First, Romney said, he’d repeal the Affordable Care Act. He’s serious about that, I presume. The problem is that, according to the Congressional Budget Office, the health care law reduces the deficit. Repeal it and the deficit goes up. Then Romney said he’d review programs and cut all that are non-essential, singling out PBS. Well, fine. That’s pennies on the budget. It wouldn’t be nearly enough to make a meaningful dent in the deficit.

After that, Romney mentioned “turning programs over to the states.” Here there is real money, particularly if Romney includes Medicaid, which will soon eclipse Medicare as the government’s most expensive health insurance program. But Romney suggested this would work because the states are more efficient. This is what he usually says. The implication is that the states can spend a lot less on the programs without dramatically reducing services.

That’s nonsense. Medicaid already pays less than every other insurance program, private and public. Cutting more from the program would inevitably force states to reduce whom or what the program covers. A year ago, when the House Republicans proposed a similar scheme, a Kaiser Family Foundation report by Urban Institute researchers crunched the numbers and determined that the Medicaid cut would mean between 14 and 27 million people would lose health insurance.

By the way, the researchers assumed states would deal with declining Medicaid money exclusively by cutting eligibility for the able-bodied and non-elderly. In fact, most of the program’s money goes to the disabled and elderly. Most likely, they’d feel at least some of the pain.

3. Medicare: Over and over again, Romney attacked Obama because the Affordable Care Act reduces Medicare spending by $716 billion. As you probably know by now, Paul Ryan’s budget made the exact same cut. And less than a year ago, Romney was praising this budget to the hilt.

But there’s another problem here: Romney’s own budget numbers don’t add up. Remember, he’s promised to cap non-defense spending at 16 percent of GDP. And he’s said he won’t touch Social Security. If he walls off Medicare, too, that would mean even sharper cuts across the board. How sharp? The Center on Budget and Policy Priorities ran the numbers. If Medicare is getting that $716 billion back, he’d have to cut other programs by an average of a third by 2016 and in half by 2022. Non-discretionary defense spending, which “has averaged 3.9 percent of GDP and never fallen below 3.2 percent,” would fall to 1.7 percent.

That’s simply not realistic. I have no problem believing Romney would cut domestic program deeply; his willingness to endorse the kinds of cuts he has specified, to Medicaid and food stamps, tell you everything you need to know about his priorities. But these figures are the stuff of fantasy. Either Romney can’t restore the Medicare dollars as he says or he’s not living up to his promises on deficit reduction.

The real shame of the exchange was that Romney's own plan got so little attention. Again, I wish Obama could have pressed Romney harder, or explained more clearly, why the voucher scheme he proposes would likely end the guarantee Medicare now makes to seniors—and why current retirees, as well as future ones, would feel the impact.

4. Health care and pre-existing conditions. Yeah, this was the part when I jumped out of my chair. Obama said that Romney’s alternative to Obamacare wouldn’t protect people with pre-existing conditions. Romney said it would. Sorry, but Romney is just plain wrong here. I’ve written about this before, so I’m just going to quote something I wrote previously:

Romney, like most Republicans, has long favored “continuous” coverage protection. But, for complicated reasons ... this protection is relatively weak unless it includes the sort of substantial regulation and subsidies that Romney, like most Republicans, has opposed. As a result, such protection would do very little for many of the people who need it most. Among other things, as Sarah Kliff points out ... “There are tens of millions of Americans who lack continuous coverage.” (A typical example would be somebody who lost a job, couldn’t keep making premium payments, and let coverage lapse.)

For people in this situation, Romney and the Republicans have traditionally said they favor coverage through “high-risk pools.” But high-risk pools are basically substandard policies: Although they cover catastrophic expenses, they leave people exposed to huge out-of-pocket costs. They also tend to be underfunded, because they cost a lot of money but serve only a small number of people. ...

So what would this mean in practice? Imagine for a second that you have cancer, diabetes, or Parkinson’s. With the coverage you’re likely to get form a high-risk pool, chances are that you’ll continue to struggle with medical bills. You’ll end up going into financial distress, just to cover your health are costs, unless you decide to start skipping treatment. And that’s obviously not a very good idea. These policies are better than nothing, for sure. But what you really need is comprehensive insurance and way to pay for it—in other words, the kind of protection that the Affordable Care Act will provide, starting in 2014, unless Romney and the Republicans repeal it.

I don’t want to pretend Obama was always as forthright as he could have been, any more than I want to suggest he was the more adept debater tonight. At one point, Obama talked about letting tax rates on higher incomes return to Clinton-era levels as essential to reducing the deficit. That’s true. But a truly serious approach to deficit reduction would let all taxes, even those on more modest incomes, return to Clinton-era levels (albeit after the economy is on sounder footing). Obama decried Romney’s plan to leave seniors “at the mercy of the private insurance system” but those are strong words from a guy whose own health care plan relies heavily on insurance plans, albeit with a lot more regulation than most conservatives like.

Still, these are tiny transgressions compared to Romney’s, which also included misleading statements about the origins of the deficit and claims of a jobs plan that is, if anything, even more unspecific than his tax plan. And I worry that nobody will call him on it.

As part of its post-debate analysis, ABC News asked correspondent Jonathan Karl to play the role of fact-checker. He picked out one statement from each side and rated it “mostly false.” But the Obama statement Karl picked was the description of Romney’s tax plan as costing $5 trillion—a figure, again, that comes straight from the Tax Policy Center. That’s not “mostly false.” If anything, it’s “mostly true.” Then Karl talked about Romney’s pre-existing condition promise, which really is “mostly false.” Sigh.

Update: Steve Benen and Greg Sargent noticed the same thing, so that's a start.

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