With the debate over the future of health care now shifted from Capitol Hill to town halls, supporters and critics of the Democrats’ legislative proposals are polishing their sound bites and sharpening their attack lines.
Increasingly, the battle looks like a presidential contest, with expensive advertising campaigns and Internet-driven efforts to mobilize local support. It can be difficult to sort fact from fiction, as angry protesters denounce the legislation at raucous public forums.
Each side hopes to win ground by boiling down one of the most complex policy discussions in history into digestible nuggets. For beachside viewers who might be more interested in iced-tea service than fee-for-service, here is a guide to the main fight points.
KEEP IT OR LOSE IT?
Mr. Obama has said repeatedly, as he told the American Medical Association in June: “If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.”
These assurances reflect an aspiration, but may not be literally true or enforceable.
SOCIALIZED MEDICINE
Or Uniquely American?
Republicans harshly criticize Democratic proposals to create a government-run insurance plan, or public option, to compete with private insurers. Republicans say the public plan would drive insurers out of business and lead to “socialized medicine” or a government takeover of health care. Democrats say they want a “uniquely American” system with public and private elements.
For now, the Republican criticism seems overblown. Major versions of the legislation all rely heavily on a continuation of private health plans, offered by employers and by insurance companies, subject to sweeping new federal regulations.
BLAMING INSURERS
Or Ensuring Blame?
Democrats have unleashed a blistering attack on private health insurers as they try to convince the vast majority of Americans who already have coverage that the current system is tilted in favor of corporate profits, not patients, and that insurers are a main obstacle to passing legislation.
Insurers say they support some of the most important Democratic proposals, including a ban on denying coverage or charging higher premiums based on pre-existing medical conditions.
The insurance industry does oppose a government-run insurance plan and could eventually mobilize against the overhaul. But insurers appear to be less of an obstacle than public apprehension over such sweeping change and skittishness among lawmakers, including centrist Democrats from Republican-leaning districts.
DEFICIT-NEUTRAL
Or Budget-Buster?
Mr. Obama has avoided dictating specific provisions of health care legislation. But he has insisted that the bill not add to the federal debt, leading Democrats to say that the overhaul will be “deficit neutral,” with the roughly $1 trillion, 10-year cost to be offset by reduced spending or new taxes.
The Congressional Budget Office has yet to issue cost estimates for the latest versions of the bill approved by three House committees. But it has warned that the legislation “would probably generate substantial increases in federal budget deficits” beyond 2019, in part because health costs are rising faster than the rate of inflation and proposed new taxes would not keep up.
Republicans use those warnings to cast doubt on the claim by Mr. Obama that the legislation will “bend the cost curve” by slowing the growth of health spending in the long term. Democrats say the overhaul will lead to savings that cannot be calculated under budgeting rules. At this point, it is difficult to know who is right.
Over the next 10 years, the budget office said, the House bill would “result in a net increase in the federal budget deficit of $239 billion,” partly because of an increase in Medicare spending to avert sharp cuts in payments to doctors scheduled to occur under existing law.
CUTTING MEDICARE
Or Preserving It?
To help finance coverage for the uninsured, Congress would squeeze huge savings out of Medicare, the program for older Americans and the disabled. These savings would pay nearly 40 percent of the bills’ cost.
The legislation would trim Medicare payments for most services, as an incentive for hospitals and other health care providers to become more efficient. The providers make a plausible case that the cutbacks could inadvertently reduce beneficiaries’ access to some types of care.
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