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Romney Health Plan Is Three-Card Monte

Romney Health Plan Is Three-Card Monte

three-card monte animation representing Romney's many healthcare positionsRomney Health Plan Deceptions

The first presidential debate between President Obama and his Republican challenger, former Massachusetts Governor Mitt Romney – and specifically the Romney health plan articulated so forcefully that night – has forced me to re-use this three-card monte animation. (see my last post on Medical Greed’s Newest Poster Boys about the medical shucksters in our midst for previous use). That, and the fact that I really like the animation – so this gives me another excuse to use it.

First, for those who don’t get out much, what is three-card monte?  It’s a card trick – a street con in which the unsuspecting are lured into betting their money on which of three cards is the elusive queen. If they guess right, they win. They seldom guess right, however. That’s because it relies on sleight-of-hand and misdirection to confuse these “marks” into thinking they’ve actually got a shot at winning when the game is stacked against them by the dealer and his shills.

Which is where the analogy to the Romney health plan claims in the first presidential debate of the general election comes into play. Let’s address each of his three cards in order. And you don’t have to guess where the queen is - because there is no queen, believe me.

Card #1 – Medicare “Reform”

First, a little context:  Republicans don’t like Medicare. They’ve opposed it from its outset. They consider it socialized medicine and would rather seniors bought health insurance directly from private insurance companies with no government intermediaries. Any attempt to refute this is disingenuous.

Now to the Romney health plan. Governor Romney went to great lengths in the first debate of the general election to reassure seniors on Medicare and those soon eligible for it that the Romney health plan would have no effect on them. He even told those sixty and over they could “stop listening” to what he had to say about the subject. That’s a bit like the three-card monte dealer telling you to “stop looking” for the queen. Why even bother since you haven’t a chance?

But not so fast, Willard. Notice how “sixty and over” was slipped in there when previous comments by Romney and his running mate, Congressman Paul Ryan (R – Wis), have always set the cut-off age for their proposed changes to Medicare as applying to those under 55, not 60. That’s kind of a major sleight-of-hand for those age 55-60. And who’s to say it won’t slip even further after the election?

And what about those 60 and over, including those currently on Medicare? Will the Romney health plan really have no impact on them, as he promises?  

Not if he repeals Obamacare as he promises to do on “day one” in office. That’s because Obamacare already affords those on Medicare several benefits its repeal with the Romney health plan would extinguish. These include…

  • Closing the Part D prescription drug “doughnut hole” that’s estimated to save seniors an average of $600 a year;

  • Free annual wellness visits and select preventive screening exams; and

  • Extended financial solvency of Medicare to 2024 vs. 2016 without Obamacare’s Medicare savings under the Romney health plan.

The following table from my eBook Obamacare – The Good, the Bad & the Missing  summarizes the differences between Obamacare and the Romney health plan in terms of their Medicare impacts:

Table comparing medicare effects of Obamacare vs. its free-market alternative

Defined Benefit or Defined Contribution          What’s the Difference?

The proposed substitution of Medicare vouchers in the Romney health plan would switch it from a defined benefit plan in which Medicare beneficiaries can count on most of their healthcare costs being covered (less deductibles, co-insurance and co-pays and with limited hospital and nursing home coverage) to a defined contribution plan under the Romney health plan. This means they’d receive only a fixed dollar amount regardless of their actual health insurance and out-of-pocket healthcare costs.  

This fundamental change with the Romney health plan is estimated to leave those enrolling in Medicare in 2023 and after responsible, by 2030, for two-thirds of their total healthcare costs vs. only one-quarter under Obamacare.

That’s 2 1/2 times the cost to these seniors with declining capacity to cope with the arcane complexities of health insurance as they age.

Of course, the Romney health plan would eliminate the Medicare savings projected under Obamacare.  Doing so means Medicare is projected to no longer be financially solvent beyond 2016  – casting doubt on the feasibility of the entire voucher program scheduled to kick in some six years later.

The only way the Romney health plan’s proposed voucher program can ever be implemented, therefore, is if Medicare benefits are cut even further than those lost with the elimination of Obamacare.

