Debate 1 reaction

So I made myself watch the entire debate. It wasn't as painful as I was expecting because 1) I was forewarned, 2) I'm well aware of the weaknesses of both candidates, so I'm not surprised to see them.

Romney did the better job covering over his weaknesses during the debate, but he's positioned himself for a lot of uncomfortable followup questions. Obama just needs to sharpen his message and shorten his answers. He also needs to practice with someone other than John Kerry (Mr. Long-Winded Answers). I'm not sure who would be a good stand-in for the short, snappy, but polite answers that Romney gave. No Democrat comes to mind, and that's a sad commentary on the Dems.

Summary

Here is my overall impression of the debate:

• Romney was strong on the attack, but purposefully vague about his own plans.
• Obama was moderately good in his defense. Unfortunately, he let his points get lost in too much detail.

Neither is talking specifically about what they would do if elected because this has pitfalls for both. Neither can definitely deliver what the electorate would like to hear--a low-pain transition to fiscal health. So they each hide the respective pain they'd inflict. Since they're both vulnerable, neither is attacking future plans as forcefully as they should be.

Their Weaknesses

Romney is declaring that he won't increase the deficit. He's not even claiming he'll lower the deficit, as a good fiscal conservative should, but only that he won't be worse than Obama on this score.

Yet he has to be vague because he did promise to cut tax rates by 20%, and he'll need to offset that by removing deductions. It looks to me as though his tax rate cut is no longer a promise, and he can probably be nailed on that. However, once he admits it, then the funny math stops being a disadvantage to him, unless of course it costs him the GOP base.

Romney has similar problems with healthcare for people who aren't covered by employers and the future of Medicare. The solutions he proposed in the primaries don't really hold water in the general. He has no answer for the uninsured, and his Medicare proposal is a voucher program that throws seniors into a tough marketplace.

Obama is mealy-mouthed about spending restraint generally. He states that he wants government to help give people opportunities, and most of us know that translates into lots of programs that suck up revenue. He doesn't sound like he's really committed to fiscal restraint.

He overreached in accusing Romney of supporting a $5 trillion dollar tax cut. He could have scored on some very pointed criticism, but now Romney has him sounding like a liar. Obama might have thrown away a big advantage there, but I hope not, because it's a strong, valid point.

Neither candidate had a strong closing statement. Obama was scattered. Romney basically said that another four years of Obama will be awful, but he (Romney) won't be awful. That didn't resonate with the audience (or CNN's focus group), and it's hardly a positive argument for electing him.

Their Strengths

Romney was detailed about what he wanted to do with Medicaid--block grant with 1% increase per year, and give the states the freedom to develop their own programs and priorities. This sounds a lot like what happened with welfare reform, which was successful in turning a huge ongoing headache into a more respectable social program. Notably, it was the only issue where Romney was specific about what he would do.

Romney is making sure he doesn't sound like a heartless robber baron who'll slash education, Medicare, Medicaid, and most government departments. He's back to saying, as he did last fall before the primary heated up, that he'll shrink the government by attrition of government workers, not by sheaths of pink slips.

Overall, Romney sounds like someone who sensibly sees that government has grown too large, and he doesn't want to grow it anymore. Instead, he wants to slim it down gently. This is a good contrast to Obama, who is still building it up.

In Obama's $90 billion for green jobs, Romney has found a great, multi-purposed stick to bash Obama with. Obama wants to spend more on teachers- bam, that $90 billion would pay for a lot of teachers. Want to close a $2 billion loophole for oil companies, bam, you spent 50 years of that money on green jobs.

Obama's strengths are in his explanation of Obamacare and restraint on Medicare spending. His critique about throwing seniors into a nasty healthcare insurance market with only vouchers rang true over and over. Romney had to keep saying that it wouldn't affect today's seniors (but damnation for the rest).

What They Won't Talk About

Neither candidate talked about the sequester, or the "fiscal cliff"--the combination of the sequester and the expiration of tax cuts. This is the hard stuff, the actual cuts, and neither candidate will touch it. Neither is offering even smaller deficits, even though deficits are still running over $1 trillion per year. There are no medals for courage awarded here.

Neither talked much about what they'd do about the Bush tax cuts, even to attack the other. Only one mention of these tax cuts -- amazing. This must be where both are extremely vulnerable, so neither will make it an issue. The moderator should have put them on the spot.

Romney continues to use Simpson-Bowles as another club with which to beat Obama. However, he doesn't embrace S-B. He pretends that he likes it, only he's got a better version. Considering how well I know Simpson-Bowles, I can declare that this is hogwash, otherwise known as craven, corrupt lying on Romney's part. However, I'm happy that Simpson-Bowles continues to be a touchstone. It doesn't die because it's a great plan.

