The document examines claims made by Obama and Romney regarding their healthcare policies during the 2012 US presidential election campaign. It analyzes several specific claims, finding that Romney's claim that Obama cut $716 billion from Medicare is false, as are Romney's assertions that the ACA will cause 50 million to lose insurance and that Obama established healthcare rationing boards. Obama's claim that Romney's Medicare plan would cost seniors $6000 more is partially true. Independent fact checkers found most Republican claims about the effects of the Democrats' healthcare policies to be false or misleading.

1. BMJ 2012;345:e7007 doi: 10.1136/bmj.e7007 (Published 16 October 2012) Page 1 of 2
Feature
FEATURE
US ELECTION
Fact and fiction in the US election healthcare debate
Various claims about the effects of Democrat and Republican health policies have been made in
the run-up to next month’s elections. Michael McCarthy examines their validity
Michael McCarthy editor
LocalHealthGuide.com, Seattle, Washington, USA
Throughout this year’s US presidential campaign, incumbent sound, extending the solvency of the financially troubled
President Barack Obama and his Republican challenger, former program by eight years, to 2024. Some of those savings do, in
Massachusetts governor Mitt Romney, have traded charges and fact, go to help pay for the expansion of insurance coverage for
countercharges about their health policies that often stretch the the uninsured under ACA, but this allows the expansion without
truth and in some cases appear to be flat-out untrue. adding to the federal deficit.
In the first presidential debate, for instance, Romney charged The consensus among most independent fact checking watchdog
that Obama has cut $716bn from Medicare to pay for his groups, such as the website PolitiFact (www.politifact.com),
healthcare reform law and instituted a plan to create a “board FactCheck.org, and the Washington Post’s fact checker blog
that can tell people ultimately what treatments they’re going to (www.washingtonpost.com/blogs/fact-checker) is that the
receive.”[1] Republican claim is false.
For his part, Obama warned that if Romney were allowed to
implement his policies, more than 50 million Americans would Claim: If ACA is repealed 50 million people
lose their health insurance and that his plans for Medicare, the will lose their health insurance
federal health insurance plan for elderly people, “would cost
the average senior about $6000 [£3700; €4600] a year.” During the presidential debate, Obama repeated the claim that
These and similar charges have been repeated in the candidates’ if his health reform bill were repealed “you’re looking at 50
stump speeches, by their campaign surrogates, and in the million people losing health insurance.” This figure is based on
thousands of attack advertisements that are saturating the projections that go out 10 years and includes people who do not
airwaves in the heavily contested swing states where the 6 have insurance now and would not, therefore, have it to lose
November election will be decided. What are the facts? should Romney be elected and repeal the law. So this claim has
been judged by most observers to be partially true. Still, a recent
Claim: Obama is cutting $716bn from study by the non-partisan Commonwealth Fund estimates that
Medicare to finance his health reform law Romney’s proposals would “increase the number of uninsured
people by 12 million compared with the baseline (no Affordable
Romney has leveled this claim repeatedly on the campaign trail, Care Act), leaving 72 million people uninsured in 2022.”[4] If
and his vice presidential running mate, Paul Ryan, repeated the implemented, on the other hand, the study concluded the ACA
charge in his television debate last week with Vice President will reduce the number of uninsured people by an estimated
Joe Biden.[2] 32.9 million, leaving 27.1 million people uninsured by 2022.
