Rick Santorum kicked off his campaign today by misrepresenting Rep. Paul Ryan’s Medicare plan and then lying about the effects of his own proposal. Santorum, who actually wants to accelerate the cuts in the GOP’s Medicare proposal, appeared on ABC’s Good Morning America to make the big announcement, but when pressed by host George Stephanopuolous on why he would want to change Medicare for current seniors, Santorum argued that seniors are already familiar with the changes he’s proposing:

STEPHANOPOULOS:You mentioned Congressman Ryan’s budget plan. It appears that you want to go farther than Congressman Ryan. You have criticized him for not applying his changes to Medicare, which Democrats say would end medicare as we know it. You would say to people 55 and older, yes, your Medicare will be changed as well?

SANTORUM: Well, remember, George, almost 25% of seniors right now have what the Ryan plan is. It’s called Medicare Advantage. And in fact that number was growing up until Barack Obama slashed the program.

STEPHANOPOULOS: But that’s an option.

SANTORUM: Well, the point is, Seniors were able to take money and go out and purchase insurance. And by the way, the seniors most likely to do it were lower income, less educated consumers. Why? because they thought it was a better deal. And the drug program, Medicare Part “D” is exactly the Ryan program. In other words, seniors get resources from the federal government, the seniors go out and make choices. No senior believes they’re being thrown off a cliff. It’s working wonderfully. Seniors love it.

Watch it:

But one can’t compare Medicare Advantage and the Ryan plan. Currently, the 25 percent of seniors who are enrolled in Medicare advantage have a choice of various private plans and traditional free-for-service Medicare. Ryan, would end the traditional Medicare option and force future seniors to purchase private insurance with “premium support” vouchers that depreciate over time. That’s the exact opposite of the Advantage program in which government payments to Medicare Advantage plans per enrollee actually averaged 109 percent of fee-for-service costs in 2010! A similar distinction applies to Medicare Part D. As Austin Frakt explains:

All Part D plans (PDPs and the drug portion of MA plans) submit bids for the cost of standard coverage. From these bids a nationwide average is computed and a statutorily determined fraction of this average cost is set as the “base premium.” Finally, a plan’s premium (charged to each enrolled beneficiary) is the base premium plus the difference between that plan’s bid and the national average bid. Thus, ignoring adjustments for beneficiary risk and other details (found here) a plan is paid by Medicare a fixed monthly per-beneficiary rate equal to the national average bid less the base premium. Because the payment is tied to national average bids (a market signal) this is a form of competitive bidding.

No such system exists in the Ryan plan or under Santorum’s expansion proposal. Under those plans, seniors would be receiving less support every year, regardless of increasing health care costs.

While Republicans are trying to privatize government health care in the United States, conservatives in Britain will promise to protect the government’s central role in that national’s health care system today when Prime Minister David Cameron rolls out his five health care pledges. The principles come following a public backlash against Cameron’s proposal for a “a radical reorganization of England’s health care system, introducing legislation that would hand responsibility for most of the country’s health budget to its 42,000 general practitioners and, his political opponents say, open the door to private competition that could threaten the foundations of socialized care.”

Essentially, Cameron is now promising not to privatize the National Health Service:

The Prime Minister will defend the shake-up in a speech that will include five guarantees about the future of the health service.

The series of personal pledges will include keeping waiting lists low, maintaining spending and no privatisation.

Others will be ensuring patient care is properly co-ordinated and that it remains universally available and free at the point of delivery, according to The Daily Telegraph.

This suggests that nurses and hospital doctors will maintain a role in commissioning patients’ services.

All of this runs counter to how Republicans like to talk about the national British health care system — as a worst case scenario that rations care and imposes unreasonable waiting times and one which Obamacare embraces. The reality of course is far more complicated. The NHS is not without its problems, but it still outranks the American alternative — in almost every quantifiable metric. For instance, according to the Commonwealth Fund’s 2012 international comparison report, the U.S. health care system “ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives”:

While many states are moving slowly to implement the requirements of the Affordable Care Act, Alabama — a red state with a Republican governor — is on track to institute the law’s health insurance exchanges and is increasing spending on its Medicaid program — all the while challenging the constitutionality of the law in court. It’s a more nuanced view of reform that recognizes the practicality of using the law’s new federal dollars to cover its citizens and the need to continue implementing the measure to receive more federal funds. Faced with the choice of money and politics, Alabama is choosing the money. Politico’s Sarah Kliff has the story:

Last week alone, Republican Gov. Robert Bentley issued an executive order to move forward on an Alabama health insurance exchange and lashed out at the state’s Republican-controlled Legislature for attempting to scale back his proposed $247 million increase in Medicaid funding by a mere $7 million. [...]

But for as much as Medicaid strains state budgets, it’s also a major contributor. In states with high rates of poverty, like Alabama — where poverty is the third-highest in the nation — the federal government provides as much as three-quarters of the entitlement program’s budget. For every dollar Alabama spends on Medicaid, Washington ponies up $2.80.

State officials are also pushing back against the GOP’s plans to block grant the Medicaid program:

“The idea of a block grant really will not save my program,” Alabama Medicaid Agency Director Bob Mullins told POLITICO in a recent interview. “I’ve already got a minimum program, and if that block grant says I have to maintain that minimum program [with less money], well, obviously, that’s not going to work very well.” [...]

Under the current matching-per-enrollee payment system, he said, “If I had 100,000 more people sign up in the next six months, I [would] get more federal drawdown.

“If you give me a block grant, I end up up a creek.”

Many other states continue to accept federal grants while claiming that the law which authorized those funds is unconstitutional. But Alabama stands alone in recognizing the ACA is established law and that any other alternative to it would leave the state with less federal dollars. It’s the kind of argument that should make a lot of sense to Republican governors and maybe even give them political cover to follow Alabam’s lead.