surprised to learn that his father had turned against the effort during his unsuccessful 1968 presidential campaign.^[33] Regarding the military draft, Romney had initially received a student deferment, then, like most Mormon missionaries, a ministerial deferment while in France, and then a student deferment.^[33][49] When those ran out, his high number in the December 1969 draft lottery (300) ensured he would not be selected.^[33][49][50]

At culturally conservative BYU, he remained isolated from much of the upheaval of the era, and did not join in protests against the war, or the LDS Church's policy at the time of denying full membership to blacks.^[24][33][43] He became president of, and an innovative fundraiser for, the all-male Cougar Club booster organization and showed a new-found discipline in his studies.^[33][43] In his senior year, he took leave to work as driver and advance man for his mother Lenore Romney's eventually unsuccessful 1970 campaign for U.S. Senator from Michigan.^[24][46] He earned a Bachelor of Arts in English with highest honors in 1971,^[43] and gave commencement addresses to both the College of Humanities and to the whole of BYU.^{[nb 7]}

The Romneys' first son, Taggart, was born in 1970^[46] while they were undergraduates at Brigham Young^[52] and living in a basement apartment.^[33][43] Ann subsequently gave birth to Matt (1971), Josh (1975), Ben (1978), and Craig (1981).^[46] Her work as a homemaker would enable her husband to pursue his career.^[53]

Romney still wanted to pursue a business path, but his father, by now serving in President Richard Nixon's cabinet as U.S. Secretary of Housing and Urban Development, advised him that a law degree would be valuable to his career.^[54][55] Thus he became one of only fifteen students to enroll at the recently created joint Juris Doctor/Master of Business Administration four-year program coordinated between Harvard Law School and Harvard Business School.^[56] Fellow students considered him guilelessly optimistic, noting his solid work ethic and buttoned-down demeanor and appearance.^[56][57] He readily adapted to the business school's pragmatic, data-driven case study method of teaching, participated in class well, and led a study group whom he pushed to get all A's.^[55] He had a different social experience from most of his classmates, since he lived in a Belmont, Massachusetts, house with Ann and two children.^[46][55] He was non-ideological and did not involve himself in the political or social issues of the day.^[46][55] He graduated in 1975 cum laude from the law school, in the top third of that class, and was named a Baker Scholar for graduating in the top five percent of his business school class.^[51][56]

Business career[link]

Management consulting[link]

Romney was recruited by several firms and chose to remain in Massachusetts to work for Boston Consulting Group (BCG), reasoning that working as a management consultant to a variety of companies would better prepare him for a future position as a chief executive.^{[54][58][nb 8]} He was part of a 1970s wave of top graduates who chose to go into consulting rather than join a major company directly.^[60] His legal and business education proved useful in his job^[54] while he applied BCG principles such as the growth-share matrix.^[61] He was viewed as having a bright future there.^[54][62]

In 1977, he was hired away by Bain & Company, a management consulting firm in Boston that had been formed a few years earlier by Bill Bain and other former BCG employees.^[61][54][63] Bain would later say of the thirty-year-old Romney, "He had the appearance of confidence of a guy who was maybe ten years older."^[64] With Bain & Company, Romney learned what writers and business analysts have dubbed the "Bain way",^[54][63][65] which consisted of immersing the firm in each client's business,^[54][64] and not just issuing recommendations but staying with the company until changes were put into place.^[61][63][66] Romney became a vice president of the firm in 1978,^[15] and worked with clients such as the Monsanto Company, Outboard Marine Corporation, Burlington Industries, and Corning Incorporated.^[58] Within a few years, he was one of Bain & Company's best consultants and was sought after by clients over more senior partners.^[54][67]

Private equity[link]

