In Mitt Romney’s 2010 book, No Apology, he discusses the
“Medicare burden” and the challenge of dealing with the rising cost
of health care entitlements. In the same section, it’s something he
claims to have been thinking about in a professional capacity for a
long time: “When I was a young consultant to a health-care
company in the late 1970s,” he says in the book, “I predicted that
health care would reach 20 percent of the GDP by 2050.”

But apparently Romney wasn’t thinking about it enough to grasp
the differences between the two major health entitlements. In a
campaign appearance in Iowa today, Romney told the crowd that he
was unsure about all the distinctions between Medicare, the federal
health entitlement seniors, and Medicaid, the jointly funded
federal-state health program for the poor and disabled, until he
started government work. “I have to admit I didn’t know all the
differences between these things before I got into government,”
Romney said, according to
TPM. Romney didn’t run for office until 1994, when he lost a
Massachusetts Senate race to Ted Kennedy.  

As governor of Massachusetts, Romney figured out the difference
soon enough: He relied on about $2
billion (so far) in bonus federal Medicaid funding to help pay
for RomneyCare, his state-based health care expansion. But he still
takes advantage of the fact that lots of voters share his early
confusion. In this year’s primary campaign, he’s repeatedly
criticized President Obama for cutting Medicare to pay for a
federal health care expansion virtually identical in structure to
RomneyCare without noting the federal Medicaid bonus that his
Massachusetts still relies on. 

Update:
As TPM’s Benjy Sarlin points out, Romney also oversaw the
purchase a $311 million hospital business while running Bain
Capital in the 1980s.