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Two of my colleagues here at what is actually the World's Greatest University, and my old friend John McDonough at the institution which only pretends to the honor, fillet Mitt Romney like a salmon on health care policy.

Props to NEJM for letting you read it yourself, but I feel I should contribute some value  added so a couple of highlights:

"Though Romney has offered many opinions and comments as a presidential candidate, he has not provided any detailed blueprint of his plans for U.S. health system reform, and his proposals provoke more questions than they provide answers."

That's one of the great things about Romney -- you could cut and paste that statement onto a discussion of just about any of his policy proposals. Anyhow, they do manage to find, after combing through his various statements, five "essential elements of his policy intentions."

  1. Repeal much of the Affordable Care Act, especially the parts having to do with expanding insurance coverage.
  2. Convert Medicare into a "defined contribution," i.e. voucher program.
  3. Make individually purchased insurance tax deductible [hey wait a minute -- I thought he wanted to eliminate tax deductions and simplify the tax code].
  4. Take away states' power to regulate health insurance markets [hey wait a minute, I thought -- oh never mind].
  5. Massively reduce federal spending on all health programs.

Does that sound good? Are you for it?

He says he'll repeal the $716 billion in Medicare savings that are part of the ACA, which he goes around falsely implying that represent a cut in benefits. (It does not.) Sayeth our informants: "Rescinding these savings would advance the insolvency of the Medicare Part A Hospital Insurance Trust Fund from 2024 to 2026 and trigger a $323 increase in premiums for most Medicare beneficiaries . . . "  Does that sound good? Are you for it?

Converting Medicare to a defined contribution program would shift growing costs to beneficiaries starting in 2023.

Turning Medicaid into a block grant and capping the federal contribution would swell the ranks of the uninsured by something on the order of 20 million people and cut benefits for those who were left, along with payments to providers.

He believes that "health care goods and services should be traded in an open market, where competition drives choice, efficiency, quality and price." That would not explain why choice, efficiency, quality and price are best in countries that have the most tightly regulated markets and socialized insurance, and why we, who in fact already have the least regulated market do the worst on those measures.

Finally, "If his proposals for a balanced budget, defense spending hikes, and non-defense spending reductions are achieved, all non-defense programs except Social Security would require cuts averaging 29% in 2016 and 59% in 2022. Included would be Medicare, Medicaid, the National Institutes of Health, Centers for Disease Control and Prevention, the Veterans Health Administration, and every other federal health program."

So all you doctors out there, who want to hold on to your sailboats. Are you for this?

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