James Carville famously said about the 1992 election, “It’s the economy, stupid.” But right afterwards, he also said, “Don’t forget about health care.”
Republican presidential nominee’s pick of Paul Ryan as his vice presidential candidate solidifies what was already clear–that this election will be the most consequential election for health care in this country’s history.
A few weeks ago, I was on a panel about the Affordable Care Act, and the question came up how the election would impact its implementation. One panelist said that he didn’t believe that even a Republican President and Congress would fully repeal the measure–too many individual provisions are too popular to undo. I tended to side more with another panelist, who suggested that even though Governor Romney passsed a similar health care reform in his state, we should take him at his word, that he would seek a full repeal as President.
What I neglected to say is that election is far more consequential than that–it’s not just the future of the Affordable Care Act and all its’ benefits, but the future of Medicare and Medicaid as well. Candidate Romney had already endorsed the Paul Ryan budget–which includes not just dramatic tax cuts geared toward the wealthy, but what many have called the end of Medicare and Medicaid as we know it. Medicare would be transformed into a voucher program; Medicaid would be relegated to block grants to states. Neither would provide the security or guarantees to patients or families. In fact, the defining characteristic of the Ryan plan is not to reduce the cost of health care, but to shift the risk and cost of health care, from the federal government–to states, seniors, and families.
This is a deliberate shift–the thinking is individual consumers, feeling the economic pain more, will be more incentivized to shop for the best value. This ignores that individuals are particularly ill-equipped to bargain for better prices–they lack the data and information, the bulk purchasing power, and the ability to say “no” in the case of needed care. That’s why the Affordable Care Act seeks systemic solutions–better research into determining the most effective treatments; getting people preventative care early; changing the incentives of our broken insurance market; and an Exchange that negotiates for better value on behalf of millions.
But now, candidate Romney has further embraced this risk shift with his vice presidential pick who seeks to dismantle the three pillars of our health system–Medicare, Medicaid, and the Affordable Care Act.
This election will be a very clear, stark choice about the future of our health care system–as part of even a larger conversation about tax fairness and middle-class opportunity. The stakes could not be higher–not just with their visions and plans, but with the challenges and opportunity that arises next year as both cuts and taxes are set to trigger on January 1, 2013 without Congressional action. The President and now his Republican challengers have seemingly gone “all in” in a poker game about their very different philosophers–but the losers in that game could be all of us, and the health care system we all rely on.