The bulk of Wednesday night’s presidential debate in Denver focused on the topic of health care. In this segment, President Barack Obama and former Mass. Gov. Mitt Romney discuss the 2010 health law.
A transcript follows.
JIM LEHRER: You want the Affordable Care Act repealed. Why?
MITT ROMNEY: I sure do. Well, in part, it comes, again, from my experience. You know, I was in New Hampshire. A woman came to me and she said, look, I can’t afford insurance for myself or my son. I met a couple in Appleton, Wis., and they said, we’re thinking of dropping our insurance, we can’t afford it.
And the number of small businesses I’ve gone to that are saying they’re dropping insurance because they can’t afford it, the cost of health care is just prohibitive. And we’ve got to deal with cost.
And, unfortunately, when you look at Obamacare, the Congressional Budget Office has said it will cost $2,500 a year more than traditional insurance. So it’s adding to cost. And as a matter of fact, when the president ran for office, he said that by this year he would have brought down the cost of insurance for each family by $2,500 a family. Instead, it’s gone up by that amount. So it’s expensive. Expensive things hurt families. So that’s one reason I don’t want it.
Second reason: It cuts $716 billion from Medicare to pay for it. I want to put that money back in Medicare for our seniors.
Number three, it puts in place an unelected board that’s going to tell people ultimately what kind of treatments they can have. I don’t like that idea.
Fourth, there was a survey done of small businesses across the country, said, what’s been the effect of Obamacare on your hiring plans? And three-quarters of them said it makes us less likely to hire people. I just don’t know how the president could have come into office, facing 23 million people out of work, rising unemployment, an economic crisis at the kitchen table, and spend his energy and passion for two years fighting for Obamacare instead of fighting for jobs for the American people. It has killed jobs.
And the best course for health care is to do what we did in my state: craft a plan at the state level that fits the needs of the state. And then let’s focus on getting the costs down for people, rather than raising it with the $2,500 additional premium.
LEHRER: Mr. President, the argument against repeal?
BARACK OBAMA: Well, four years ago, when I was running for office, I was traveling around and having those same conversations that Gov. Romney talks about. And it wasn’t just that small businesses were seeing costs skyrocket and they couldn’t get affordable coverage even if they wanted to provide it to their employees. It wasn’t just that this was the biggest driver of our federal deficit, our overall health care costs, but it was families who were worried about going bankrupt if they got sick, millions of families, all across the country.
If they had a pre-existing condition, they might not be able to get coverage at all. If they did have coverage, insurance companies might impose an arbitrary limit. And so as a consequence, they’re paying their premiums, somebody gets really sick, lo and behold, they don’t have enough money to pay the bills, because the insurance companies say that they’ve hit the limit.
So we did work on this, alongside working on jobs, because this is part of making sure that middle-class families are secure in this country.
And let me tell you exactly what Obamacare did. Number one, if you’ve got health insurance, it doesn’t mean a government takeover. You keep your own insurance. You keep your own doctor. But it does say insurance companies can’t jerk you around. They can’t impose arbitrary lifetime limits. They have to let you keep your kid on your insurance plan until you’re 26 years old. And it also says that you’re going to have to get rebates if insurance companies are spending more on administrative costs and profits than they are on actual care.
Number two, if you don’t have health insurance, we’re essentially setting up a group plan that allows you to benefit from group rates that are typically 18 percent lower than if you’re out there trying to get insurance on the individual market.
Now, the last point I’d make before …
LEHRER: Two minutes — two minutes is up, sir.
OBAMA: No, I think — I had five seconds before you interrupted me, was the irony is that we’ve seen this model work really well in Massachusetts, because Gov. Romney did a good thing, working with Democrats in the state to set up what is essentially the identical model, and as a consequence people are covered there. It hasn’t destroyed jobs. And as a consequence, we now have a system in which we have the opportunity to start bringing down costs, as opposed to just leaving millions of people out in the cold.
LEHRER: Your five seconds went away a long time ago.
All right, Governor. Governor, tell the president directly why you think what he just said is wrong about Obamacare?
ROMNEY: Well, I did with my first statement.
