Monday, September 08, 2008

The Future of America's Healthcare: Obama vs. McCain

Recently at dinner, a few friends and I were discussing politics and healthcare. While we all had our own opinions, we came to the sad realization that none of us really knew the candidates plans in depth. I had previously written about Obama's and Clinton's healthcare plans, but that was months ago, and did not include anything about McCain's proposals. Curious, I tried reading a little bit online about the two proposals. I came across an article in the New England Journal of Medicine regarding their positions:
McCain's plan embraces market forces and promotes individually purchased insurance (see red box). Its centerpiece is a change in the tax treatment of health insurance. Currently, workers do not pay taxes on health insurance premiums paid by their employers. The McCain plan would eliminate this tax exclusion and use the revenue generated — projected to be $3.6 trillion over 10 years — to pay for refundable tax credits for Americans obtaining private insurance ($2,500 for individuals, $5,000 for families). Uninsured Americans could use their credits to help buy insurance coverage on the individual market, and workers with employer-sponsored insurance could use theirs to offset the cost of paying taxes on their employers' premium contributions or to purchase coverage on their own.
The article discusses Obama's healthcare plan well:
In contrast to John McCain's emphasis on markets and deregulation, Barack Obama's reform plan relies on an employer mandate, new public and private insurance programs, and insurance-market regulation (see blue box). The core of the Obama plan is a requirement that employers either offer their workers insurance or pay a tax to help finance coverage for the uninsured (some small businesses would be exempt, and others would be subsidized). The Obama plan would also create two new options for obtaining health insurance: a new government health plan (similar to Medicare) and a national health insurance exchange (a purchasing pool analogous to the Massachusetts Connector) that would offer a choice of private insurance options. Both would be open to persons without access to group health insurance or other public insurance, as well as to small businesses that wanted to purchase coverage for their workers. Income-related subsidies would be provided to help lower-income persons afford coverage. And private insurers could not deny coverage because of preexisting conditions or charge substantially higher premiums to sick enrollees: the Obama plan would end medical underwriting according to health status.
Admittedly, I am a bit biased towards Obama, but I think I'll discuss my thoughts in a future post after I have had more time to digest their proposals. Anyone out there already come to a conclusion? How does McCain's free market solution compare to Obama's hybrid government / competition plan?

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  1. Is messing with taxes the way to better health care? Such a proposal is so small minded.
    As long as health care is managed by for-profit, private companies, it will never be truly universal, and poor people (indeed, anyone not wealthy enough to pay out of pocket) will continue to suffer from lack of access to care, underinsurance, etc.
    The real solution would involve a departure from "market" solutions, much like a single payer solution. Hillary admitted that such a plan was not politically feasible (or was it Obama)--so people have thought of it.
    A study in the annals of internal medicine showed that 60% physicians approve of such a single payer plan.
    Why not??
    House resolution 676, sponsored by Congressman Dennis Kucinich and many others, is the right way to go.
    Messing with tax cuts here, credits there, mandates and so forth, is too convoluted and masks the true crisis of health care--which is that a system based on profits will never put the health of people first, which is what health care must do.

  2. forgot to add: both plans really are a sad attempt to solve the problem. we've seen what the "universal" mandate looks like in massachusetts (failure)--so why are we still talking about mandates??

  3. Good comment! I strongly agree - the ultimate solution will require some kind of neutral insurer with the incentive to maximize health / well-being and not profits. The only entity that fits that bill is the government (or some other form of public-private "single payer" entity). However, as I recall, Obama said that if he were starting from scratch he would go this route, it is not politically feasible to do so in this environment.

    That is the reason everyone is so focused on mandates. If you cannot have a single payer, what you can do is have everyone become vested in the current system. It serves both ends: there is pseudo-universal coverage (which is still better than the status quo), and insurance companies will go along because they realize they must change, but this route preserves some role for them. It's a sad state of affairs, but I think it will take someone with an enormous amount of political capital to burn to make any real change.



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