Ann Arbor, Michigan—Did Mitt Romney’s speech on health care satisfy his conservative detractors? Did it lay out a coherent alternative to the Affordable Care Act? These are important questions and I’ll get to them in a moment. But, first, let me tell you about my favorite moment of his presentation on Thursday.

It happened near the end, after Romney was done with his PowerPoint slides and taking some questions from the audience. From the back of the auditorium, I couldn’t hear what was being asked. But one question prompted Romney to talk about ways of making medical care more efficient, including something called “Value Based Insurance Design” that had come up in conversation earlier in the day.

If you’re a health care wonk, like I am, you know all about VBID. It’s basically a vision for redesigning health benefits, so that people pay less for services that provide value and more for services that don’t. And it makes sense that it would have been on Romney’s mind at the moment: The researchers best known for developing it are based at the University of Michigan, where Romney happened to be speaking.

That Romney would cite VBID as an example of how to reform health insurance speaks to his intellectual sophistication and managerial skill. It’s a trait that runs through his career in the private and public sectors, where he frequently demonstrated an ability to grasp a problem, analyze it, and come up with a solution.

Unfortunately, that citation also speaks to Romney’s essential political dilemma. If you read the Affordable Care Act and turn to section 2713(c), you’ll find a provision calling upon Medicare to experiment with—wait for it—VBID. And if you paid attention to President Obama’s deficit reduction proposal a few weeks ago, you may recall that Obama proposed letting the agency in charge of Medicare introduce VBID more quickly.