Reason vs. Madness

That would be Barack Obama and WM Romney, arguing for their health care policies side-by-side, which you can read right here in the new NEJM. (And yes, they have kindly invited to masses to read it.)

I hereby assert the privilege of the chair to make the following comments:

Obama provides a coherent, focused, spirited defense of the Affordable Care Act, and proudly claims the label of Obamacare. He also directly, cogently and unabashedly criticizes the claims of his opponent. My conclusion? He didn't write this himself, because he sure as hell never talks this way.

Here's a taste:

My opponent in this election, Mitt Romney, has a radically different vision for the future of our health care system — even if it means running from his past as the architect of health reform in Massachusetts. He would begin by repealing Obamacare on day 1. Your patients would once again be charged excessive copays for preventive care, and millions of Americans would be one illness or injury away from bankruptcy. He would undo the progress we are making toward a more coordinated delivery system. Romney and his running mate, Congressman Paul Ryan, have proposed a budget that could force drastic cuts to investment in medical research, eliminating 1600 National Institutes of Health grants and slowing our progress on scientific and medical breakthroughs. They have pledged to turn Medicaid into a block grant and slash its funding by a third — plunging tens of millions more Americans into the ranks of the uninsured and leaving our hospitals and health care providers to grapple with an increasing burden of uncompensated care. And they are committed to ending Medicare as we know it by turning it into a voucher program, with insurance companies set to make millions while seniors and people with disabilities are forced to pay thousands more every year.

Romney, as usual, is long on rhetoric, short on specifics, and wrong when he does offer any up. He claims the PPACA increases taxes by $1 trillion, which will "hit the middle class hard and drive medical innovation overseas." This is of course utter nonsense. The major revenue sources in the bill are an added tax of 3.8% on unearned income for high-income taxpayers, which I suppose does include people who Romney thinks are the "middle class"; an annual fee paid by insurance providers, which fund the Patient Centered Outcomes Research Institute; and a  40% excise tax on health insurance annual premiums in excess of $10,200 for an individual or $27,500 for a family, which is not designed to actually raise revenue but to discourage employers from providing such "cadillac" plans. There are various smaller taxes on medical device makers and odds and ends, but the total of new revenues over ten years is $392.1 billion, which is less than 2/5 of $1 trillion. So he's just flat out lying -- in the pages of the New England Journal of Medicine. If his article were peer reviewed, it would have been rejected.

The Act doe raise the Medicare tax by .9%, which makes it more reflective of reality. I kind of wish it didn't do that, since the tax is regressive. However, the poor and middle class will save money as a result of the act, and get affordable health care, more than offsetting anything they have to pay.

Romney repeats the lie about $716 in cuts to Medicare, which I don't think I have to re-debunk here.

Then he says:

If elected President, I will repeal Obamacare and replace it — not with another massive federal bill that purports to solve all our problems from Washington, but with common-sense, patient-centered reforms suited to the challenges we face.
In the health care system that I envision, costs will be brought under control not because a board of bureaucrats decrees it but because everyone — providers, insurers, and patients — has incentives to do it. Families will have the option of keeping their employer-sponsored coverage, but they will also be empowered to enjoy the greater choice, portability, and security of purchasing their own insurance plans. As a result, they will be price-sensitive, quality-conscious, and able to seek out the features they want. Insurers will have to compete for their business. And providers will find themselves operating in a context where cost and price finally matter. Competition among providers and choice among consumers has always been the formula for better quality at lower cost, and it can succeed in health care as well.

If people decide not to take their employer's health insurance, but to go out on their own and try to buy insurance on the non-group market, it will cost them vastly more, and if they have any pre-existing conditions, they won't be covered. They'll also face life-time caps, and the possibility that their policy will be canceled if they get sick -- in other words, all the problems the PPACA was designed to solve. These "competitive markets" Romney talks about have always existed, and they exist today, and they do not have the results he claims they do. He is not proposing anything specifically that would change that. So it's nothing but BS.

Will Obama be able to articulate that in next televised debate? Stay tuned.