Romney was restless for a company of his own to run, and in 1983, Bill Bain offered him the chance to head a new venture that would buy into companies, have them benefit from Bain techniques, and then reap higher rewards than consulting fees.^[54][61] He initially refrained from accepting the offer, and Bain re-arranged the terms in a complicated partnership structure so that there was no financial or professional risk to Romney.^[54][64][68] Thus, in 1984, Romney left Bain & Company to co-found the spin-off private equity investment firm, Bain Capital.^[66] In the face of skepticism from potential investors, Bain and Romney spent a year raising the $37 million in funds needed to start the new operation, which had fewer than ten employees.^[58][64][69] As general partner of the new firm, Romney spent little money on costs such as office appearance, and saw weak spots in so many potential deals that by 1986, few had been done.^[54] At first, Bain Capital focused on venture capital opportunities.^[54] Their first big success was a 1986 investment to help start Staples Inc., after founder Thomas G. Stemberg convinced Romney of the market size for office supplies and Romney convinced others; Bain Capital eventually reaped a nearly sevenfold return on its investment, and Romney sat on the Staples board of directors for over a decade.^[54][69][70]

Romney soon switched Bain Capital's focus from startups to the relatively new business of leveraged buyouts: buying existing firms with money mostly borrowed against their assets, partnering with existing management to apply the "Bain way" to their operations (rather than the hostile takeovers practiced in other leverage buyout scenarios), and selling them off in a few years.^[54][64] Existing CEOs were offered large equity stakes in the process, owing to Bain Capital's belief in the emerging agency theory that CEOs should be bound to maximizing shareholder value rather than other goals.^[70] Bain Capital lost most of its money in many of its early leveraged buyouts, but then started finding deals that made large returns.^[54] The firm invested in or acquired Accuride, Brookstone, Domino's Pizza, Sealy Corporation, Sports Authority, and Artisan Entertainment, as well as lesser-known companies in the industrial and medical sectors.^[54][64][71] He ran Bain Capital for fourteen years, during which time the firm's average annual internal rate of return on realized investments was 113 percent.^[58] Much of this profit was earned from a relatively small number of deals; Bain Capital's overall success–to–failure ratio was about even.^{[nb 9]}

Less an entrepreneur than an executive running an investment operation,^[67][72] Romney was skilled at presenting and selling the deals the company made.^[68] The firm initially gave a cut of its profits to Bain & Company, but Romney persuaded Bain to give that up.^[68] Within Bain Capital, Romney spread profits from deals widely within the firm to keep people motivated, often keeping less than ten percent for himself.^[73] Viewed as a fair manager, he received considerable loyalty from the firm's members.^[70] Romney's wary instincts were still in force at times, and he was generally data-driven and averse to risk.^[54][70] He wanted to drop a Bain Capital hedge fund that initially lost money, but other partners prevailed and it eventually gained billions.^[54] He also personally opted out of the Artisan Entertainment deal, not wanting to profit from a studio that produced R-rated films.^[54] Romney was on the board of directors of Damon Corporation, a medical testing company later found guilty of defrauding the government; Bain Capital tripled its investment before selling off the company, and the fraud was discovered by the new owners (Romney was never implicated).^[54] In some cases, Romney had little involvement with a company once acquired.^[69]

Bain Capital's leveraged buyouts sometimes led to layoffs, either soon after acquisition or later after the firm had left.^[61][68][69] How jobs added compared to those lost due to these investments and buyouts is unknown, due to a lack of records and Bain Capital's penchant for privacy on behalf of itself and its investors.^[74][75][76] In any case, maximizing the value of acquired companies and the return to Bain's investors, not job creation, was the firm's fundamental goal, as it was for most private equity operations.^[69][77] Bain Capital's acquisition of Ampad exemplified a deal where it profited handsomely from early payments and management fees, even though the subject company itself ended up going into bankruptcy.^[54][70][77] Dade Behring was another case where Bain Capital received an eightfold return on its investment, but the company itself was saddled with debt and laid off over a thousand employees before Bain Capital exited (the company subsequently went into bankruptcy, with more layoffs, before recovering and prospering).^[74] Bain was among the private equity firms that took the most fees in such cases.^[64][70]

In 1990, Romney was asked to return to Bain & Company, which was facing financial collapse.^[66] He was announced as its new CEO in January 1991^[78][79] but drew only a symbolic salary of one dollar.^[66] He managed an effort to restructure the firm's employee stock-ownership plan, real-estate deals and bank loans, while rallying the firm's thousand employees, imposing a new governing structure that included Bain and the other founding partners giving up control, and increasing fiscal transparency.^[54][58][66] Within about a year, he had led Bain & Company through a turnaround and returned the firm to profitability without further layoffs or partner defections.^[58] He turned Bain & Company over to new leadership and returned to Bain Capital in December 1992.^[54][79][80]