And should that happen, the Romney health plan’s voucher program is expected to attract younger and healthier seniors and leave older, sicker elders in traditional Medicare. This will leave Medicare with higher costs to care for this sicker population. The vouchers, however, will only pay for insurance costing no more than the second least expensive private plan. This will  leave these vulnerable seniors still in traditional Medicare, and their families, holding the bag for the difference. 

That difference is likely to be enormous, as reflected in the light blue portion of the following graph:

Romney health plan will leave future seniors paying for excess medical spending in light blue in this graph

Under the Romney health plan, future seniors will have to pay for the large expenses indicated in light blue in this graph out of their own pockets – or go without needed medical care altogether.

How this is “protecting and preserving” Medicare for future generations, as the Romney health plan proclaims,  is one of those verbal distractions for which three-card-monte is so famous.

Before leaving the subject of Medicare, Mr. Romney claims that Obamacare’s savings come, in part, at the expense of hospitals and other non-physician providers who may choose to stop serving Medicare patients as a result. This scare tactic is without merit, however. Medicare is most hospitals’ largest customer. The likelihood of hospitals ceasing to serve Medicare patients because of Obamacare’s 1% a year payment reductions is slim to none.

(For more on the Medicare impacts of the Romney health plan and Obamacare, see this free chapter from Obamacare – The Good, the Bad & the Missing).

Card #2 – Pre-existing Conditions

Another point Governor Romney was adamant about in the debate was that the Romney health plan would, like Obamacare, also cover pre-existing medical conditions. An aide to the Governor, however, clarified the next day that this wasn’t so. Instead, the Romney health plan does nothing more than existing law requires. Those with pre-existing medical conditions who maintain continuous health insurance coverage won’t be denied coverage. 

According to an ABC News report:

“One of his (Romney’s) top aides, Eric Fehrnstrom, qualified in the post-debate ‘spin room’…’We’d like to see states do what Massachusetts did,’ Fehrnstrom said. ‘In Massachusetts we have a ban on pre-existing conditions.’  The Massachusetts law, which provided the blueprint for the Affordable Care Act (Obamacare), requires insurance companies take all comers. By contrast, candidate Romney’s proposal would not, instead leaving that decision to the states (emphasis added).”

As noted by ABC News, this contrasts with Obamacare’s requirement that those with pre-existing conditions in any and all states can’t be denied coverage whether they’ve maintained continuous coverage or not (many cannot due to job loss or other disruptions in coverage).

The devil’s in the details, as they say. And the details are that the Romney health plan adds nothing to the ability of those with pre-existing conditions to gain coverage. This again contrasts with Obamacare’s provisions that include temporary state-based coverage for pre-existing conditions until 2014. Private insurers will then be precluded from denying coverage to individuals based on pre-existing medical conditions (see here for details).

Thanks for nothing, Governor.

Card #3 – Independent Payment Advisory Board

The third card in Governor Romney’s three-card-monte deck during the first presidential debate was the Independent Payment Advisory Board provided for under Obamacare. At least Mr. Romney refrained from using the dog whistle term “death panels” first attributed to former Alaska Governor Sarah Palin. However, he bordered on ascribing to this board life-and-death powers that amount to the same thing.

Here’s what the fact-checking site  found in their analysis of Romney’s claim:

“When explaining why he opposed the health care law, Romney said Barack Obama ‘put in place a board that can tell people ultimately what treatments they’re going to receive…

“He also said this: ‘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.’ And later: ‘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…

Romney health plan allows healthcare costs to grow unchecked represented by medical caduceus and dollar sign

Senate Passes Insurance Industry Aid Bill (Photo credit: Mike Licht,

“Obama refuted Romney’s remark, saying, ‘Let me just point out first of all this board that we’re talking about can’t make decisions about what treatments are given.’…

“We will note up front that Romney used somewhat softer words than some other critics of the board in that he didn’t use the words ‘ration’ or ‘unaccountable.’…

“Our ruling…

“He (Romney) avoided the more inaccurate and harsher wording of some other critics, who have falsely described the board as ‘rationing’ care. But Romney’s claim can leave viewers with the impression that the board will sit around a table and talk about whether grandpa can get his bypass or not, and that’s not the case…

“The board can reduce how much the government pays health care providers for services, reduce payments to hospitals with very high rates of re-admissions or recommend innovations that cut wasteful spending. And there are questions about whether that could lead to different treatment decisions, but Romney’s comments give a misleading impression. We rate his statement Mostly False.”