Take-away

I notice that there isn't a lot of video circulating from this debate. There was no knock-out moment. Romney looks like a stronger opponent, but the same weaknesses are still there. Obama will be able to reverse this setback, and Romney has very little he can capitalize on. Romney may have won the debate on style, but it's not a lasting or substantial victory.

That's either Jim Lehrer or the truth.

Image: politicalhumor.about.com

Transcript here.

Paul Ryan - A serious pick

PJ of Viable Opposition has asked for my opinion on the choice of Paul Ryan for the Republican VP nomination. I can't delve into the strategic and tactical considerations the way professional pundits do. This is just my gut reaction: it's a good, solid pick.

When the GOP didn't know what their fiscal program should look like, this guy provided the roadmap. When the GOP asked themselves WTF were they going to do about Medicare (without being too scary), this guy came through again. The only other Republicans to submit budget plans were Ron Paul and ...  Rand Paul?!? (And the RINOs on the Simpson-Bowles commission, but they don't count in this GOP.)

So there's a bit less pixie dust in the Romney campaign today. But there's still plenty because the Ryan's latest budget has plenty of handwaving.

I also notice that Ryan doesn't want to be the heavy who tells Grandma that she can't have spinal fusion or a kidney transplant or has run out of dialysis days, so he's passing the job on to insurance companies. Great way to handle that difficult issue, GOP. Now you don't even have to try to contain medical costs--that is being outsourced in the traditional GOP fashion.

Nonetheless, Ryan has given the GOP the method for containing Medicare costs. Under his plan, they would soon be deciding how large the pot of money is, and that's what Americans will get for their vouchers subsidized premiums. It's a better solution than the-sky's-the-limit. I can't say much more in its favor than that.

I look forward to a bit more substantial campaign, and a much closer look at the Ryan budget and its fudges. At least there will be some numbers--something for a nerd like me to crunch on.

Image: patheos.com

Flashback: Romney was always going to pick someone solid. At least the campaign should be more substantial.

A Bloomberg summary of Ryan budget positions.

Crude joke that you may want to skip. You can misread the headline as: Paul Ryan - A serious prick. 

Solving the Healthcare Cost Puzzle

Republican solution: Block-grant Medicaid (limits federal costs), voucherize Medicare (again, Feds get to set limits on their contribution).

Democrat solution: um, decrease reimbursement to doctors, a bunch of other nips and tucks.

The Republicans have the solution that is simpler to understand, that's for sure. Of course that's not the best way to judge a policy proposal, but when it's put up against a complicated, incoherent plan, it does pretty well.

 Truth squad

But in many ways, the whole political debate about providing healthcare is incoherent because there are many competing interests, and not all of them are openly declared. Here is a sampling of some of the objectives in the debate:

• Provide healthcare to as many people as possible.
• Provide healthcare to as many Americans as possible, but not to immigrants.
• Provide healthcare to productive members of society (and retired productive members of society).
• Eliminate the problem that some people don't have health insurance.
• Provide enough healthcare to the uninsured so that it's not embarrassing or unchristian, but also minimize taxpayer expense.
• Allow patients and doctors to make healthcare choices without interference from bureaucrats.
• Protect individuals from the high cost of healthcare by spreading the cost to larger groups.
• Slow down the growth of healthcare costs dramatically.
• Demonstrate that life is the most important consideration no matter what.
• Cast doubt on the motives of your opponents regarding healthcare availability, cost, and who shoulders the bill.

I probably missed some goals, but it does paint the picture. There are goals for healthcare coverage, goals for handling healthcare expenses, and goals for winning elections.

• Too much of the political debate is centered on electoral goals where it's important to cast doubt on your opponent and insulate your side. Clarity, not surprisingly, is sacrificed. 
• When it comes to individuals deciding how to vote or what to advocate for, often the issue is fear of losing access to needed healthcare, plus the desire to shift costs. Cost prevention or cost containment may not register.

 A goal we can agree on?

In the all debate, fear, and sniping, something that is often lost is whether we should try to make our medical spending more efficient and how. Efficient really means not doing the low value or no value procedures. If we don't want to cut the number of procedures, we have to squeeze what we pay for them. That means not passing the Doc Fix every year, and hoping the people doing the work won't resent performing the same job for a lot less money.

Rather than simply squeezing the providers, I'd prefer to cut the number of procedures. But no one  seems to want to talk about making do with less medical care. I can easily do it as a personal choice (sure-I'll wait five years for my next colonoscopy!), but how can we get large numbers of people to sign on? And make the right decisions about what to trim?

 Doctor's advice

Really, the doctors should start this revolution. We have more trust in them than in having our insurance companies or government panels make the recommendations. Doctors could save the entire country a lot of money by cutting back on the testing they recommend. I saw an article (now irretrievably lost in the web) that Americans spend 40% more on outpatient testing than other advanced countries, so this is one area we can definitely trim back.