Romney took a leave of absence from Bain Capital in February 1999 to serve as the President and CEO of the 2002 Salt Lake City Olympic Games Organizing Committee.^[54][81] By that time, Bain Capital was on its way to being one of the top private equity firms in the nation,^[68] having increased its number of partners from 5 to 18, with 115 employees overall, and $4 billion under its management.^[64][69] Bain Capital's approach of applying consulting expertise to the companies it invested in became widely copied within the private equity industry.^[25][69] Economist Steven Kaplan would later say, "[Romney] came up with a model that was very successful and very innovative and that now everybody uses."^[70]

Personal wealth[link]

In August 2001, Romney announced that he would not return to Bain Capital.^[81] He transferred his ownership to other partners and negotiated an agreement that allowed him to receive a passive profit share as a retired partner in some Bain Capital entities, including buyout and investment funds.^[73][82] Because the private equity business continued to thrive, this deal brought him millions of dollars in annual income.^[73] As a result of his business career, by 2007, Romney and his wife had a net worth of between $190 and $250 million, most of it held in blind trusts since 2003.^[82] In 2012, it was estimated that he had amassed twice the net worth of the last eight presidents combined,^[83] and would rank among the four richest in American history if elected.^[83][84]

An additional blind trust existed in the name of the Romneys' children and grandchildren that was valued at between $70 and $100 million as of 2007.^[85] The couple's net worth remained in the same range as of 2011, and was still held in blind trusts.^[86] In 2010, Romney and his wife received $21.7 million in income, almost all of it from investments, of which about $3 million went to federal income taxes (a rate of 13.9 percent, based upon the beneficial rate accorded investment income by the U.S. tax code) and almost $3 million to charity, including $1.5 million to the LDS Church.^[87] Romney has always tithed to the church, including stock from Bain Capital holdings.^[13][88][89] In 2010, the Romney family's Tyler Charitable Foundation gave out about $650,000, with some of it going to organizations that fight specific diseases such as cystic fibrosis and multiple sclerosis.^[90]

Local LDS Church leadership[link]

During his years in business, Romney also served in the local lay clergy (consisting of all Mormon men over the age of 12).^[13] Around 1977, he became a counselor to the president of the Boston Stake.^[91] He later served as bishop of the ward (leader of the congregation) at Belmont, Massachusetts, from 1981 to 1986, acting as the ecclesiastical and administrative head of his congregation.^[92][93] As such, in addition to home teaching, he also formulated Sunday services and classes using LDS scriptures to guide the congregation.^[94] He forged bonds with other religious institutions in the area when the Belmont meetinghouse was destroyed by a fire of suspicious origins in 1984; the congregation rotated its meetings to other houses of worship while it was rebuilt.^[88][93]

From 1986 to 1994, he presided over the Boston Stake, which included more than a dozen wards in eastern Massachusetts with about 4,000 church members altogether.^[67][94][95] He organized a team to handle financial and management issues, sought to counter anti-Mormon sentiments, and tried to solve social problems among poor Southeast Asian converts.^[88][93] An unpaid position, his local church leadership often took 30 or more hours a week of his time,^[94] and he became known for his tireless energy in the role.^[67] He generally refrained from overnight business travel owing to his church responsibilities.^[94]

He took a hands-on role in general matters, helping in maintenance efforts in- and outside homes, visiting the sick, and counseling troubled or burdened church members.^[92][93][94] A number of local church members later credited him with turning their lives around or helping them through difficult times.^[88][93][94] Some others were rankled by his leadership style and desired a more consensus-based approach.^[93] Romney tried to balance the conservative dogma insisted upon by the church leadership in Utah with the desire of some Massachusetts members to have a more flexible application of doctrine.^[67] He agreed with some modest requests from the liberal women's group Exponent II for changes in the way the church dealt with women, but clashed with women whom he felt were departing too much from doctrine.^[67] In particular, he counseled women not to have abortions except in the rare cases allowed by LDS doctrine, and also in accordance with doctrine, encouraged prospective mothers who were not in successful marriages to give up children for adoption.^[67] Romney later said that the years spent as an LDS minister gave him direct exposure to people struggling in economically difficult circumstances, and empathy for those going through problematic family situations.^[96]

