As more than a year of furious campaigning draws closer to its frenzied conclusion, Wednesday's debate promises to be an epic clash of two political titans.
The Rumble in the Rockies between Mitt Romney and Barack Obama will pit the battle-scarred survivor of a cutthroat primary cage match against the grizzled veteran of four years of polarized partisan pummeling. Two candidates enter, one candidate leaves, and the, and the very fate of democracy hangs in the balance.
At least, that's the idea; the real thing will probably be a lot less exciting. Wednesday's debate, the first of three, will feature a moderate Democrat and a (sometimes) moderate Republican hashing through well-worn talking points. For the last few weeks, both Romney and Obama have spent hours in rehearsals, scripting out their responses to a slew of likely questions, honing witty zingers that they hope may earn them a few seconds of air time on news shows and a couple of clips that go viral on YouTube.
But if real drama actually occurs, one likely flashpoint will be health care reform. President Obama's signature legislation, which is expected to extend insurance coverage to 30 million Americans, has been attacked by Republicans on the basis of its cost, its new regulations, its potential effect on the health care industry, and a host of other points, both real and imaginary. Adding to the drama is the fact that Romney instituted an almost identical program when he was governor of Massachusetts. But in his quest for the Republican nomination, the GOP standard-bearer has joined the forces arrayed against Obamacare, tying himself in rhetorical knots to explain why he now opposes ideas he once championed.
Both men need to score points on the Patient Protection and Affordable Care Act Wednesday. The president needs to explain why it's vital to ensuring the health -- both physical and economic -- of the middle class. Romney has to explain how he plans to do away with it but still protect Americans' health. Here are some key points over which the candidates will probably clash.
How to Pay for It
One of Obamacare's biggest downsides is its cost. Modern health care isn't cheap, and Obama's plan will extend Medicaid and insurance subsidies to millions of new Americans. According to the Congressional Budget Office, the program will likely cost more than a trillion dollars between 2013 and 2022. On the other hand, the program's mix of taxes and cost-cutting moves would, according to the CBO, increase the deficit by a comparatively modest $109 billion over ten years.
• What Romney Might Say: Romney has made much of Obamacare's $1 trillion price tag, reducing the program's finances to a simple equation, wherein its costs are covered by "slashing" $500 billion from the Medicare budget and levying $500 billion in taxes "on everyone from middle-class families to innovative medical device makers." If Romney can make this charge stick, he'll score points against Obama.
• What Obama Might Say: The so-called $500 billion Medicare "cut" has been campaign fodder for months, and the Obama administration has emphasized that the Medicare savings won't come from cutting the program, but from slowing its rate of growth, as well as more aggressively prosecuting those committing Medicare fraud. Similarly, the much-discussed tax increases are largely focused on the medical establishment, although a few taxes, such as a small levy on the use of tanning beds, will impact some middle-class consumers.
• Potential Pitfalls: The trouble for Obama is that the debate's structure will make it hard for him to parry Romney's attack with an in-depth analysis of health care funding -- and any attempt to do so would likely bore his audience. If he hopes to refute the claim that his signature program will tank the economy, he'll have to explain its funding in a pithy, sharp way.
Who Is Responsible For It
In concept, it's hard to argue against making it easier for people to get health care: It's expensive, everyone needs it eventually, and too many people don't have access to it. The question, then, is not whether the government should be involved in health care, but where and at what level. And that is one area in which Romney and Obama notably clash.
• What Romney Might Say: For most of the election cycle, Romney has tried to distance himself from the Massachusetts health care program that was the template for Obamacare. However, in recent weeks, he has slightly changed his tune, taking more credit for his role in insuring millions of Bay Staters -- and arguing that giving everyone emergency room care qualifies as a health plan.
To differentiate himself from the president, Romney has focused on the question of who, exactly, is responsible for providing health coverage. Pledging to work with Congress to "replace" the Patient Protection and Affordable Care Act, he has promised to "issue Obamacare waivers to all 50 states."
Therein lies the heart of Romney's idea: He intends to replace the national health care plan with state-based ones, giving "each state the power to craft a health care reform plan that is best for its own citizens." Ultimately, however, he places responsibility firmly in the hands of individual consumers, stating that "I also want individuals to be able to buy insurance, health insurance, on their own."
• What Obama Might Say: If Obama engages Romney's argument, he might point out that states already have the ability to reject his Medicaid expansion. It's more likely, however, that he will focus on the plan's wide-ranging impact for millions of voters.
• Potential Pitfalls: Romney's tenure as Massachusetts governor makes him highly vulnerable on the subject of government-sponsored health insurance, and his recent defense of emergency room care is full of holes -- and contradicts his former statements. His argument that government at the state level is vastly different from government at the national level is abstruse, at best, and he faces an uphill battle trying to explain how Romneycare significantly differs from Obamacare.
Its Long-Term Consequences
Since many of Obamacare's reforms will slowly be phased in over the next few years, its ultimate effect has yet to be determined. For Obama and Romney, selling or torpedoing the plan will rely heavily on the ability to convincingly describe a world in which the Affordable Care Act is in full bloom.
• What Romney Might Say: In early September, Romney promised to "make sure that those with pre-existing conditions can get coverage," an apparent policy reversal that one of his aides quickly retracted. More generally, however, he has attacked the plan for its size and complexity, as well as for its policies, which he argues will "will make America a less attractive place to practice medicine, discourage innovators from investing in life-saving technology, and restrict consumer choice." In addition, he claims that it could cause "up to 20 million" Americans to "lose the insurance they currently have, the insurance they like and the insurance they want to keep." Independent fact checkers have determined that this last statement is demonstrably false.
• What Obama Might Say: While Romney will face a challenge in his attempt to paint a dire picture of Obamacare's effects when they haven't arrived yet, the president will also find it hard to demonstrate the benefits of a program that is still being slowly phased in. Some elements, like the creation of a high-risk pool for people with pre-existing conditions, and making it illegal for insurers to refuse coverage to people under the age of 19 based on pre-existing conditions, have already gone into effect, but their impact hasn't been widely studied or reported.
Similarly, while the percentage of people with health care coverage rose during the last year, the anemic growth rate of 0.6% was less than impressive. In light of this, Obama will likely focus on the more far-reaching aspects of the PPACA, many of which aren't scheduled to go into effect until January 2014.
• Potential Pitfalls: Because full implementation of the Affordable Care Act still to come, neither candidate will be able to stick strictly to provable facts to make their case. The key, then, will be for each man to explain his personal vision of how health care should be run in America -- and hope he can tell a compelling story that voters will want to endorse.
Bruce Watson is a senior features writer for DailyFinance. You can reach him by e-mail at firstname.lastname@example.org, or follow him on Twitter at @bruce1971.