Health policy will claim several minutes of its own during Wednesday night’s first presidential debate. The debate between President Obama and Governor Romney is primarily about the economy. Both topics tend to be detached from sound “economics” per se at the campaign level, but the handling of health care during the next presidential term (and beyond) could either strengthen or sink prospects for renewed economic growth.
The Obama playbook and debating points for health policy are written. Much of it falls under the fiction (either mystery or horror) category.
Thus far, Romney’s campaign has neither targeted the political vulnerabilities of Obamacare to any great extent, nor framed a concise alternative vision of health reform.
Don’t expect any remarkable transformations tomorrow night, in terms of new policy details that could capture additional support from remaining independent, undecided voters.
However, there are several tactical enhancements that could move Romney beyond uncomfortably sidestepping his role as Massachusetts governor in facilitating an individual mandate, an exchange-like “Connector,” and Medicaid expansion. Simply promising to repeal Obamacare and not reinstall Romneycare version 2.0 in its place, while outsourcing everything else to state governments, won’t cut it. But Romney also can’t afford to create (or borrow) a new health policy agenda overnight.
Of course, the GOP candidate should provide a few thematic signals of WHY a Romney White House would move in a different direction that will improve the health care we receive. It’s not just to undo the damage of Obamacare but to provide fairer tax treatment for all health care purchasers and revamp our health care system to be more accountable and responsive to patients and consumers (instead of only to politicians and interest groups). Plus, a better version is needed of “Message: I care” when it comes to protecting the most vulnerable Americans in a sensitive and sustainable manner.
But after establishing a threshold of credibility for a positive approach to health reform, Romney’s mission in the health debate tomorrow remains to win an election, not summarize a health policy tutorial (not even in PowerPoint). In terms of picking up new voters at this late date, the Romney debating points will need to be direct and devastating in reminding television viewers why they dislike Obamacare so much. Its two core vulnerabilities that the president cannot deflect involve taxes and trust.
(Sorry, the individual mandate is off-limits, as a pre-existing condition for both candidates).
Romney needs to highlight the long chain of tax increases (especially the hidden, indirect, and unindexed ones) put in place to finance a large portion of Obamacare’s future costs and how all of them will hit workers and patients one way or another.
The Republican nominee then needs to tie this to the larger Achilles heel of Obamacare: How it was constructed on a hollow foundation of broken promises, accounting fictions, and “whatever it takes” politics to deliver control of key health care decisions into the hands of unaccountable political bureaucracies in Washington. Why? Because the architects of Obamacare and the president are always sure that they know what is best for the rest of us, who cannot be trusted to make independent decisions in line with our own personal preferences, needs, and values.
Governor Romney should admit that he doesn’t know every detail of what might be best for American health care. But he should not have to, because hundreds of millions of patients, consumers, and the medical providers THEY choose will; in a more decentralized, depoliticized, competitive, and transparent health care system.