1994 U.S. senatorial campaign[link]

By 1993, Romney had been thinking about entering politics, partly based upon Ann's urging and partly to follow in his father's footsteps.^[46] He decided to challenge incumbent Democratic U.S. Senator Ted Kennedy, who was seeking re-election for the sixth time. Kennedy was potentially vulnerable that year – in part because of the unpopularity of the Democratic Congress as a whole, and in part because this was Kennedy's first election since the William Kennedy Smith trial in Florida, in which Kennedy had suffered some negative public relations regarding his character.^[97][98][99] Romney changed his affiliation from Independent to Republican in October 1993 and formally announced his candidacy in February 1994.^[46] He took a leave of absence from Bain Capital in November 1993, and stepped down from his church leadership role during 1994, due to the campaign.^[100][94]

Radio personality Janet Jeghelian took an early lead in polls among candidates for the Republican nomination for the Senate seat, but Romney proved the most effective fundraiser.^[101][102] He won 68 percent of the vote at the May 1994 Massachusetts Republican Party convention; businessman John Lakian finished a distant second and Jeghelian was eliminated.^[103] Romney defeated Lakian in the September 1994 primary with over 80 percent of the vote.^[15][104]

In the general election, Kennedy faced the first serious re-election challenger of his career in the young, telegenic, and well-funded Romney.^[97] Romney ran as a fresh face, as a businessperson who stated he had created ten thousand jobs, and as a Washington outsider with a solid family image and moderate stances on social issues.^[97][105] When Kennedy tried to tie Romney's policies to those of Ronald Reagan and George H. W. Bush, Romney responded, "Look, I was an independent during the time of Reagan-Bush. I'm not trying to take us back to Reagan-Bush."^[106] Romney stated: "Ultimately, this is a campaign about change."^[107] After two decades out of public view, his father George re-emerged during the campaign.^[108][109]

Romney's campaign was effective in portraying Kennedy as soft on crime, but had trouble establishing its own positions in a consistent manner.^[110] By mid-September 1994, polls showed the race to be approximately even.^{[97][111][112]} Kennedy responded with a series of attack ads, which focused on Romney's seemingly shifting political views on issues such as abortion and on the treatment of workers at the Ampad plant owned by Romney's Bain Capital.^{[97][113][114]} The latter was effective in blunting Romney's momentum.^[70] Kennedy and Romney held a widely watched late October debate without a clear winner, but by then, Kennedy had pulled ahead in polls and stayed ahead afterward.^[115] Romney spent $3 million of his own money in the race and more than $7 million overall.^{[116][nb 10]} In the November general election, despite a disastrous showing for Democrats overall, Kennedy won the election with 58 percent of the vote to Romney's 41 percent,^[54] the smallest margin in Kennedy's eight re-election campaigns for the Senate.^[119]

2002 Winter Olympics[link]

Romney, president and CEO of the Salt Lake Organizing Committee for the 2002 Winter Olympics, speaking before a curling match

Romney returned to Bain Capital the day after the election, but the loss had a lasting effect; he told his brother, "I never want to run for something again unless I can win."^[46][120] When his father died in 1995, Mitt donated his inheritance to BYU's George W. Romney Institute of Public Management and joined the board and was vice-chair of the Points of Light Foundation (which had incorporated his father's National Volunteer Center).^[45][81] His mother died in 1998. Romney felt restless as the decade neared a close; the goal of simply making more money was losing its appeal to him.^[46][120] He no longer had a church leadership position, although he still taught Sunday School.^[92] During the long and controversial approval and construction process for the $30 million Mormon temple in Belmont, he feared that as a political figure who had opposed Kennedy, he would become a focal point for opposition to the structure.^[93] He thus kept to a limited, behind-the-scenes role in attempts to ease tensions between the church and local residents, but locals nonetheless sometimes referred to it as "Mitt's Temple".^[88][92][93]