The claim refers to provisions of the 2010 health reform law,
the Patient Protection and Affordable Care Act (ACA), that Claim: Romney will “voucherize” Medicare
reduces Medicare spending over 10 years by $716bn, according
to the most recent estimate by the Congressional Budget Office, Currently, Medicare is a “defined benefit” program, which
which provides independent assessments of the budgetary effects means it guarantees that the government will pay for all covered
of legislation.[3] medical services. Romney has proposed converting Medicare
into a “defined contribution” plan in which seniors would be
Democrats assert, however, that the savings come primarily
given “premium support,” a subsidy that would allow them to
from reductions in payments to insurers and hospitals and will
purchase their own insurance on the private market. According
have no effect on benefits. They say that slowing the growth of
to the proposal, the subsidy would be enough to cover the second
Medicare spending actually makes the program more financially
mxmc@mac.com
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2. BMJ 2012;345:e7007 doi: 10.1136/bmj.e7007 (Published 16 October 2012) Page 2 of 2
FEATURE
least expensive plan available. Supporters of the proposal argue spending cuts if costs rise beyond a target growth rate and if
that giving seniors a choice of more and less expensive plans Congress fails to act to address the increase. But the power of
will create a competitive market that will drive insurers to lower the board is limited, and by law it cannot ration care, restrict
costs and improve quality. The term “voucherize” is unpopular benefits, shift costs to beneficiaries, alter eligibility, or limit
with seniors—and used freely by the Democrats to attack the treatments doctors prescribe.[5] The fact checking organizations
plan—but most observers say the label is accurate. agree that the claim is untrue.
Claim: Romney’s Medicare voucher Competing interests: The author has completed the ICMJE unified
disclosure form at www.icmje.org/coi_disclosure.pdf (available on
program would cost the average senior request from the corresponding author) and declares no support from
$6000 a year any organisation for the submitted work; no financial relationships with
any organisation that might have an interest in the submitted work in
This is a claim the Democrats have made repeatedly, arguing
the previous three years; and no other relationships or activities that
that because the premium support payments would not keep up
could appear to have influenced the submitted work.
with medical inflation, seniors would end up paying more and
more out of pocket. The claim, however, is based on an earlier Provenance and peer review: Commissioned; not externally peer
version of the proposal and does not account for a more recent reviewed.
revision that sets the size of the subsidy to the price of the
1 2012 presidential debate: President Obama and Mitt Romney’s remarks in Denver on
second cheapest private plan available. If this is the case, Oct. 3. www.washingtonpost.com/politics/decision2012/2012-presidential-debate-president-
supporters argue, the subsidy would always cover some form obama-and-mitt-romneys-remarks-in-denver-on-oct-3-running-transcript/2012/10/03/
of basic health plan. Although the Democratic claim is based 2
24d6eb6e-0d91-11e2-bd1a-b868e65d57eb_story.html.
2012 vice-presidential debate: Vice President Biden and Rep. Paul Ryan’s remarks in
on an older proposal, the lack of specifics in the Republican’s Danville, Ky, on Oct.11. www.washingtonpost.com/politics/decision2012/2012-vice-
new proposal has prompted some fact checking organizations, presidential-debate-vice-president-biden-and-rep-paul-ryans-remarks-in-danville-ky-on-
oct11-running-transcript/2012/10/11/a5167f1e-13cd-11e2-ba83-a7a396e6b2a7_story.
such as PolitiFact, to rate this claim “half-true.” html.
3 Elmendorf DW. Letter to John Boehner, Speaker of the House, US House of
Representatives, 24 July 2012. http://cbo.gov/sites/default/files/cbofiles/attachments/
Claim: Obama’s health reform law 43471-hr6079.pdf.
4 Health care in the 2012 presidential election: how the Obama and Romney plans stack
includes provisions to implement up. 2012. www.commonwealthfund.org/Publications/Fund-Reports/2012/Oct/Health-Care-
in-the-2012-Presidential-Election.aspx?page=2.
rationing that will deny care to Medicare 5 Independent Payment Advisory Board. A new approach to controlling Medicare spending.
Kaiser Family Foundation, 2011. www.kff.org/medicare/upload/8150.pdf.
patients
This is often called the “death panel” claim and refers to the Cite this as: BMJ 2012;345:e7007
Independent Payment Advisory Board, an expert panel created © BMJ Publishing Group Ltd 2012
by the ACA that will have the authority to institute Medicare
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