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The Obama-Romney Debate – Big Winner is Massachusetts Health Reform

Posted by John McDonough  October 3, 2012 11:10 PM

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Some quick reactions on the health care debates in tonight's first presidential debate:

Tough for both when stats and debating points are flying everywhere fast and furious.

Massachusetts: The big winner from tonight's debate regarding health policy may be the Massachusetts health reform program.  Here's a point about health that both O and R agree on -- Massachusetts health reform is good and it working well. I'm sure that makes ObamaCare and RomneyCare opponents choke -- nice to have it agreed on by both candidates for president.

Romney added: "What we did in Massachusetts is a model for nation -- state by state. Whisking aside the 10th amendment is not the answer." The US Supreme Court weighed in on constitutional violations, and the ACA stands tall. RomneyCare works only because the federal government pays the lion's share of the tab.

Pre-Existing Conditions: Romney says: "People with pre-existing conditions are covered under my plan." First, there is NO Romney plan -- there are vague generalities. Romney made the same statement on Meet the Press a few weeks ago, and within hours, Romney's staffers clarified to say he only meant people with pre-existing conditions who are ALREADY covered. Those people are already covered under a law passed in 1996.

$716 Billion in Medicare Cuts to Pay for ObamaCare. Romney was effective in repeatedly charging that ObamaCare cuts $716 billion, and Obama never countered directly. Missed opportunity. If Romney were to succeed in putting the money back in the pockets of insurance companies, the result will be speeding up the financial insolvency of the Medicare Trust Fund from 2024 to 2016 -- guaranteeing a Medicare financial crisis in 2024 -- and raising the premiums for every current enrollee on Medicare, all 47 million of them.

Unelected Board. This refers to the ACA's Independent Payment Advisory Board that makes recommendations on ways to reduce the rate of growth of Medicare spending if it rises at unacceptably high levels. It can't reduce benefits, cut eligibility, or raise taxes. Because Medicare's rate of growth has declined way beyond expectations, the board -- which has yet to be appointed -- has no authority to do anything until at least 2019. The notion that the board would decide what treatments individuals get is untrue and is a polite way a bringing back the "death panel" charge without calling it that.

Coverage for Uninsured Americans: Romney said: the Congressional Budget Office says 20 million will lose insurance if ObamaCare goes into effect. Untrue. CBO estimated that full implementation of the ACA would reduce the number of uninsured Americans by 32 million. About five million fewer Americans would have private employer-based coverage, though only because they will opt for better coverage available through the ACA, not because they are forced out of coverage.

Cost of Health Care: Romney says the cost of health care has gone up $2500 in the past four years, and Obama says premiums have been growing more slowly than at anytime in the past 50 years. I think premiums went up at a slower rate during the Clinton years, but Obama's point is correct that we have seen a significant deceleration of health premium inflation, both private insurance and Medicare, since the ACA was signed. Also, over this past summer, for the first time ever, insurance companies sent rebate checks for more than $1 billion to US consumers. That has never happened before.

Lots and lots more to chew on here.  Good that there was so much talk about health policy.  I am not sure the American public is any wiser tonight about this complex area than they were going into it. 

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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