In tonight’s first presidential debate, Governor Romney and President Obama will spend 15 minutes discussing healthcare. This is a perilous topic for both, but whoever wins this debate within the debate will take a big step to winning on November 6th.

The Affordable Care Act, or ObamaCare as both candidates now call it, will be center stage. The president will offer his standard defense, saying it helps middle-class families by making insurance more affordable and more secure.

But the president knows a full-throated defense will not work. A majority of Americans have consistently supported repeal since day one.

Rather than defend the indefensible – higher costs, higher taxes, Medicare cuts, government expansion – the president will attack.

First, he will tie together ObamaCare and the reform law Gov. Romney signed in Massachusetts, arguing that they are the same.

Gov. Romney should stipulate that there are some policy similarities between the two, but that the differences are what matter. He can deflect this attack and return the spotlight to the president’s unpopular law by clearly saying:

“I did not raise taxes. You raise taxes by $500 billion.

“I did not cut Medicare. You cut Medicare by more than $700 billion to pay for a new entitlement that the public opposed. Your cuts jeopardize seniors’ access to care.

“I did not empower unelected bureaucrats to get in between seniors and their doctors. You created a board of bureaucrats that will change Medicare benefits and dictate how much to pay doctors.

“I vetoed significant portions of the law, like penalties for businesses if they don’t comply. You bury businesses under a mountain of new regulations and penalize them, possibly hundreds of millions of dollars for large companies.”

The president will respond that his law does not cut Medicare. He will argue that it actually strengthens Medicare by providing full prescription drug coverage and delaying the program’s bankruptcy by nearly ten years.

He will quickly pivot from ObamaCare to his second attack: Gov. Romney would “end guaranteed benefits and turn Medicare into a voucher program.”  This is Medi-scare personified.

Gov. Romney will explain that seniors will have the power to choose and the financial resources to buy private coverage among competing health plans or stay with traditional Medicare. Either choice will offer coverage at least as generous as today’s benefits.

Choice and competition will dramatically lower costs, just like the prescription drug benefit where costs are 40 percent below original estimates. This will strengthen Medicare and guarantee it is there for future generations.

It is not an overstatement to say that the election may hinge on who wins the healthcare issue.

The president can win if he keeps the focus away from ObamaCare and puts Gov. Romney back on his heels by lauding his Massachusetts reforms and attacking his Medicare plan.

Gov. Romney can win if he deflects these charges by effectively articulating his Medicare plan and reminding voters that ObamaCare spends too much, taxes too much, and lowers the quality of care too much.

Merritt is a managing director at Leavitt Partners, the healthcare intelligence firm led by former HHS secretary Mike Leavitt. This post first appeared on The Hill.

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10 Responses for “The Health Care Debate Within the Debate”

  1. DeterminedMD says:

    Republocrats. We will watch 2 people debate why the status quo should stay unchanged. Vote for the rich white guy, watch him abandon middle America and enslave it to capitalism without boundaries, or, vote for the black getting rich guy who wants to make middle America dependent on debt ridden government programs and enslave it to politicians without boundaries.

    Either way you will end up enslaved and unrepresented, and either guy in the White House will be surrounded by untouched cronies, who by the way do not have to answer to their health care plans.

    This is the best we’ve got folks, garbage in, garbage out, and you the public have only yourselves to blame. Enjoy your election in less than 5 weeks, health care as we knew it died in Massachusetts in 2007, and now the rest of the country is catching up now.

    Pathetic, insincere, selfish, and self destructive. Now there are great bumper stickers to adhere to your auto rears!

  2. Cynthia says:

    Despite Obama totally bombing out at the debates, at least the first set of debates, I still believe Romney and Ryan won’t win. So to me, it won’t be “the bad cops” that’ll cut Medicare and SS. It will be “the good cop” Obama, and the party that cheered for the Simpson Bowles compromise when it was mentioned at their convention as an example of “reasonable” compromise, that’ll do the neo-liberal hatchet job on Medicare and SS. It’ll be the so-called “party of the people” and their selfless, “protecting the middle class” leader who will do this.

    The real answer to the Medicare funding crisis is Medicare for All. Put us all in one pool, and the answer to Social Security is to impose the tax without a cap on ALL earnings, including capital gains. But clearly the Democratic party is not going to be that party that presents these answers. To present the real solution, we will have to make it clear to the party leaders that we will abandon them and form a party of our own unless they take up our solutions. They will not listen. Then let the Dems be the party of Wall Street stooges and clueless crossover Republicans, and may they soon become extinct.

  3. DeterminedMD says:

    Disclaimer up front, I did not watch the debate last night because after a long day of insurance lameness and a fair amount of patient entitlement the last few days, couldn’t stomach listening to 2 narcicists droning on why one of them should be “President”.

    That said, if it is true that Romney basically said at one point, “why did you (Obama) just focus on passing PPACA the first 2 years in office when the economy continued to sour”, that is a loud and vivid interpretation of leadership without any representation. Not that Romney has any better clue what to do with health care run amok, but, neither did nor still does to now that equally clueless egomaniac in the White House now.

    And irregardless of who occupies the White House next January, Reid will still be a Senator from Nevada and I will bet anyone with any attentive skills Nancy Pelosi will continue to misrepresent from California by at least 75% of her district. Says volumes to what people demand from their government.

    Wow, this is not an election, this is a defining moment of how lame the public is and expect their “leaders” to do what is best. Yeah, the only problem is, best for the politicians, NOT for the public.

  4. I think that there are positives and negatives to both parties healthcare solutions. Obama’s would benefit more Americans. It will be interesting to see how healthcare changes within the next year or two

    • DeterminedMD says:

      Just won’t benefit providers being able to provide. Oh, and now that Medicare is penalizing hospitals for alleged premature discharging, really will do wonders to motivate such services to be fully invested in care interventions, because, hey, PPACA is to guarantee people will get better and it will cost less.

      Face it, politicians don’t call me to help them write legislation to help them manage business matters, so, you’d think they’d call me when it would involve health care ones? No, because they aren’t interested in really problem solving health care, just cost.

      But to share the last comment above, it will be interesting to see how health care changes within the next year or two. And if Obama stays in the White House and health care issues do deteriorate, will you come a’knockin at his door to ask “can you fix this now?” Or perhaps you can go next door to talk to Nancy and ask her if she is finally done reading the 900-2000 pages she told us to wait and let all her buddies read and digest it from 2010? Or better yet, see if your own federal reps and Senators will have to live under these guidelines the rest of us have to.

      Yeah, I’m sure you’ll get honest and direct replies from that bunch!!!

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