The Health Care Debate Within the Debate

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.