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David May is assistant manager editor/features of Modern Healthcare.
David May is assistant manager editor/features of Modern Healthcare.

It's debatable

Will Obama and Romney take advantage of faceoff to detail policy positions?


By David May
Posted: September 29, 2012 - 12:01 am ET
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There's no doubting that Americans love a good debate. Here's hoping that the initial faceoff this week between the two presidential nominees doesn't disappoint.

Wednesday's debate, to be moderated by PBS “NewsHour” anchor Jim Lehrer, will focus solely on domestic policy issues. So given the heft of the nation's $2.7 trillion healthcare industry and how it somehow impacts every single one of the nearly 315 million residents of this country, the challenges facing the industry are likely to become prominent talking points during the 90-minute event.

And that's the problem. At this point in the process, we don't need sketchy ideas and rote lines from stump speeches. In the dwindling number of days until the election, everyone is looking for real substance as the candidates explain their policy proposals. The debate will also provide time for immediate rebuttal from the other side, helping viewers decide for themselves who is making a more persuasive argument.

Lehrer is among the best at moderating these events and covering all the bases, so it's a sure thing significant time will be spent on healthcare. During that allotted time, here's what we hope to hear:

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From Mitt Romney—since he continually reminds us that from the first day after he's sworn into office, he'll be working to repeal and replace the Patient Protection and Affordable Care Act—what, if any, provisions in the ACA would he retain? After all, a number of provisions in the law remain highly popular.

Again, we don't want broad strokes any longer. Now it's all about the specificity of his vision for healthcare reform. Most would believe that vision would resemble Romneycare, the universal coverage plan working pretty well in Massachusetts, which he signed into law. But apparently that hasn't been the case for some time now.

And here are some questions for President Barack Obama to answer: As critics point out and several studies are projecting, the ACA, as is, will likely have little effect on the relentless upward cost curve in healthcare. How would he plan to ensure the “Affordable Care” part of the law is more than just two words in its title? What specific changes, if any, does he believe are necessary in the sweeping legislation to slow and even reverse the current spending trends?

Then there's Medicare. Both candidates need to defend their positions on the program's future. Of course, before they can defend those positions, they need to enumerate them. If Romney supports a privatized, premium-support approach as promoted by his running mate, Rep. Paul Ryan (R-Wis.), what does he say to future seniors who fret about affordability of their care? And if Obama continues to back the status-quo fee-for-service model, how can he guarantee long-term solvency, given the grim estimates from the program's trustees?

Healthcare certainly can't dominate this domestic policy debate. Few will argue against the notion that, yes, once again, in the home stretch of this campaign, it's still the economy, stupid. The 24 million people unemployed and the underemployed will be yelling, “Jobs! Jobs! Jobs!” at their TV screens if the discussion begins to look like another town hall meeting over healthcare reform. But the healthcare beast does need to be tamed if we're ever to get our budgets closer to being balanced.

Serious answers to the questions posed above would be a good start. Remember, millions of voters will be tuned in. But the candidates will have limited time before the voters start to tune them out.


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