Healthcare takes center stage at political conventions

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Healthcare takes center stage at political conventions
Healthcare takes center stage at political conventions
Healthcare policy is having its day in the spotlight of presidential politics as Republicans and Democrats rekindle their sparring over the Affordable Care Act, Medicare and Medicaid.

Healthcare policy holds perils for both presidential contenders. The public soured on Obamacare, as both sides now call it, during its long and tortured passage through the Congressional sausage grinder. The law has seen a modest uptick in public support since the Supreme Court upheld its basic Constitutionality last summer and many of its particulars poll well, but it's poorly understood and broadly unpopular as a whole (in good measure because of Republican grumbling about shadowy backroom deals with the drug industry). Because it's loathed by many rank-and-file Democratic voters as having given away too much to insurers and pharmas, Congressional Democrats wanted to talk about anything but the law following its passage in March 2010, and after the midterm election that followed, there were far fewer of them, as a combination of dispirited Dems and fired-up Republicans led to a rout that gave the GOP control of the House of Representatives and sharply diminished the Democrats' Senate majority.  

But that doesn't mean that the issue is a winner for Gov. Romney, who would just as soon not remind his Obamacare-loathing base that, as chief executive of Massachusetts in 2006, he passed legislation which, as Democrats gleefully note, served as a template for the ACA four years later. And partisans on both sides would just as soon forget that the template for that law, which aimed to extend health insurance to nearly all of the state's residents while preserving a robust marketplace for private insurance, came out of a conservative think tank.  

Still, both campaigns seem to have decided they can no longer dance around the elephant in the room, so to speak, and healthcare has featured prominently in several convention speeches. Romney's VP pick, Wisconsin Rep. Paul Ryan, cast it as the casus belli that would propel his side to victory in November.

“Here we were faced with a massive job crisis so deep that if everyone out of work stood in single file, that unemployment line would stretch the length of the entire American continent,” he said in his Tampa speech last week. “You would think that any president, whatever his party, would make job creation and nothing else his first order of economic business, but this president didn't do that. Instead, we got a long, divisive, all or nothing attempt to put the federal government in charge of health care.” The law, he said, “comes to more than 2,000 pages of rules, mandates, taxes, fees and fines that have no place in a free country.”

Ryan revived a line of attack that served the Republicans well in 2010, particularly with older voters. Obamacare, he said, was funded in part by reallocating billions from Medicare – a move he cast as “the biggest, coldest power play of all.”

“An obligation we have to our parents and grandparents is being sacrificed, all to pay for a new entitlement we didn't even ask for,” said Ryan, who went on to speak of how Medicare was there for his family when they were caring for his grandmother with Alzheimer's.

President Clinton responded to that point in his own convention speech yesterday, noting that Ryan has proposed the same cuts and that those cuts would not impact Medicare benefits (in theory, anyway).  “It takes some brass to attack a guy for doing what you did,” said Clinton, who noted that the Medicare savings, in part, would offset the closing of the “donut hole” coverage gap in the Medicare prescription drug benefit.

“Now, at least on this issue, on this one issue, Governor Romney has been consistent,” said Clinton. “He attacked President Obama too, but he actually wants to repeal those savings and give the money back to the insurance company. He wants to go back to the old system, which means we'll reopen the doughnut hole and force seniors to pay more for drugs, and we'll reduce the life of the Medicare trust fund by eight full years.” Medicare, he said, would go broke by 2016.

Romney and Ryan argue that Medicare must move to a voucher system for future generations of retirees – they draw the line at Americans currently under 55 – in which seniors would be given an annual allotment to buy insurance with. That would, the argument goes, help hold down spiraling healthcare costs and deter unnecessary procedures by giving seniors “skin in the game.” Democrats counter that the shift from quantitative to qualitative incentives for reimbursement set in motion under the ACA will hold costs down. Clinton noted that the rate of growth in Medicare spending has declined dramatically over the last two years, though it's unclear whether that's attributable to Obamacare or mainly to recessionary scrimping. The Republican ticket also favors substantial cuts to Medicaid, which Clinton charged would “really hurt a lot of poor kids” and seniors.

Clinton's case for the ACA was, as many pundits noted, far more detailed that that which Obama himself has put forth. In fact, the degree to which the Democrats' convention has showcased the ACA, including speeches by Health and Human Services chief Kathleen Sebelius and several ordinary people who've benefited from Obamacare, marked a 180-degree about-face on the topic. But the emotional argument for a law viewed ambivalently by many of the party faithful was made by Michelle Obama, who told convention-goers in Charlotte that “Barack refused to listen to all those folks who told him to leave health reform for another day, another president. He didn't care whether it was the easy thing to do politically …. He did it because he believes that here in America, our grandparents should be able to afford their medicine, our kids should be able to see a doctor when they're sick, and no one in this country should ever go broke because of an accident or an illness.”
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