Unfortunately, doctors often have a business interest in recommending testing, since GE has sold them a bunch of expensive medical equipment, and the docs need to make those payments. There is also malpractice fear. I think someone is going to have to persuade and guide our medical professionals, but that brings us back to the hated insurance companies or government bureaucrats. Oh what a mess. Still, I hope it would be possible for some of our larger medical groups, like Kaiser Permanente and the Mayo Clinic, to study what treatments and testing are effective and cost-efficient. If we can save enough money by stripping out inefficient medical spending, we may not have to touch that third rail: rationing of medical care.

I'll break the taboo, just a bit, and talk about rationing. But to some people, any management of healthcare choices is rationing. In one way I agree, but I see it as good rationing. (Similarly, there is good discrimination, which is what you use if you date only sane, responsible people.) In the future, we may need to ration medical care on a variety of criteria including: odds of survival, odds of recovery to productive status, cost of care, citizenship, etc. This is where the arguments really heat up, and I don't want to go there yet. Let's remove inefficient spending from our system, and see how much breathing space that gives us.

Maybe we can pay with play money...

Extra: Explore some detailed data on healthcare spending with this nifty/easy tool.

Romney's economic plan - FAIL

It's time for me to accept that Romney may well be Republican nominee, despite the appearance that half the Repub base can't stand him. Since I live in Massachusetts, I've experienced Romney as a governor but I can barely remember it. That indicates that he wasn't a great governor or an awful one. That's the sum of my firsthand experience. For any other questions, I have to research just like anyone else. This comment from an Atlantic blog seconded my impression of him and prompted my flurry of Romney research:

"He's seeped himself in the republican orthodoxy with a wink wink and nod and a smile at the camera.  I think he can largely free himself from that come the general election." --Atlantic post

My impression of Romney as a campaigner: polished delivery, strong on the details, personable, moderate. I don't remember many policy proposals, but the entire field has been rather lean on policy (except 9-9-9), so that's par for the course. I had to look at the goods, so I skimmed Romney's 87-page economic plan.

The good news is that the plan is not a typical Republican conservative supply-side fairy tale. Of course there's Obama-bashing on every other page, but there's some promising stuff too. What I liked:

• Lower tax rate on cap gains, dividends, interest, but importantly, only for tax payers under $200,000.
• Cut corporate rate to 25% and end rules that discourage repatriation of overseas profits.
• An explicit shout-out to Simpson-Bowles' recommendations on tax reform - broader tax base, simpler, fewer deductions.
• A cap on regulation that measures compliance costs, and doesn't allow an overall rise in compliance costs.
• A bit of respect for Dodd-Frank disguised as criticism.
• Cut, cap, and balance but at 20% of GDP, not the 18% level that most conservatives quote.

What I didn't like:

• Eliminate estate tax (but this is such a Republican plank, I'm not too surprised).
• Mention of the illusory tax compliance cost of $400 billion a year. I don't believe we spend 2.7% of our GDP in tax compliance. Where the spending is concentrated, in complex business arrangements,  will likely remain.
• A poke in the eye at the auto industry over the bail-out--UAW made out, but investors (carefully not called creditors) got screwed. I predict he'll change his tune on this one in the general campaign.
• Only small fixes to Social Security.
• A shout-out to Ryan's plan to voucherize Medicare, but with unspecified differences. This void shows how dangerous a definite policy commitment would be. I doubt that Romney will choose the deeply unpopular voucher approach.
• Turn Medicaid into a block grant. (I'm on the fence as to whether this will be beneficial or not.)
• Support for a balanced budget amendment that is more a strait-jacket than a workable plan.
• Tough talk about sanctioning China for currency manipulation.

Gaping holes in the plan:

• No plan for the uninsured or for lowering health care costs.
• No specific areas of spending cuts, but a reduction of the federal workforce by attrition.
• No proposed federal budget with numbers.

So, my overall impression is that the plan isn't extreme considering it came from a Republican: no major tax cuts, a reasonable goal on regulation. But it fails in two essential ways:

• It isn't a plan unless it contains actual numbers.
• It isn't honest about what will be painful. 

This plan is meant to get Romney elected, and only then will we find out if he'll grapple with tough issues. I'm sure no one is surprised that Romney is playing it safe.

 ...but don't expect a straight answer.

Should I review Michele Bachmann's plan now? ... No, I'll stick to real candidates.

Update 12/13/11. Romney announced his plans for Medicare reform, and they look a lot like Ryan's plan to voucherize the program.The big advantage of vouchers is that the federal government can decide how much to spend year-to-year. A big disadvantage is that it puts cost-containment onto insurance companies. To be fair, cost-containment is the boogey man in all Medicare plans. ...Oh, it's not a voucher, it's premium support. Don't ask me to explain the non-existent difference between the two.


Wall Street Journal review of Romney's plan