* Debate fails to articulate health policies
* Campaign rhetoric, hyperbole cloud national issue
By David Morgan
WASHINGTON, Oct 4 President Barack Obama and his
Republican challenger Mitt Romney agree that the $2.8 trillion
U.S. healthcare system is broken, but neither candidate on
Wednesday presented voters with a clear idea of how to fix it.
Their comments about Medicare, Medicaid and healthcare in
general dominated more than one-quarter of a presidential debate
and gave both candidates a chance to articulate their policies
for an estimated 50 million viewers.
Healthcare is a top issue in the Nov. 6 election. The U.S.
healthcare system is the world's most expensive, with spiraling
cost growth that has been blamed for keeping U.S. wages down,
eroding retirement security of future seniors and ballooning the
contribution of public health spending to the federal debt and
"I would be hard-pressed to think that anyone watching would
come away with a clear sense, either of what each candidate
would do, or what the implications of those policies would be,"
said Dr. Arthur Kellermann, a health policy expert at the Rand
Both candidates spoke compassionately about people they had
met who could not afford health insurance or needed care, either
for themselves or their families.
But Romney shed little new light on his own reform agenda.
Instead, he attacked Obama's healthcare law with shopworn
Republican campaign themes. He repeated a claim - widely
discredited by independent analysts - that the president would
cut $716 billion from the Medicare program for the elderly and
The alleged cut is the savings Obama gleaned from increases
in payments to Medicare's healthcare providers and which
Romney's running mate, Wisconsin congressman Paul Ryan, included
in his own budget proposal as chairman of the House of
Representatives Budget Committee.
Obama allowed Romney's characterization to go unchallenged,
saying that his healthcare reforms are modeled on the changes
Romney oversaw in Massachusetts as state governor.
Romney also avoided a direct answer to whether he supports a
Medicare "voucher" system, a charge that Democrats have made
since the summer in an attempt to erode vital Republican support
among older Americans.
"What I support is no change for current retirees and near
retirees in Medicare, and the president supports taking $716
billion out of that program," said Romney, brushing off two
attempts by moderator Jim Lehrer to get an answer on vouchers.
Romney would convert Medicare from a guaranteed benefit
program to a system providing fixed voucher-like payments that
beneficiaries could use to purchase coverage either from
traditional Medicare or a private insurer.
Critics say that could leave beneficiaries vulnerable in
coming years to rising out-of-pocket healthcare costs, including
private insurance premiums, and endanger traditional Medicare by
leaving it with the sickest people.
But Romney presented his plan as a menu of choices between
"the current Medicare program or a private plan," without cost
Romney suggested Obama's healthcare reforms had failed to
prevent healthcare cost increases that have occurred since the
Patient Protection and Affordable Care Act became law in 2010.
The law does not come fully into force until 2014.
Obama responded: "Over the last two years, healthcare
premiums have gone up, it's true, but they've gone up slower
than anytime in the last 50 years."
Government actuaries say healthcare spending is increasing
at historically low rates of around 4 percent a year, but
analysts attribute that mainly to the weak economy.