Furthermore, the IPAB is explicitly prohibited by the ACA legislation from rationing care. As reported by

“The health care law directs a new national board (the IPAB)…to identify Medicare savings. It’s forbidden from submitting ‘any recommendation to ration health care,’ as Section 3403 of the health care law states. It may not raise premiums for Medicare beneficiaries or increase deductibles, coinsurance or co-payments. The IPAB also cannot change who is eligible for Medicare, restrict benefits or make recommendations that would raise revenue (emphasis added).”

Ducking “Tough Choices”

So Romney was careful to avoid polarizing terms like “death panels” that his focus groups have probably shown turn off undecided voters.  However, he certainly embraced the core precept that distorts this honest attempt to get our medical spending under control. If anything, the biggest flaw of Obamacare regarding the IPAB is that it doesn’t take effect for hospitals until 2020. By that time, our healthcare costs will be at least 75% higher than today.

And there are even worse things to fear than such outsized, and unaffordable, increases in our healthcare costs. Many of the medical abuses and neglect of patient safety discussed in Our Healthcare Sucks are neglected by Obamacare and would be made even worse by the Romney health plan. The latter would largely deregulate both health insurers and providers. This will leave them free to ramp up these abusive practices as they have already in America’s least regulated states.

If Romney and his Republican supporters were really interested in making the “tough choices” they like to tout, they’d think the IPAB a dandy idea. Instead, they’d rather duck the issue by shifting costs to seniors as the vouchers in the Romney health plan will do. It’s pretty clear the objective of the Romney health plan is to preserve profits for medical suppliers by restoring Obamacare’s “cuts” – which are really savings – and making future Medicare beneficiaries pay for them.

Perhaps the most misleading aspect of this assault on regulating healthcare costs in America is the premise that the IPAB being “unelected” is somehow a bad thing. This presumes Congress, with its 10% approval rating, has a stellar history of making “tough choices”.  We have only to look at its annual ritual of caving in to lobbyist pressures by failing to enforce the reductions in Medicare payments to doctors under the so-called “SGR” formula adopted in the late 1990’s. Congress has failed to implement this cost-containment measure each and every year it comes up for a vote – without fail.  Instead, it approves increases in doctor payments.

This is precisely the reason the IPAB structure was chosen – to remove it from the self-serving hands of Congress. Yet Romney somehow tries to turn elected officials failing to do their jobs into a virtue by assailing this board of “unelected officials”.

That, my friends, is double-dealing of the slickest sort…proving “Slick Willard” makes “Slick Willie” look like an amateur by comparison.

Snake Oil, Anyone?

What Governor Romney proved in this first debate performance is that he’s a hell of a salesman. When his party hands him a lemon of a healthcare policy – one in conflict with his own history as Governor of Massachusetts, where he oversaw the prototype for Obamacare that he now disparages – he’s managed to turn it into lemonade.  And he did so with a litany of distortions, distractions and deceptions that threw his opponent off his game in the first presidential debate.

Apparently, no one on team Obama foresaw that Mr. Romney might reverse himself on so many fronts.  Nor did they expect him to do so with gusto befitting a truly exceptional three-card monte con man.

Shame on them for being so clueless.  And shame on us if we fall for any of it.

For more on Obamacare, see this outline of
Obamacare – The Good, the Bad and the Missing.

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2 Awesome Comments So Far

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  1. Emmy
    October 11, 2012 at 11:20 pm #

    Great post and a great analogy! Thanks for this John. I LOVE the blog.

    • John Lynch
      October 12, 2012 at 1:35 pm #

      Thanks for commenting, Emmy. Unfortunately, there’s a lot more than our money on the line with THIS game of three-card monte.

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