Few states can claim to be as uniformly conservative as Utah, where many Mormon residents consider Mitt Romney a native son. (Romney claimed a whopping 93 percent of the GOP primary vote here.) But even Utahns appear to be deeply worried about the impact of proposals by Romney and his running mate Rep. Paul Ryan (R-Wis.) to make deep cuts in Medicare and Medicaid.
Last Thursday night, Sen. John McCain (R-Ariz.) was in Salt Lake City to campaign for Mia Love, the African American mayor of Saratoga Springs and tea party darling who’s trying to knock off the state’s only Democratic House member, Jim Matheson. At an open-air amphitheater in West Valley City McCain and Love held a town hall meeting attended by about 250 people. There they were peppered with questions by people who identified themselves as loyal Republicans but were seriously concerned that the Romney-Ryan proposals would make life harder for them. Ironically, Love and McCain attempted to quell their supporters’ concerns by offering up proposals that have already been implemented—by President Barack Obama.
One woman took issue with the Ryan-Romney Medicare plan, which would shift much of the cost of health care onto seniors by turning it into a voucher program. Ryan and Romney insist that none of those changes would affect anyone over 55. The woman told McCain that she was under 55, and that she has been diagnosed with breast cancer. She was very concerned that she would not be able to get affordable insurance or Medicare under Romney’s vision of the government health care plan.
Another woman, Jessica Kerr, the mother of a child with autism, said, “I know you say we’ve got to cut, cut, cut. I’m concerned with the cuts to the disabled and Medicare and Medicaid.” Kerr, who identified herself as a loyal Republican, told the story of being on a waiting list now for four years to get medical assistance for her disabled child and finding her concerns falling on deaf ears of the state legislators. Love, who has supported the Ryan plan to cut $1.5 trillion out of the Medicaid budget (pdf) over the next decade and drop between 14 and 27 million people from the program, responded, “Anyone who has said to you or anyone else that I’m going to pull the rug out from under you…is absolutely lying to you.”
When asked what they thought should be done to fix health care, Love and McCain offered up an unintentional endorsement of some of the very laws that they’ve been campaigning angrily against for the past two years, Obamacare and the federal stimulus package. “We have to reform our health care system or it’s going to be gone completely,” Love responded to Kerr. She pointed to doctors who buy new equipment and then are driven to use the equipment on as many patients as possible to pay for it. To put an end to such practices, Love said the country needs to move away from the fee-for-service health care model and toward a “fee for outcomes” system. “If we start aligning the incentives with the outcomes we’ll start getting better health care, we’ll get better services, and we’ll get more health care available for those who need it,” she said.
Love seemed unaware that Obama has already made huge strides in doing just these things through the Affordable Care Act. The health care reform law created and funded a host of new projects to move Medicare away from fee-for-service practices and towards different payment models, such as Accountable Care Organizations. These groups of providers work to coordinate care for patients and reduce duplication of service and unnecessary hospitalizations. If they succeed, they can share in the savings they help create. The law also includes pilot projects in which Medicare will reimburse health care providers for “episodes” of care, rather than for every service provided, thus creating incentives for doctors and hospitals to better coordinate care and focus on outcomes—just as Love suggested.
McCain offered up a proposal for reducing health care costs by relying more on technology, specifically by “putting people’s health care records on computers,” which he said “will reduce the error rate by some 90 percent, I’m told. But there are no incentives to do that because we have a system where the incentives are reversed. Maybe the president thinks the system is just fine.”
In fact, the president’s 2009 stimulus package included billions in funding for electronic records systems. The Department of Health and Human Services already has paid out nearly $6 billion to more than 100,000 doctors and hospitals to help them adopt and “meaningfully” use electronic records systems. That investment in infrastructure and technology should do exactly what McCain would like to see, that is, reducing costs and expensive, tragic medical errors.
Aside from inadvertently embracing Obamacare, Love didn’t have much else to offer on the subject of health care policy, a problem that came into sharp relief after the meeting when a woman with multiple sclerosis, the same illness suffered by Romney’s wife, Ann, came up and told her that injections she needed to combat the disease cost $46,000 a year, costs she couldn’t afford. Love looked momentarily baffled and then told the woman that the high cost of her medical treatments demanded a “free-market solution.” She then punted to an assistant, whom she directed to arrange a meeting with the woman to further discuss the issue.
While the Salt Lake audience clearly had concerns about the Republican health care proposals, its members probably won’t pull the lever for Obama. Their devotion to Romney is long-standing, and McCain’s cheerleading for the GOP presidential candidate got the night’s loudest applause by far.
But it was clear that many people weren’t especially satisfied with Love’s or McCain’s explanations of their party’s health care plans. Kerr’s husband, Nathan, later told the Salt Lake Tribune, “There’s a general movement in the country right now, and I understand it, that we should cut everything. But what I’m concerned about is this sort of libertarian view that the weak should just fall off the edge of the Earth. It’s a little bit of a dangerous proposal to say government should have no role and we should cut everything.”
That loyal Utah Republicans were willing to get up and express their concerns is telling. If their party’s health care platform is too radical for their blood, the Romney-Ryan team ought to be pretty worried about the rest of the country.