James M. Berklan, McKnight’s Editor

Long-term care providers might find they have some wrenching decisions to make, thanks to the Romney-Ryan presidential ticket.

If healthcare reform is to your professional liking, can you vote for the guy who has led perhaps the loudest Congressional charge to upend it? How about voting for the man who would essentially do away with the current Medicare system? Or maybe you can’t run fast enough to the voting booth now?

These, of course, are all just reflections. Ryan’s push toward privatizing parts of Medicare would stand little hope with a split Congress.

It’s clear that Romney is going to make the economy, if not healthcare outright, the campaign cornerstone. As well he should. “It’s the economy, stupid,” famously elected one president in recent memory, and it’s liable to do it again.

In choosing Ryan, Romney and his handlers have proved they learned from past GOP mistakes. Ryan pulls far more conservatively than his partner (as Dan Quayle did for his George H.W. Bush pairing). But he scores higher on the scales of, well, intelligence and charisma.

And dare we bring up John McCain’s desperate choice of Sarah Palin four years ago? In contrast, Ryan already has waged high-profile political battles on a national stage, hails from a fairly populous state in the heart of America — and by some accounting, might even edge the Woman Who Could See Russia From Her Backyard in the good looks department.

In Ryan, Romney has an ideologue to play to the right, a fund-raiser who can energize donors to open their bank vaults and, yes, youthful energy. As well as an antidote to a graying, slower basketballer?

Yet this presidential race is not going to come down to vice presidential candidates. It never does. They are just secondary factors. Anybody hear from Quayle lately? And just who were Bob Dole’s and John Kerry’s running mates again? [For the record: the staid Jack Kemp and the disgraced John Edwards.]

It’s all about the campaign at this stage. The economy is the barometer and this time Democrat Obama has to do more than sell hope and take advantage of the embarrassing implosion of a Republican predecessor.

He also has an economic record to defend. If he does well there, it doesn’t matter what Romney does, or if Romney’s running mate is named Jack Ryan, Buddy Ryan or Private Ryan.