Ann Romney was diagnosed with multiple sclerosis in 1998; Mitt described watching her fail a series of neurological tests as the worst day of his life.^[46] After two years of severe difficulties with the disease, she found while living in Park City, Utah (where the couple had built a vacation home) a mixture of mainstream, alternative, and equestrian therapies that gave her a lifestyle mostly without limitations.^[53] When the offer came for him to take over the troubled 2002 Winter Olympics and Paralympics, to be held in Salt Lake City in Utah, she urged him to take it, and eager for a new challenge, he did.^[120][121] On February 11, 1999, Romney was hired as the president and CEO of the Salt Lake Organizing Committee for the Olympic and Paralympic Winter Games of 2002.^[122]

Before Romney came on, the event was running $379 million short of its revenue benchmarks.^[122] Plans were being made to scale back the Games to compensate for the fiscal crisis, and there were fears the Games might be moved away entirely.^[123] The Games had also been damaged by allegations of bribery involving top officials, including prior Salt Lake Olympic Committee president and CEO Frank Joklik. Joklik and committee vice president Dave Johnson were forced to resign.^[124] Romney was chosen by Utah figures looking for someone with expertise in business and law and with connections to the state and the LDS Church.^[125] The appointment faced some initial criticism from non-Mormons, and fears from Mormons, that it represented cronyism or gave the Games too Mormon an image.^[30]

Romney ran the planning for the Games like a business.^[126] He revamped the organization's leadership and policies, reduced budgets, and boosted fundraising, alleviated the concerns corporate sponsors and recruited many new ones.^[120][125] He appealed to Utah's citizenry with a message of optimism that helped restore confidence in the effort.^[120][126] He worked to ensure the safety of the Games following the September 11, 2001 terrorist attacks by coordinating a $300 million security budget.^[121] Overall, he oversaw a $1.32 billion budget, 700 employees, and 26,000 volunteers.^[122] The federal government provided between approximately $400 million^{[125][127][128]} and $600 million^[126][129] of that budget, much of it a result of Romney's having aggressively lobbied Congress and federal agencies.^{[129][130][131]} It would prove to be a record level of federal funding for the staging of a U.S. Olympics, a fact Romney would cite as a selling point during his campaign for the Massachusetts governorship.^[128][130] An additional federal $1.1 billion was spent on indirect support in the form of highway and transit projects.^[132]

Romney emerged as the public face of the Olympic effort, appearing in photographs, news stories and Olympics pins.^[120] Robert H. Garff, the chair of the organizing committee, later said that "It was obvious that he had an agenda larger than just the Olympics,"^[120] and that Romney wanted to use the Olympics to propel himself into the national spotlight and a political career.^[125][133] Garff believed the initial budget shortfall was not as bad as Romney portrayed, given there were still three years to reorganize.^[125] Utah Senator Bob Bennett said that much of the needed federal money was already in place and an analysis by The Boston Globe stated that the committee already had nearly $1 billion in committed revenues.^[125] Olympics critic Steve Pace, who led Utahns for Responsible Public Spending, thought Romney exaggerated the initial fiscal state in order to lay the groundwork for a well-publicized rescue.^[133] Kenneth Bullock, another board member of the organizing committee and also head of the Utah League of Cities and Towns, often clashed with Romney at the time, and later said that Romney deserved some credit for the turnaround but not as much as he claimed:^[120] Bullock said: "He tried very hard to build an image of himself as a savior, the great white hope. He was very good at characterizing and castigating people and putting himself on a pedestal."^[125]

Despite the initial fiscal shortfall, the Games ended up clearing a profit of $100 million.^[134] His performance as Olympics head was rated positively by 87 percent of Utahns.^[135] Romney and his wife contributed $1 million to the Olympics, and he donated to charity the $1.4 million in salary and severance payments he received for his three years as president and CEO.^[136]

