Reality-checking health care comments in the Republican debate

The Republican candidates for president finally focused on health care at the end of their third debate this week. There was little discussion of Obamacare, perhaps because their uniform opposition to the law is widely known. Instead, they addressed most of their comments to Medicare.  (For a transcript of the debate, click here.)

It was nice to hear discussion of such an important issue, but the remarks left many questions - not in what was said but in what wasn't.

Senator Rand Paul, himself a physician, took a bipartisan tack in blaming Medicare's problems not on either party but on demographics - too many seniors supported by too few workers. "It's your grandparents' fault for having too many damn kids," he joked.

His plan to fix it – raise the eligibility age. But he didn't say how older people would find coverage. If they are still employed, they might delay retirement, provided they are healthy enough to keep working. Otherwise, there is only one sure way to find guaranteed health insurance – Obamacare. Is that what Senator Paul has in mind?

Former Arkansas governor Mike Huckabee pointed to the burden of chronic disease. "We don't have a healthcare crisis in America; we have a health crisis."

True enough. The cost of treating chronic disease is crippling not just Medicare but also many private insurance plans. "Eradicate those and you fix Medicare, you fix America and its economy...," he reasoned. Good idea, but much easier said than done.

Former Florida governor Jeb Bush is the only Republican candidate who has proposed a detailed health plan. Among other elements, it would provide tax credits to those without access to employer-sponsored coverage while repealing the Obamacare requirement that insurers cover everyone. It's an easy way to reduce regulation, but good luck finding an insurance company that would cover those who are ill.

According to Donald Trump, the issue is straightforward. "It's very simple. We're going to make a really dynamic economy from what we have right now…" I discussed his plan in a previous blog post. Who knew health reform could be so easy?

Ohio governor John Kasich called for using an approach he applied to Medicaid in his state - incentives to keep people healthy. There's nothing wrong with that idea for the working age population, but how would it apply to the elderly, who are prone to illness regardless of lifestyle choices?

Ben Carson, a retired surgeon, would let people opt out of Medicare and invest funds to cover their own expenses. "How do we utilize our intellect rather than allowing the government to use its, quote, 'intellect'?," he asked. Unfortunately, he didn't supply an answer.

Florida senator Marco Rubio sought to reassure elderly voters that "we're all talking about reforms for future generations. Nothing has to change for current beneficiaries. My mother is on Medicare and Social Security. I'm against anything that's bad for my mother." Does he mean to say that Medicare reform would be bad for beneficiaries? That's not very reassuring.

Health care is a vital service for every American, and it consumes almost one-fifth of the entire economy. The system could not survive, let alone thrive, without government support in some form. No candidate, Republican or Democrat, has all the answers. But it would be nice to know that those who would be president have given the issue detailed thought.

But there was one statement that shined through with remarkable accuracy. Former New York Governor George Pataki weighed in on vaccination, a topic raised in a previous debate. "It's ridiculous that in the 21st century we're questioning whether or not vaccines are the appropriate way to go. Of course they are," he declared.

He is absolutely correct. But he said it in the early debate between candidates with low poll numbers. And most people probably don't know he is running.

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