America, “We’ve Lost a Pod”: What Romney and Obama Didn’t Say…

While polls immediately following Wednesday’s Presidential debate in Denver suggested that Mitt Romney came out of the contest way ahead of Barack Obama, the real winners were clearly America’s fact-checkers and policy wonks. Sure, Romney may see a bump in his poll numbers after his performance, but it’s the detail-oriented folks—some might say experts—that really get to delve into the content as they aim to correct and rationalize the multitude of competing arguments and “data”. By contrast, the evening’s losers were: Michelle Obama, who spent her 20^th wedding anniversary watching the debacle; everyone on Twitter disinterested by politics; and moderator, Jim Lehrer, who “lost a Pod” due to poor facilitation. That’s right. After a full 90-minutes of debate, Lehrer was unable to keep the candidates’ comments concise enough and we missed out on what might have been the most exciting part of the debate: an open back-and-forth between Obama and Romney.

Nevertheless, health care comprised a large portion of the debate with both candidates touching on everything from the origins of ObamaCare—a label for the Affordable Care Act that Romney apologized to Obama for using, but one which Obama said he actually welcomed—to insurance premiums and a discussion of the Medicare Independent Payment Advisory Board, or IPAB. Still, given all the misinformation put forth by both Romney and Obama during the second Pod, it appeared by the end that neither had actually read the Affordable Care Act and that both needed new accountants.

But perhaps we should give the candidates the benefit of the doubt. Maybe, just maybe several important and highly anticipated topics were not simply forgotten or purposefully overlooked by the candidates, but were rather innocent victims of the last, lost Pod. Had the last Pod not become a casualty of debate, we might have heard about the following:

The Supreme Court Decision on the Affordable Care Act. Given the numerous amicus briefs, intense public emotions and extensive media coverage surrounding the President’s signature bill, it was shocking that neither President Obama nor Romney touched on the case. With the next four years offering an enormous opportunity to dramatically alter the landscape of the Court, and the highly partisan spin taking place during the debate, it was surprising that we didn’t hear either candidate discuss the case. Obama could have pointed to the ruling to give more credibility to health reform, while Romney could have capitalized on the close 5-4 decision arguably rewritten by Chief Justice Roberts to make the claim that ObamaCare— particularly the unpopular individual mandate—isn’t the best way to implement reform. We could have heard that, but we didn’t.

Then there was the diabolical 47 percent. Seriously. This was a softball lobbed right down the middle for President Obama. It hung there in the air in front of him for a full 90 minutes, untouched, while he took swings at several other topics and missed. Obviously, this gaffe isn’t one that Romney would be expected to draw attention to himself, but why on earth didn’t Obama go after the low-hanging fruit? Was he worried that he’d come off as too attacking? Perhaps. But the President never brought it up, and he should have. You can bet that Romney was ready with a prepared response on the topic. Too bad we never got to see him use it.

Reproductive rights. This past year has seen monumental coverage of reproductive rights as the Affordable Care Act and state legislatures have gone head-to-head over funding. Planned Parenthood and Susan G. Komen Foundation have clashed over support, Plan B became a battleground for HHS and the FDA, and politicians have made one gaffe after another (think “putting an aspirin between your knees for birth control” and “legitimate rape” for starters). Yet, once again, President Obama didn’t bring up a topic where he enjoys a lot of popular support for his position on the issues. Romney and the GOP have been behind most of the chaos and it would have been very easy for Obama to associate Romney with Todd Akin and the lack of women’s rights many women associate with the GOP. This was certainly a missed opportunity for Obama as women will undoubtedly be the deciders of this election.

A humanizing glimpse of Mitt Romney. It’s well known that Romney’s wife, Ann, has Multiple Sclerosis.It’s also been pointed out repeatedly that the Romney campaign has shied away from discussing the disease and its impact on their family. However, in last night’s debate, Governor Romney spent a lot of time and effort to come across as compassionate and in touch with the average American. In fact, he essentially led off his comments talking about health care and the economy, telling personal narratives about the impact of our broken system and the Great Recession on Americans. He focused on others, but he never focused on himself. Although I’m sure many would advise him to stay away from any topics that associate him with money, disease and his personal experience would have endeared him to so many. In a recent interview Ann said her husband’s response to the disease had been, “He said to me, ‘I don’t care how sick you are. I don’t care if you’re in a wheelchair. I don’t care if I never eat another dinner in my life. I can eat cereal and toast and be just fine. As long as we’re together, everything will be OK.’” That paints the picture of a man who actually cares about others, which is an image Romney desperately needs to convey to undecided voters. Perhaps he was just waiting to be accused of his comments about the 47% before unleashing this most personal secret weapon. Alas, America, we lost a pod, and the world may never know.

 

IPAB

Contrary to the title, the IPAB is not a new Apple product. Rather, it is the “Independent Payment Advisory Board” created by the Affordable Care Act to solve the problem of ever-increasing Medicare spending. In people’s worst nightmares, the IPAB is a death panel that will make decisions about how to ration health care for the elderly and disabled. Images of 15 people sitting in a room handing out death sentences flash through the minds of the anti-government crowd. Of course, nothing could be further from the truth, as the IPAB has no authority to limit benefits, increase beneficiaries’ out-of-pocket costs, or otherwise alter the Medicare program in any way that would “ration” care.

So, what can the IPAB actually do to promote slower spending growth in Medicare? They can suggest legislation, that’s what. Legislation that, for example, would reduce or alter the way in which payments are made to providers. It’s debatable if the recommendations from IPAB will work to actually control spending. What’s not up for debate is whether action will be taken, and that’s what I’m most pleased about.

You see, I hear often from family and friends about how Congress “never does anything” and how we should “vote the whole sorry bunch out and start from scratch.” It doesn’t seem to matter which party is in power, either. Congressional disapproval knows no party affiliations. And this isn’t just a trend among my social circle. Americans generally disapprove of the job Congress is doing. The IPAB puts an end to that, and here’s how:

Starting in 2013, the chief actuary of the Centers for Medicare and Medicaid Services (CMS) will report both a projected and a target Medicare growth rate for the next five years. If the projected growth rate exceeds the target growth rate, IPAB is tasked with making recommendations to bring things in line. These recommendations are formally submitted to Congress as proposed legislation. In the past, this is where progress ceased to occur, but no longer.

With the ball in Congress’ court, the options are straightforward. Congress may either enact the legislation recommended by IPAB, introduce and enact its own legislation that achieves the same cost savings as the recommendations from IPAB, or fail to act. If Congress fails to act, however, the secretary of the Department of Health and Human Services must implement IPAB’s recommendations, which cannot be overruled by either the executive or the judicial branches. In short, when Medicare spending increases too rapidly, something will be done to address it, even if Congress fails to act.