Debating Health Care

Jim Lehrer, moderator of the October 3, 2012, presidential debate in Denver


The first presidential debate will be held tomorrow evening, and Jim Lehrer, the moderator, has announced that health care will be a featured topic in the second half of the 90-minute session.

This should present an opportunity for Mitt Romney to gain some ground. After all, Obamacare remains unpopular and was a major reason voters turned to the GOP in the 2010 midterm elections.

But health care is also a challenging issue for Governor Romney, given his role in enacting a plan in Massachusetts that in some ways is similar to Obamacare. The president will no doubt try to deflect all criticism of his program by arguing that Romneycare was the model for it.

This isn’t true, of course. Romneycare was a much more modest, state-based initiative — with a fraction of Obamacare’s spending and regulation and none of its taxes. Importantly, Romneycare did not attempt, as Obamacare does, to micromanage the delivery of health services to patients, nor did it cut Medicare to pay for new entitlement spending.

In recent weeks, polling has shown Obama closing the gap with Romney with senior voters. This is almost certainly the result of dishonest attacks accusing the Romney-Ryan campaign of proposing “vouchercare” to replace Medicare’s benefit structure and then claiming it would increases costs for each senior by $6,400 a year, starting a decade from now. Both claims have been thoroughly debunked, but that hasn’t stopped the Obama campaign from continuing to use them.

Governor Romney must forcefully rebut these attacks, of course, but he should quickly get past a defensive posture and aggressively attack the president over the Medicare cuts in Obamacare. These cuts remain incredibly unpopular with seniors. Specifically, Governor Romney must remind voters that 4 million seniors are going to lose their Medicare Advantage plans because of the law’s $300 billion in payment-rate reductions. A study by the Heritage Foundation has estimated these cuts will cost the average Medicare Advantage enrollee $3,700 by 2017. Other cuts in the law are so deep that 15 percent of hospitals and nursing homes will have no choice but to drop out of the program to avoid losing money on Medicare patients.

Beyond Medicare, Governor Romney must not only point out the excessive spending, taxes, and regulation of Obamacare; he must also make it clear that Obamacare was entirely unnecessary. There is a better way to fix the problems in American health care, as Governor Romney began to point out in his recent New England Journal of Medicine article. The problems have their source in misguided federal policies, which Governor Romney could not reverse when he led Massachusetts state government but could as president of the United States.

To be effective at this stage in the campaign, Governor Romney must convince middle-class voters that his approach to reform will provide them with the security they need without the big-government intrusions they dislike in Obamacare. Romney’s plan would broaden coverage by expanding the tax break for employer-sponsored plans to cover individually purchased plans as well. This would help the millions of households that lack access to employer plans to get and retain insurance. The plan would fill in the cracks in existing rules aimed at preventing insurers from charging higher premiums for those with preexisting conditions. The rules currently work well for people enrolled in group insurance, but do not work well for those who need or want to buy insurance themselves in the individual market. These reforms, along with properly funded state-run high-risk pools, can provide the insurance security Americans want without the trillion-dollar price tag and bureaucracy of Obamacare.

Historically, voters have trusted Democrats much more than Republicans on health care. That certainly was the case in 2008. But Obamacare has changed the political conversation. The president pushed through a plan that remains terribly unpopular. Governor Romney has the arguments necessary to exploit this political opportunity, and he should use them.


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