Romney was widely praised for his efforts with the 2002 Winter Olympics^[121] including by President George W. Bush,^[25] and it solidified his reputation as a turnaround artist.^[125] Harvard Business School taught a case study based around his actions.^[61] He wrote a book about his experience titled Turnaround: Crisis, Leadership, and the Olympic Games, published in 2004. The role gave Romney experience in dealing with federal, state, and local entities, a public persona he had previously lacked, and the chance to re-launch his political aspirations.^[120] He was mentioned as a possible candidate for statewide office in both Massachusetts and Utah, and also as possibly joining the Bush administration.^{[121][137][138]}

Governor of Massachusetts[link]

2002 gubernatorial campaign[link]

In 2002, Republican Acting Governor Jane Swift's administration was plagued by political missteps and personal scandals.^[135] Many Republicans viewed her as a liability and considered her unable to win a general election.^[139] Prominent party figures – as well as the White House – wanted Romney to run for governor,^[137][140] and the opportunity appealed to him for its national visibility.^[141] One poll taken at that time showed Republicans favoring Romney over Swift by more than 50 percentage points.^[142] On March 19, 2002, Swift announced she would not seek her party's nomination, and hours later Romney declared his candidacy,^[142] for which would face no opposition in the primary.^[143] In June 2002, Massachusetts Democratic Party officials contested Romney's eligibility to run for governor, citing residency issues involving his time in Utah for the Olympics.^[144] That same month, the bipartisan Massachusetts State Ballot Law Commission unanimously ruled that he was an eligible candidate.^[145]

He again ran as a political outsider,^[135] saying he was "not a partisan Republican" but rather a "moderate" with "progressive" views.^[146] Supporters of Romney hailed his business success, especially with the Olympics, as the record of someone who would be able to bring a new era of efficiency into Massachusetts politics.^[143] The campaign was the first to use microtargeting techniques, in which fine-grained groups of voters were reached with narrowly tailored messaging.^[147] Nevertheless, Romney initially had difficulty connecting with voters and fell behind his Democratic opponent, Massachusetts State Treasurer Shannon O'Brien, in polls before rebounding.^[148] During the election he contributed over $6 million – a state record at the time – to the nearly $10 million raised for his campaign overall.^[149][150] Romney was elected governor on November 5, 2002, with 50 percent of the vote to O'Brien's 45 percent.^[151]

Tenure, 2003–2007[link]

Massachusetts State House portrait of Governor Mitt Romney, by artist Richard Whitney

When Romney was sworn in as the 70th governor of Massachusetts on January 2, 2003, ^[152] both houses of the Massachusetts state legislature held large Democratic majorities.^[153] He picked his cabinet and advisors more on managerial abilities than partisan affiliation.^[23] Upon entering office in the middle of a fiscal year, he faced an immediate $650 million shortfall and a projected $3 billion deficit for the next year.^[138] Unexpected revenue of $1.0–1.3 billion from a previously enacted capital gains tax increase and $500 million in unanticipated federal grants decreased the deficit to $1.2–1.5 billion.^[154][155] Through a combination of spending cuts, increased fees, and removal of corporate tax loopholes,^[154] the state ran surpluses of around $600–700 million for the last two full fiscal years Romney was in office, although it began running deficits again after that.^{[nb 11]}

Romney supported raising various fees by more than $300 million, including those for driver's licenses, marriage licenses, and gun licenses.^[138][154] He increased a special gasoline retailer fee by two cents per gallon, generating about $60 million per year in additional revenue.^[138][154] (Opponents said the reliance on fees sometimes imposed a hardship on those who could least afford them.)^[154] Romney also closed tax loopholes that brought in another $181 million from businesses over the next two years and over $300 million for his term.^[138][160] Romney did so in the face of conservative and corporate critics that considered them tax increases.^[160]

The state legislature, with Romney's support, also cut spending by $1.6 billion, including $700 million in reductions in state aid to cities and towns.^[161] The cuts also included a $140 million reduction in state funding for higher education, which led state-run colleges and universities to increase tuition by 63 percent over four years.^[138][154] Romney sought additional cuts in his last year as governor by vetoing nearly 250 items in the state budget, but all were overridden by the heavily Democratic legislature.^[162]

