On Health Care, Obama, Romney Work to Differentiate Themselves
by John Corker | Wright State University
President Obama and Governor Romney squared off in the first of three presidential debates Wednesday night. It was a debate focused solely on domestic issues, with 60 percent of the time allotted for the economy, 20 percent for the role of government and 20 percent for health care.
In actuality, both candidates consistently overran their allotted time to speak, often talking over the futile attempts of moderator Jim Lehrer (executive editor and former anchor of PBS News Hours) to cut them off and move on. As a result, nearly three quarters of the debate was spent differentiating their views on job creation and tax codes.
But the relatively short amount of time they spent debating health care was well worth it. Both candidates had spent the months leading up to the debate attempting to differentiate their plans with rhetoric and histories that were ironically very similar. On Wednesday night, however, both candidates were more specific as to how their plans for the future of health care actually differ; and the disparities were noticeable.
Regarding the hot topic of Medicare, Obama explained that he planned to “protect and strengthen” Medicare not by changing its current delivery model, but by reducing overall costs of health care (no specifics offered) and by cutting costs within the Medicare program. He claimed that his administration had already saved or recovered $50 billion in Medicare dollars by cracking down on fraud and abuse. He also noted the $600/year that each Medicare beneficiary (and, by association, the government) was saving on prescription drugs through programs established under the Affordable Care Act. He proposed $716 billion in further Medicare savings over the next decade by reducing reimbursement payments to health insurance companies (through the Medicare Advantage program), hospitals and physician providers.
It is with this last proposal that Governor Romney took particular exception. He labeled these $716 billion in “savings” as “cuts,” that would negatively impact all current and future Medicare beneficiaries. And he claimed that these enormous cuts to providers would cause more than 4 million current Medicare beneficiaries to lose their coverage, citing studies that indicated 15 percent of hospitals and nursing homes and 50 percent of doctors would stop seeing Medicare patients under such reimbursement cuts.
Romney, on the other hand, stated that – under his plan – Medicare would not change for anyone currently 55 years of age and older. For those younger than 55, Romney proposes to institute a tiered “premium support” program that would provide beneficiaries with a fixed amount of money (based upon their income) that each could apply towards the purchase of their own, private health insurance plan. He claimed that a government option (similar to current Medicare) would be available to compete alongside these private plans, and that “at least two” different plans would be available at no cost to the beneficiary. Romney proclaimed that all beneficiaries should be allowed to choose their health care plan, and that market forces should be allowed to take the lead in lowering costs and increasing efficiency.
But Obama labeled Romney’s plan for premium support as nothing more than a “voucher” system, citing his own economic studies that indicated Romney’s plan would increase costs for each beneficiary by $6,000/year. He also claimed that the option for so many different plans would allow for “cherry-picking” on the part of private insurance companies of younger, healthier beneficiaries; ultimately leaving the government option to suffocate under the weight of their sicker, more expensive counterparts.
Regarding the state-based Medicaid program, Obama’s views have been clear ever since “Obamacare” was passed in 2010. Under the ACA, in an attempt to significantly reduce the number of uninsured Americans, all states are encouraged to expand their Medicaid programs to cover all citizens earning up to 133 percent of the federal poverty level. The federal government promises to pick up 100 percent of the cost of this expansion for the first few years, ultimately scaling back their support to 90 percent of costs within five years.
But Romney plans to “repeal and replace Obamacare on day 1″ of his term. And while he would replace the ACA with many programs already in place under it, his plan for Medicare is quite different. Romney proposes to replace the current system of federal Medicaid funding and oversight with a block grant system that would provide each state with the amount of money they received the previous year, plus inflation and an additional one percent. States would be allowed to use this money as they pleased, in order to insure their own citizens. The former Governor stated that this freedom to “take care of their own poor” has been a wish of his colleagues across the country for years.
Romney went on to cite studies that claimed that, under Obamacare, health insurance costs would increase for every American by an average of $2,500/year (a claim that Obama denied, citing that group rates for the currently uninsured had decreased by 18 percent under the ACA). He also cited studies indicating 75 percent of small business owners say Obamacare makes them less likely to hire new workers, and 20 million people would lose their employer-provided health insurance coverage next year when the ACA takes full effect and businesses begin to drop coverage.
He continued to reiterate his distaste for the ACA’s Independent Payment Advisory Board (IPAB), a group of independently appointed health care experts and physicians charged with identifying feasible ways to reduce overall health care costs, calling it a “bunch of unelected bureaucrats who will dictate what care patients receive.”
Obama, of course, countered by stating that the IPAB is forbidden under the ACA from making any decisions regarding care received by patients, and that without the independently appointed board, patients would be left to the “merciless cost shifting” practices of private insurance companies. Furthermore, he incredulously pointed out that the ACA was based upon the very same principles that Romney applied to health care reform in Massachusetts and stated could be a “model for the nation.” He claimed that 50 million people would lose their health insurance if Obamacare was repealed.
Romney was quick to rebut, however, that his health care law in Massachusetts was a “bipartisan” initiative (unlike Obamacare), that it did not raise taxes on the wealthy like Obamacare, and clarified his statement that the program could serve as a model for “state-based programs across the nation,” not for a “federal” government “take-over” of health care. He reiterated his closely-held belief that the federal government was incapable of effectively lowering health care costs.
Ironically, towards the end of their back-and-forth, both candidates cited the Mayo Clinic as a “perfect example” of how their respective plans would be more effective. Obama cited Mayo’s emphasis on the ACA principles of coordinated care, primary care prevention and a pay-for-performance reimbursement model. Romney, on the other hand, cited Mayo as an example of “private market forces” working to provide care of the highest quality at lower costs.
Clearly, there will be a whole lot of fact-checking being done over the next couple of days. But there is no doubt that the two candidates took significant steps Wednesday night toward differentiating their plans for the future of health care in America. Which do you think has a better chance of reducing costs in health care while increasing quality, Romney’s “trickle-down economics” or Obama’s “trickle-down government?” While there is still much to be clarified and fleshed out, what has been a pretty murky issue to date for the discerning voter is beginning to clear up.
On to the next debate.
John Corker is the NextGen Journal Health Care Correspondent and a third-year student at the Wright State University Boonshoft School of Medicine. He is a 2007 graduate of the University of Notre Dame and a host of the 'Radio Rounds' medical talk show (www.radiorounds.org).