Howard Gleckman
Doug Schoen
Barack Obama and Mitt Romney during the Presidential Debate Denver, Colorado. (Click on the image to see the entire gallery)
While President Obama and Mitt Romney clashed about many issues last night in the first presidential debate, the greatest sparring between the two presidential candidates took place over health care, particularly over their plans for reforming the highly charged issue of Medicare.
Both Romney and Obama made it very clear that they did not want to cut Medicare, making strong promises to protect the health care program for seniors, especially the prescription drug benefit. But that is where agreements between the two candidates ended.
Romney came out particularly strong on Medicare. He repeatedly claimed that Obama cut $716 million from Medicare to help pay for the Affordable Care Act, Obama’s signature health care reform law. While Obama insisted that his cuts do not directly reduce benefits for seniors and instead lessen payments to providers, including insurance companies, Romney countered that by cutting providers’ fees, patient treatment would certainly be affected. And Romney underscored that his Medicare plan would not impact current beneficiaries or those close to entering the system.
Obama accused Romney of wanting to make Medicare a voucher program. He claimed that traditional Medicare would collapse under Romney’s plan to offer subsidies for private insurance, as private insurers would pick the healthiest seniors, leaving the public health plan with the sickest, most-expensive-to-cover patients.
But Romney was successful in neutralizing this line of attack. He insisted people would be allowed to choose between the current Medicare program as is or a private plan, and the choice would be entirely up to them. He said he would guarantee Medicare for the long term by providing high benefits for low-income people while lowering some benefits for higher-income people.
Romney also attacked the Medicare Independent Payment Advisory Board (IPAB) strongly, which was created with the passage of the 2009 Affordable Care Act. IPAB is comprised of a 15-member unelected board that would be singly responsible for enacting spending cuts in the Medicare program without being held accountable for their decisions.
As Governor Romney said last night, IPAB “puts in place an unelected board that’s going to tell people, ultimately, what kind of treatments they can have. I don’t like that idea.”
Governor Romney is correct on IPAB. IPAB lacks transparency and oversight, substituting an unelected board for government, without any true checks and balances by Congress. IPAB is flawed and unethical, and quite simply, is a dangerous shortcut in place of more meaningful, pro-growth reform.
IPAB is a threat to critical medical treatments and services for all Medicare beneficiaries. Rather than improving the quality of care, the board will have to make standard line item cuts that reach annual targets, which will reinforce rather than fix systemic problems and create unsustainable savings.
Major changes in the Medicare program should be decided by elected officials who will be held be accountable for their decisions. Such an arbitrary system lacks transparency and oversight and gives too much power to unelected individuals.
Medicare reform must be done in a way that protects policies and programs that work. Thankfully, both Obama and Romney were emphatic on Wednesday about protecting the prescription drug benefit program, Part D, one of Medicare’s most productive programs.
Part D is the most cost-effective and successful entitlement program the federal government runs. The program, which is run on a free enterprise model, has been successful and effective in saving lives, saving money and offering people more choices.
Thanks to strong competition, the prescription drug program is costing the government and beneficiaries far less than initial projections. Last year, the Congressional Budget Office (CBO) reduced its baseline 10-year spending projection for all of Medicare by $186 billion, two-thirds of which is accounted for by a reduction in Part D spending.
Medicare reform will undoubtedly be a hotly debated issue in these final weeks before the election. While Romney came out strongest last night, he will certainly be challenged by Obama on this issue in the remaining few weeks of the campaign. The candidate who can convince voters that his reform plan is best will enhance his changes of securing a victory significantly.