The cuts in state spending put added pressure on localities to reduce services or raise property taxes, and the share of town and city revenues coming from property taxes rose from 49 to 53 percent.^[138][154] The combined state and local tax burden in Massachusetts increased during Romney's governorship but remained below the national average.^[138]

Romney sought to bring near-universal health insurance coverage to the state. This came after Staples founder Stemberg told him at the start of his term that doing so would be the best way he could help people,^{[163][164][165]} and after the federal government, owing to the rules of Medicaid funding, threatened to cut $385 million in those payments to Massachusetts if the state did not reduce the number of uninsured recipients of health care services.^{[23][163][166]} Although he had not campaigned on the idea of universal health insurance,^[165] Romney decided that because people without insurance still received expensive health care, the money spent by the state for such care could be better used to subsidize insurance for the poor.^[164][165]

After positing that any measure adopted not raise taxes and not resemble the previous decade's failed "Hillarycare" proposal, Romney formed a team of consultants from diverse political backgrounds.^{[23][163][166]} Beginning in late 2004, they came up with a set of proposals more ambitious than an incremental one from the Massachusetts Senate and more acceptable to him than one from the Massachusetts House of Representatives that incorporated a new payroll tax.^{[23][163][166]} In particular, Romney pushed for incorporating an individual mandate at the state level.^[21] Past rival Ted Kennedy, who had made universal heath coverage his life's work and who, over time, had developed a warm relationship with Romney,^[167] gave the plan a positive reception, which encouraged Democratic legislators to cooperate.^[163][166] The effort eventually gained the support of all major stakeholders within the state, and Romney helped break a logjam between rival Democratic leaders in the legislature.^[163][166]

On April 12, 2006, Romney signed the resulting Massachusetts health reform law, commonly called "Romneycare", which requires nearly all Massachusetts residents to buy health insurance coverage or face escalating tax penalties, such as the loss of their personal income tax exemption.^[168] The bill also establishes means-tested state subsidies for people who do not have adequate employer insurance and whose income is below a threshold, with funds that were previously used to compensate for the health costs of the uninsured.^{[169][170][171]} He vetoed eight sections of the health care legislation, including a controversial $295-per-employee assessment on businesses that do not offer health insurance and provisions guaranteeing dental benefits to Medicaid recipients.^[168][172] The legislature overrode all eight vetoes, but the governor's office said the differences were not essential.^[172] The law was the first of its kind in the nation and became the signature achievement of Romney's term in office.^{[166][nb 12]}

At the beginning of his governorship, Romney opposed same-sex marriage and civil unions, but advocated tolerance and supported some domestic partnership benefits.^{[166][174][175]} Faced with the dilemma of choosing between same-sex marriage or civil unions after the November 2003 Massachusetts Supreme Judicial Court decision legalizing same-sex marriages (Goodridge v. Department of Public Health), Romney reluctantly backed a state constitutional amendment in February 2004 that would have banned same-sex marriage but still allow civil unions, viewing it as the only feasible way to ban same-sex marriage in Massachusetts.^[176] In May 2004, Romney instructed town clerks to begin issuing marriage licenses to same-sex couples, but citing a 1913 law that barred out-of-state residents from getting married in Massachusetts if their union would be illegal in their home state, no marriage licenses were to be issued to out-of-state same-sex couples not planning to move to Massachusetts.^[174][177] In June 2005, Romney abandoned his support for the compromise amendment, stating that the amendment confused voters who oppose both same-sex marriage and civil unions.^[174] Instead, Romney endorsed a petition effort led by the Coalition for Marriage & Family that would have banned same-sex marriage and made no provisions for civil unions.^[174] In 2004 and 2006, he urged the U.S. Senate to vote in favor of the Federal Marriage Amendment.^[178][179]

In 2005, Romney revealed a change of view regarding abortion, moving from the "unequivocal" pro-choice position expressed during his 2002 campaign to a pro-life one in opposition to Roe v. Wade.^[166] He subsequently vetoed a bill on pro-life grounds that would expand access to emergency contraception in hospitals and pharmacies^[180] (the veto was overridden by the legislature).^[181]