First of all, I like the way we did it in Massachusetts. I like the fact that in my state, we had Republicans and Democrats come together and work together. What you did instead was to push through a plan without a single Republican vote. As a matter of fact, when Massachusetts did something quite extraordinary — elected a Republican senator to stop Obamacare, you pushed it through anyway.
So entirely on a partisan basis, instead of bringing America together and having a discussion on this important topic, you pushed through something that you and Nancy Pelosi and Harry Reid thought was the best answer and drove it through.
What we did in a legislature 87 percent Democrat, we worked together: 200 legislators in my legislature, only two voted against the plan by the time we were finished. What were some differences? We didn’t raise taxes. You’ve raised them by $1 trillion under Obamacare. We didn’t cut Medicare. Of course, we don’t have Medicare, but we didn’t cut Medicare by $716 billion.
We didn’t put in place a board that can tell people ultimately what treatments they’re going to receive. We didn’t also do something that I think a number of people across this country recognize, which is put people in a position where they’re going to lose the insurance they had and they wanted.
Right now, the CBO says up to 20 million people will lose their insurance as Obamacare goes into effect next year. And likewise, a study by McKinsey and Company of American businesses said 30 percent of them are anticipating dropping people from coverage.
So for those reasons, for the tax, for Medicare, for this board, and for people losing their insurance, this is why the American people don’t want Obamacare. It’s why Republicans said, do not do this, and the Republicans had the plan. They put a plan out. They put out a plan, a bipartisan plan. It was swept aside.
I think something this big, this important has to be done on a bipartisan basis. And we have to have a president who can reach across the aisle and fashion important legislation with the input from both parties.
OBAMA: Gov. Romney said this has to be done on a bipartisan basis. This was a bipartisan idea. In fact, it was a Republican idea. And Gov. Romney at the beginning of this debate wrote and said what we did in Massachusetts could be a model for the nation.
And I agree that the Democratic legislators in Massachusetts might have given some advice to Republicans in Congress about how to cooperate, but the fact of the matter is, we used the same advisers, and they say it’s the same plan.
When Governor Romney talks about this board, for example, unelected board that we’ve created, what this is, is a group of health care experts, doctors, etc., to figure out, how can we reduce the cost of care in the system overall.
Because there are two ways of dealing with our health care crisis. One is to simply leave a whole bunch of people uninsured and let them fend for themselves, to let businesses figure out how long they can continue to pay premiums until finally they just give up, and their workers are no longer getting insured, and that’s been the trend line.
Or, alternatively, we can figure out, how do we make the cost of care more effective? And there are ways of doing it.
So at Cleveland Clinic, one of the best health care systems in the world, they actually provide great care cheaper than average. And the reason they do is because they do some smart things. They say, if a patient’s coming in, let’s get all the doctors together at once, do one test instead of having the patient run around with 10 tests. Let’s make sure that we’re providing preventive care so we’re catching the onset of something like diabetes. Let’s pay providers on the basis of performance as opposed to on the basis of how many procedures they’ve engaged in.
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.
And the fact of the matter is that, when Obamacare is fully implemented, we’re going to be in a position to show that costs are going down. And over the last two years, health care premiums have gone up — it’s true — but they’ve gone up slower than any time in the last 50 years. So we’re already beginning to see progress. In the meantime, folks out there with insurance, you’re already getting a rebate.
Let me make one last point. Gov. Romney says, we should replace it, I’m just going to repeal it, but we can replace it with something. But the problem is, he hasn’t described what exactly we’d replace it with, other than saying we’re going to leave it to the states.
But the fact of the matter is that some of the prescriptions that he’s offered, like letting you buy insurance across state lines, there’s no indication that that somehow is going to help somebody who’s got a pre-existing condition be able to finally buy insurance. In fact, it’s estimated that by repealing Obamacare, you’re looking at 50 million people losing health insurance at a time when it’s vitally important.
LEHRER: Let’s let the governor explain what you would do if Obamacare is repealed. How would you replace it?
ROMNEY: Well, actually it’s lengthy description. But, number one, preexisting conditions are covered under my plan. Number two, young people are able to stay on their family plan. That’s already offered in the private marketplace. You don’t have to have the government mandate that for that to occur.
