The health care debate

Just finished watching the Presidential debate. It seems the emerging consensus is that Romney was strong and aggressive while Obama was pretty flat-footed. Not discussed yet is the fact that it’s well past time to put Jim Lehrer out to pasture. He was completely ineffective and in particular let Romney grab much of the airtime.

Yesterday I suggested three questions for Lehrer to put to the candidates on health care:

  1. How would you address the issue of patients with pre-existing conditions?
  2. How should the delivery system (as opposed to the financing system) evolve as part of health care reform?
  3. Can we afford to exempt everyone over 55 from changes to the Medicare system?

Lehrer didn’t ask any of these questions directly but all three topics were covered in one form or another. The boldest discussion of health care, though was Romney’s clever but specious claim that Obama is the one who’s cutting Medicare.

Going from memory, here’s my impression of how these three questions were answered:

  • On pre-existing conditions, Romney said he’d keep that provision in place although he didn’t explain how he’d manage to do that. Obama tried to explain that Romney’s plan (such as it is) would only apply to people who’d maintained continuous coverage, but he didn’t do a good job of making his point.
  • Both Obama and Romney cited the Cleveland Clinic in the swing state of Ohio as an example of delivery system changes. Obama made the reasonable point that these best practices were worth learning from (which is actually a very consulting-oriented thing that Romney also probably believes) but Romney tried to scare people by talking about the government getting between doctor and patient. I would like to have heard something about primary care
  • Unfortunately both Obama and Romney started from the premise that everyone over 55 could be exempted from changes to Medicare. It was actually worse considering that Romney attacked Obama for going after Medicare now. This was the greatest disservice to the debate. An honest answer would have been that we can’t wait a decade or more to start fixing Medicare
October 3, 2012

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