Romney generally used the bully pulpit approach towards promoting his agenda, staging well-organized media events to appeal directly to the public rather than pushing his proposals in behind-doors sessions with the state legislature.^[166] Romney dealt with a public crisis of confidence in Boston's Big Dig project – that followed a fatal ceiling collapse in 2006 – by wresting control of the project from the Massachusetts Turnpike Authority.^[166]

During 2004, Romney spent considerable effort trying to bolster the state Republican Party, but it failed to gain any seats in the state legislative elections that year.^[138][182] He was given a prime-time appearance at the 2004 Republican National Convention, and was already being discussed as a potential 2008 presidential candidate.^[183] Midway through his term, Romney decided that he wanted to stage a full-time run for president,^[184] and on December 14, 2005, announced that he would not seek re-election for a second term.^[185][186] As chair of the Republican Governors Association, Romney traveled around the country, meeting prominent Republicans and building a national political network;^[184] he spent part or all of more than 200 days out of state during 2006, preparing for his run.^[187]

He had a 61 percent job approval rating in public polls after his initial fiscal actions in 2003, but it began to sink after that.^[188] His frequent out-of-state travel contributed to a decline in his approval rating towards the end of his term;^[189][188] at 34 percent in November 2006, his rating level ranked 48th of the 50 U.S. governors.^[190] Dissatisfaction with Romney's administration and the weak condition of the Republican state party were among several factors that led to Democrat Deval Patrick's lopsided win over Republican Kerry Healey, Romney's Lieutenant Governor, in the 2006 Massachusetts gubernatorial election.^[191][189]

Romney filed to register a presidential campaign committee with the Federal Election Commission on his penultimate day in office as governor.^[192] His term ended January 4, 2007.

2008 presidential campaign[link]

Holding an "Ask Mitt Anything" session in Ames, Iowa, in May 2007

Romneys on Mackinac Island at the 2007 Republican Convention

At a rally in Battle Creek, Michigan, in mid-January 2008

Romney formally announced his candidacy for the 2008 Republican nomination for president on February 13, 2007, at the Henry Ford Museum in Dearborn, Michigan.^[193] In his speech, he frequently invoked his father and his own family and stressed experiences in the private, public, and voluntary sectors that had brought him to this point.^[193][194] He said, "Throughout my life, I have pursued innovation and transformation,"^[194] and casting himself as a political outsider, said, "I do not believe Washington can be transformed from within by a lifelong politician."^[195]

Romney's campaign initially emphasized his résumé of a highly profitable career in the business world and his stewardship of the Olympics.^{[184][196][nb 13]} He also had political experience as governor, together with a political pedigree courtesy of his father, and had a reputation for a strong work ethic and energy level.^{[184][196][65]} Ann Romney, who had become an outspoken advocate for those with multiple sclerosis,^[199] was in remission and would be an active participant in his campaign,^[200] helping to soften his political personality.^[65] Moreover, a number of commentators noted that with his square jaw and ample hair graying at the temples, the 6-foot-2-inch (1.88 m)^[201] Romney – referred to as handsome in scores of media stories^[202] – physically matched one of the common images of what some believed a president should look like.^{[66][203][204][205]} Romney's liabilities included having run for senator and served as governor in one of the nation's most liberal states, having taken some positions there that were opposed by the party's conservative base, and subsequently shifting those positions.^{[184][196][200]} His religion was also viewed with suspicion and skepticism by some in the Evangelical portion of the party.^[206]

Romney assembled for his campaign a veteran group of Republican staffers, consultants, and pollsters.^[196][207] He was little-known nationally, though, and stayed around the 10 percent range in Republican preference polls for the first half of 2007.^[184] He proved the most effective fundraiser of any of the Republican candidates;^[208] his Olympics ties helped him with fundraising from Utahns and from sponsors and trustees of the games.^[136] He also partly financed his campaign with his own personal fortune.^[196] These resources, combined with the mid-year near-collapse of nominal front-runner John McCain's campaign, made Romney a threat to win the nomination and the focus of the other candidates' attacks.^[209] Romney's staff suffered from internal strife and the candidate himself was indecisive at times, constantly asking for more data before making a decision.^[196][210]