For a campaign that was supposed to be all about the economy, we’ve spent a lot of time talking about health care. As you might guess, I think that’s entirely appropriate. The election’s impact on who gets medical care, and how much that health care costs, is likely to be enormous. On no single issue may the contrast between President Obama and Mitt Romney’s plans be so stark.

But with just days left before the election, conversation about health care remains unfortunately, if understandably, fragmented. We’ve argued over what Romney has in mind for Medicare—and how his plan from Medicaid, taken straight for Paul Ryan, will play out. We’ve spent all kinds of time debating the impact of the Affordable Care Act—on individuals, businesses, and taxpayers. But we’ve almost always had these conversations separately, as if the issues were distinct from one another. They’re not.

The health care system is one big ecosystem, full of intertwined policies. If you’re a senior citizen, will you have a harder time getting care because of cuts to Medicare? It depends, in part, on what’s happening to Medicaid. If you have a job and it provides insurance, how would you react if you lost that coverage? That really depends on what alternative insurance options exist.

And it’s only when you look at all the policies together that the significance of what each man is proposing becomes clear. Obama wants our health care system to keep evolving in the way it has for nearly a century, so that people have greater financial protection from medical bills. Romney seems to have the opposite impulse. The policies he favors would leave more people exposed to crippling medical bills, either because they don’t have insurance or the coverage they have is inadequate. Romney likes to describe Obamacare as radical, but the changes Romney envisions are arguably more sweeping—and, for anybody facing the prospect of serious illness, a lot more threatening. The health care system would actually start to look more like it did in the early 20th Century, before modern insurance even existed.

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