Even though “Obamacare” was a constant point of dispute during the Republican primaries, with all the candidates attacking Romney for the similarities between his Massachusetts plan and the President’s plan, you heard relatively little about health care at the Tampa Republican convention. Until Wednesday night, that is. And then what you heard was mostly flat out wrong.
It started the first full evening of the Convention, (Tuesday), when the Republican candidate for Lt. Governor of Delaware cited a small business owner who wanted to expand his business but could not because of regulations and “Obamacare.” No details were given, but the speaker didn’t mention the subsidies that small businesses get for offering health insurance to their employees – a provision of the health reform law. She made it sound like the ACA was a huge barrier for small business growth, even though the state exchanges are designed to help individuals and small business employees find affordable coverage in the early years.
The keynote speaker of Tuesday evening, Gov. Chris Christie of New Jersey, mentioned the ACA only once by characterizing it as putting “bureaucrats” in charge of health care and coming between a patient and “her” doctor, even though the law bends over backward to delegate power to the states and none of the provisions disturbs the patient-doctor relationship.
Even the mischaracterized Independent Payment Advisory Board (IPAB), which is often cited as an example of government bureaucracy, is composed of private individuals with deep health care experience, and cannot ration health care or make changes to the basic benefits of Medicare. The IPAB can only make recommendations to Congress about how to save money in the Medicare program, recommendations that Congress can accept or replace with their own recommendations.
Guns a blazin’
On Wednesday evening, however, the attack on the Affordable Care Act, named “Obamacare” by its adversaries, came out in full force. Rep. Paul Ryan, the Vice Presidential nominee, made Medicare and the ACA one of the major issues in his speech, and much of what he said was inaccurate and distorted.
First of all, Obama and Ryan want to spend exactly the same amount on Medicare. Both propose slowing spending in Medicare to the gross domestic product plus .05 percent. But Obama proposes to slow growth by restraining and restructuring payments to hospitals and doctors; Ryan proposes to slow growth by fundamentally changing the nature of the program from a “defined benefit” to a “defined contribution” (think pension vs. 401k). What Ryan suggested was that the Democrats would strip Medicare to save the ACA and help the poor, ignoring the fact that the Ryan plan would take the same amount from Medicare but use it for deficit reduction and potentially transfer it to the defense budget.
What you did not hear at the Republican convention were any details about Ryan’s plan to restructure Medicare, or anything at all about how to solve the problems that the ACA tries to solve – covering the uninsured in America or increasing quality of care. Calls to repeal “Obamacare” did not explain how the Republicans would keep the insurance industry from rejecting people with pre-existing conditions, cover children, help seniors with prescription drug costs or provide preventive care to millions of Americans.
Perhaps conventions are not where you expect truth to be told. But should they at least be places where lies are not so blatant? Thursday evening, we will hear from the Republican nominee, Mitt Romney. It is unlikely he will spend time touting his health care legislation in Massachusetts or mention health care in any significant way. Republicans will leave Tampa with the idea that the ACA must be repealed but with little idea of what might replace it as a solution for our rising health care costs or our increasing number of uninsured.
Next week, the Democrats will have a chance to explain how they would save Medicare and implement the ACA. Will they exaggerate their achievements? No doubt. Will they be more specific about how they will tackle our budget issues and what they will do to strengthen Medicare, Medicaid and Social Security? We should hope so.