Jeff Levine is an award-winning journalist who was the medical correspondent for CNN for 17 years.  He has also worked on Capitol Hill for Senator Byron Dorgan, as Washington bureau chief for WebMD, and as a media specialist at Ketchum. A guest contributor to Health-E Minds, the following post represents Jeff’s perspective on the presidential election debates, based on his opinions generated during his many years of observing and reporting on healthcare and politics. To read Jeff’s commentary on the earlier debates, click here.  – Nancy Hicks, Senior Vice President, Associate Director, Ketchum North America Healthcare Practice

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By the time this entry is published, the last
presidential debate will be over, but the final word on health care reform awaits the electoral outcome and pending legal actions by conservative opponents.

While debate number two did provoke some interesting exchanges over women’s health, specifically the value of Planned Parenthood as a provider of services beyond abortion, the candidates bypassed another opportunity to describe their vision writ large.

Certainly, the selection of audience questions was a factor, and the debate wasn’t limited to domestic issues.  However, the problem with understanding health care is that it is at once totally compelling and on the other hand, virtually incomprehensible—save for the policy shamans. 

We are all players in the health care game, and we all, one-way or another, have our lives on the line.  But do we understand the rulebook?  This is an opportunity for demagogic mischief and distortion. 

“Health care is too confusing an issue for a debate. In the first debate, for example, Romney asserted that under his ‘plan’ the problem of pre-existing conditions was dealt with, but look at his website: I can’t find there where that problem is dealt with. Whatever one may think of Obama’s plan, at least it’s out there, for all to see,” Princeton health care economist Uwe Reinhardt, PhD told me in an email.

Gail Wilensky, PhD who headed the Medicare and Medicaid program under President George W. Bush wasn’t surprised health care wasn’t topic A:

“The economy is more important for the ‘undecideds’, and health care came up in the first debate.”

One of the ongoing arguments is about the future of Medicare and whether the new law reduces benefits to seniors.  Marilyn Moon, PhD — a former Medicare trustee and director of the health program at the American Institutes for Research says there’s reason for confusion:

“People need to understand that this is not a simple issue:  the changes are aimed at payments to care providers and largely exempt beneficiaries, but some of the changes could affect access to care--seeming to favor Romney's position.”

On the other hand, Moon says, putting the money back would ultimately hurt the program.

“Restoring the $716 billion [cut from the Medicare budget under reform] as Romney wants would raise premiums and cost sharing for beneficiaries and still generate pressure to make changes elsewhere that might be even more harmful to beneficiaries--arguments in favor of Obama's approach.”

Whether the debate over health care reform has clarified or obfuscated the issue, it has raised the visibility of a topic that by its very nature defies a simple solution.  Or perhaps we have already arrived at least a partial answer but don’t know it. 

That’s one thing voters will have to decide on November sixth.  If the policy matters don’t resonate, and the sound bites don’t add up, the question may boil down to this calculation: Which candidate’s plan offers the greatest benefit to the greatest number at the lowest cost? 

The way you answer that question may say as much about you as the plan itself.