Viewpoints: Romney's surprisingly strong defense of Mass. health plan; Challenger's 'pretend' proposal for the nation

The New York Times: An Unhelpful Debate
The first debate between President Obama and Mitt Romney, so long anticipated, quickly sunk into an unenlightening recitation of tired talking points and mendacity. With few sparks and little clarity on the immense gulf that truly separates the two men and their policies, Wednesday's encounter provided little guidance for voters still trying to understand the choice in next month's election. ... On health care, Mr. Romney pretended that he had an actual plan to replace the Affordable Care Act, and that it covered pre-existing conditions. He has no such plan, and his false claim finally roused the president to his only strong moment of the evening. The country doesn't know the details, he said, of how Mr. Romney would replace Wall Street reform, or health care reform, or tax increases on the rich because Republicans don't want people to understand the hard trade-offs involved in these decisions (10/4).

The Wall Street Journal: Romney Takes Center Stage
Mr. Romney was also strong and fluent on health care, somewhat remarkably. The only major point Mr. Obama scored was noting the similarities between his plan and Mr. Romney's Massachusetts model, but the Republican brushed off those attacks by describing the broader harm ObamaCare will inflict on U.S. medicine and the abusive way Democrats jammed the bill through Congress over the objections of the American public. In particular he put Mr. Obama on the defensive about the so-called Independent Payment Advisory Board, the 15-member "expert" and unelected commission that will tell doctors how to practice and seniors the treatments they are allowed to receive. The President struggled to stick to his own talking points, perhaps because the damaging details speak for themselves. Mr. Obama was also on the backfoot on Medicare, which was supposed to have doomed Mr. Romney (10/4).

The Wall Street Journal: The Romney Reboot Arrives
(Obama's) references to what he would do with a second term were minimal. Instead, he had to spend most of the 90 minutes trying to defend his policies from Mr. Romney's critique. This was most notable on the biggest issue of all -; the future of ObamaCare. Mr. Obama's defense of the 15-member review board came down to citing some process reforms at the Cleveland Clinic. Gov. Romney immediately turned that around as an example of a private institution experimenting its way toward new ideas-;a difference of policy and philosophy. Not least, Mr. Romney has finally found his way to a workable defense of his Massachusetts health-care plan, emphasizing that whatever its merits, it was a major legislation that was passed on a bipartisan basis. Mr. Obama was left muttering that the Washington GOP should have taken cues from Massachusetts (Daniel Henninger, 10/3). 

The Washington Post: Romney's Personality Shift
Having hidden his Massachusetts health-care plan behind "Repeal Obamacare" rhetoric in the primaries, Romney warmly embraced his own plan -; without explaining why repealing a national health-care system modeled on his plan would in any way be consistent with his sloganeering against the president's central achievement (E.J. Dionne Jr., 10/4). 

The Washington Post: The Audacity Of Romney
Health care has always required enormous audacity from Romney. While his attempt to distinguish his Massachusetts plan from Obamacare wasn't persuasive to someone like me, who has studied the details for years, I think it would have appeared perfectly reasonable to less wonky voters. I won't rehearse them all here, but Romney previewed his staccato talking points on this matter in the Republican primary debates, and I wrote then that (to my astonishment) he was on his way to a politically sufficient position. That Romney can not only pull this off but also go on offense while doing it (when in fact Romneycare is basically the same as Obamacare) takes remarkable dexterity (Matt Miller, 10/4). 

The Washington Post: Obama Didn't Come Ready To Play
To summarize: Romney won't raise taxes, he won't cut the budget for education, he'll increase military spending and he'll somehow balance the budget. The math doesn't work, but if the number of math teachers declines on his watch, perhaps fewer people will figure that out. ... Romney repeated attack lines and Obama declined to refute him the second or third time around -; most particularly, on Romney's assertion that Obama was gutting Medicare by more than $700 billion. Obama's attack on Romney's plan for Medicare, by contrast, was more nuanced, more complicated and fuzzier -; and he did not repeat it anywhere near the number of times Romney repeated his own attacks (Harold Meyerson, 10/4).

The Washington Post: In Presidential Debate, Obama, Romney Evaded The Hard Truths
If anyone hoped that Wednesday night's debate between President Obama and Mitt Romney would shake the presidential candidates off their canned talking points, they would have ended the evening disappointed. The first of three encounters between the two men did underscore major contrasts between the two candidates: on keeping or repealing Obamacare, on financial regulation, on dealing with the deficit, on the fundamental role of government. Mr. Romney lauded "free people and free enterprises, doing things together," and derided Mr. Obama's approach as "trickle-down government" (10/3).

CNN: Romney Wasn't Stellar, But Obama Fell Short
Inevitably, the president was going to bring up Romney's health care program in Massachusetts during this face-off, so for debate-watchers it was just a question of how adequately Romney would defend himself. Thanks to his opponent, he got a little help right out of the gate. Obama's request of Romney that he "please elaborate" dripped with gratuitous sarcasm. ... Romney's defense of his Massachusetts record supplied the Republican nominee with one of his stronger moments of the night. He managed to spin Romneycare not as evidence of flip-flopping, but as an example of his ability to work in a bipartisanship fashion. Aimed straight at independents, this was a signal Romney needed to send, and the look on Obama's face suggests that he knew the governor had gotten the better of him (Alan Schroeder, 10/4).

The New York Times: Contraception And Religious Liberty
Leaders of the Roman Catholic Church, prominent Republicans and other social conservatives have spent the past year making inflammatory allegations that an Obama administration rule requiring employer health plans to cover birth control without a co-pay tramples on religious freedom. An important federal court decision issued Friday rejected that attack as without foundation (10/3).

New England Journal of Medicine: Moneyball And Medicine
In both medicine and baseball, advocates of evidence-based approaches argued for the enhanced vision of statistical techniques, which revealed what tradition or habit had obscured. The difference between an all-star and an average hitter, for example, works out to about one hit every other week. ... Early proponents of controlled medical trials similarly pointed to how difficult it was for an individual practitioner to determine a treatment's efficacy. ... The true relevance of moneyball to medicine, however, lies not just in the quantification of performance but in the appreciation of value (Christopher J. Phillips, Drs. Jeremy A. Greene and Scott H. Podolsky, 10/3).

Journal of the American Medical Association: The "Iron Triangle" Of Health Care: Access, Costs, And Quality
When I talk about health policy, I often refer to the iron triangle of health care. The 3 components of the triangle are access, cost, and quality. One of my professors in medical school used this concept to illustrate the inherent trade-offs in health care systems. His point was that at any time, you can improve 1 or perhaps even 2 of these things, but it had to come at the expense of the third. ... The lesson of the iron triangle is that there are inherent trade-offs in health policy. If we wanted to conduct the debates honestly, we would acknowledge these and allow the public to decide what they really want-;and what they are willing to sacrifice to get it (Dr. Aaron Carroll, 10/3). 

Milwaukee Journal Sentinel: Mental Health Changes Overdue
In April 2011, the Milwaukee County Board adopted to redesign the county's Behavioral Health Division and integrate mental health care into our community…. It has been 18 months since the Redesign Task Force was created, yet no plan for implementing these desperately needed improvements has been written…. The problems have been identified, and solutions have been recommended. We must put the best interests of the patients before all else and see this redesign process through to a successful finish (Joe Sanfelippo, 10/3).