The 1st Presidential Debate

Wednesday night 58 million television viewers watched presidential hopeful Mitt Romney square off against President Barak Obama in the 2012 campaign’s first presidential debate.  By most accounts Romney won the contest hands down.  But in my opinion the real winner was the American voting electorate.  Romney was clear and decisive.  He did not look or sound like the caricature portrayed by the Democrats and the lapdog media.  At the risk of being redundant, I’ll add my insight to the growing commentary. 

Healthcare overall and Medicare specifically was appropriately emphasized in this domestic policy debate.  What I found interesting was Romney’s command over the topic and Obama’s lack of command.  Romney’s thoughts were organized and he showed a command of the facts.  Obama was disjointed and relied on overused sound bites describing his plan and Romney’s approach to Medicare reform. 

Obama actually made the first reference to health care; describing the “$716 billion we were able to save from the Medicare program by no longer overpaying insurance companies by making sure that we weren’t overpaying providers. And using that money, we were actually able to lower prescription drug costs for seniors by an average of $600, and we were also able to make a — make a significant dent in providing them the kind of preventive care that will ultimately save money throughout the system.” 

Romney was quick to reply that Obama had just described a savings of “$1 for every $15 you’ve cut. They’re [seniors] smart enough to know that’s not a good trade.  I want to take that $716 billion you’ve cut and put it back into Medicare. By the way, we can include a prescription program if we need to improve it.  But the idea of cutting $716 billion from Medicare to be able to balance the additional cost of Obamacare is, in my opinion, a mistake.” 

Romney referred to the $716 billion four more times, explaining that it’s not savings at all, if it’s spent to fund provisions in Obamacare.  Wisely, the President never mentioned the number again.  Obama talked about the popular insurance provisions in reform plan: no lifetime limits, dependents up to age 26 remaining on their parents’ insurance plans, elimination of pre-existing conditions exclusions, the 85% minimum for insurance plan spending relative to the premium, and that’s about it. 

Romney accepted these provisions as part of the replacement pledge (of course after the repeal).  These are provisions that are in the Massachusetts plan passed when he was governor of that state, emphasizing the bipartisan nature of that legislation and the strictly partisan process that led up to the passage of Obamacare.  After possibly his best public defense of Romneycare to date, he quickly moved on to a description of the Independent Payment Advisory Board, the 15-member unelected board of experts that will make important decisions on pricing and spending that will affect access to medical care in both the public and private sectors. 

President Obama’s response to IPAB was bringing up the cost-saving success of the Cleveland Clinic and its integrated approach to medical care delivery.   In his mind the success is somehow an example of what IPAB is all about.  “Now, so what this board does is basically identifies best practices and says, let’s use the purchasing power of Medicare and Medicaid to help to institutionalize all these good things that we do.”  Romney was quick to counter with a devastating retort “ In my opinion, the government is not effective in — in bringing down the cost of almost anything.  As a matter of fact, free people and free enterprises trying to find ways to do things better are able to be more effective in bringing down the cost than the government will ever be.  Your example of the Cleveland Clinic is my case in point, along with several others I could describe.  This is the private market. These are small — these are enterprises competing with each other, learning how to do better and better jobs. I used to consult to businesses — excuse me, to hospitals and to health care providers. I was astonished at the creativity and innovation that exists in the American people.” 

Romney concluded by saying that “in order to bring the cost of health care down, we don’t need to have a board of 15 people telling us what kinds of treatments we should have. We instead need to put insurance plans, providers, hospitals, doctors on target such that they have an incentive, as you say, performance pay, for doing an excellent job, for keeping costs down, and that’s happening.  Innermountain Healthcare does it superbly well, Mayo Clinic is doing it superbly well, Cleveland Clinic, others.”  OUCH!

All in all, it was a good night for Romney and a shot of adrenaline for his campaign.  The President will obviously rethink his strategy for the next two debates.  It will be interesting to see how many will view the next debate between Vice President Biden and Congressman Ryan.  This may turn out to be the best reality TV of the season.