But let’s come back to something the president and I agree on, which is the key task we have in health care is to get the cost down so it’s more affordable for families. And then he has as a model for doing that a board of people at the government, an unelected board, appointed board, who are going to decide what kind of treatment you ought to have.
In my opinion, the government is not effective 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 enterprises competing with each other, learning how to do better and better jobs.
I used to consult to hospitals and to health care providers. I was astonished at the creativity and innovation that exists in the American people.
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. Intermountain Healthcare does it superbly well, Mayo Clinic is doing it superbly well, Cleveland Clinic, others.
But the right answer is not to have the federal government take over health care and start mandating to the providers across America, telling a patient and a doctor what kind of treatment they can have.
That’s the wrong way to go. The private market and individual responsibility always work best.
OBAMA: Let me just point out first of all this board that we’re talking about can’t make decisions about what treatments are given. That’s explicitly prohibited in the law. But let’s go back to what Gov. Romney indicated, that under his plan, he would be able to cover people with preexisting conditions.
Well, actually Governor, that isn’t what your plan does. What your plan does is to duplicate what’s already the law, which says if you are out of health insurance for three months, then you can end up getting continuous coverage and an insurance company can’t deny you if it’s been under 90 days.
But that’s already the law, and that doesn’t help the millions of people out there with preexisting conditions. There’s a reason why Gov.Romney set up the plan that he did in Massachusetts. It wasn’t a government takeover of health care. It was the largest expansion of private insurance. But what it does say is that “insurers, you’ve got to take everybody.”
Now, that also means that you’ve got more customers. But when Gov. Romney says that he’ll replace it with something, but can’t detail how it will be in fact replaced and the reason he set up the system he did in Massachusetts was because there isn’t a better way of dealing with the preexisting conditions problem.
It just reminds me of, you know, he says that he’s going to close deductions and loopholes for his tax plan. That’s how it’s going to be paid for, but we don’t know the details. He says that he’s going to replace Dodd-Frank, Wall Street reform, but we don’t know exactly which ones. He won’t tell us. He now says he’s going to replace Obamacare and ensure that all the good things that are in it are going to be in there, and you don’t have to worry.
And at some point, I think the American people have to ask themselves, is the reason that Gov. Romney is keeping all these plans to replace secret because they’re too good? Is it because that somehow middle-class families are going to benefit too much from them?
No. The reason is, is because, when we reform Wall Street, when we tackle the problem of pre-existing conditions, then, you know, these are tough problems and we’ve got to make choices. And the choices we’ve made have been ones that ultimately are benefiting middle-class families all across the country.
LEHRER: We’re going to move to …
ROMNEY: No, I have to respond to that.
LEHRER: No, but …
ROMNEY: Which is my experience as a governor is if I come in and lay down a piece of legislation and say, it’s my way or the highway, I don’t get a lot done. What I do is the same way that Tip O’Neill and Ronald Reagan worked together some years ago. When Ronald Reagan ran for office, he laid out the principles that he was going to foster. He said he was going to lower tax rates. He said he was going to broaden the base. You’ve said the same thing, you’re going to simplify the tax code, broaden the base.
Those are my principles. I want to bring down the tax burden on middle-income families. And I’m going to work together with Congress to say, OK, what are the various ways we could bring down deductions, for instance? One way, for instance, would be to have a single number. Make up a number, $25,000, $50,000. Anybody can have deductions up to that amount. And then that number disappears for high-income people. That’s one way one could do it. One could follow Bowles-Simpson as a model and take deduction by deduction and make differences that way. There are alternatives to accomplish the objective I have, which is to bring down rates, broaden the base, simplify the code, and create incentives for growth.
And with regards to health care, you had remarkable details with regards to my pre-existing condition plan. You obviously studied up on my plan. In fact, I do have a plan that deals with people with pre-existing conditions. That’s part of my health care plan. And what we did in Massachusetts is a model for the nation state by state. And I said that at that time.
The federal government taking over health care for the entire nation and whisking aside the 10th Amendment, which gives states the rights for these kinds of things, is not the course for America to have a stronger, more vibrant economy.