Dr. Clif Cleaveland, Commentary
The presidential campaigns of Sen. John McCain and Sen. Barack Obama present strikingly different approaches to health-care reform. Detailed, nonpartisan summaries are available at health08.org, PresidentialRx.com and at Briefing Book: Issues ’08 at MSNBC.com.
I offer snapshots of each plan.
* The John McCain plan:
At present health insurance benefits provided by employers are excluded from taxation. Sen. McCain proposes changing the tax code to treat health insurance coverage as ordinary, taxable income. The revenue that this generates would fund tax credits of $2,500 for an individual or $5,000 for a family to apply to the purchase of health insurance coverage.
Health insurance companies would be permitted to sell products across state lines, thereby loosening regulations on the insurance industry. Companies would be free to offer a wider variety of products that individual purchasers could tailor to their needs. The plan predicts that competition and choice would lead to greater variety and efficiency and lower costs for health-care coverage.
The McCain plan opposes business and personal mandates for coverage. In cooperation with states, the McCain proposal would establish a Guaranteed Access Plan to provide health insurance for people denied coverage from commercial plans because of pre-existing health conditions. Poor and unemployed persons would be offered income-related subsidies to purchase coverage.
The plan further proposes reform of medical liability laws, promotion of alternative forms of access and medical treatment such as clinics in retail outlets, and new initiatives for disease prevention.
* Sen. Obama’s plan:
While promoting universal access, there is no mandate for universal coverage except for children. Adults would have the right of not participating in any plan. Businesses, excluding very small enterprises, would have a “play-or-pay” option: either provide health insurance as a benefit for workers or contribute to a new public program which would provide insurance for employees.
Current tax laws regarding health insurance benefits remain in place. The Federal Government would provide partial subsides for catastrophic health events. Medicaid and the State Children’s Health Plans would be strengthened.
The Obama plan would establish two new programs. A National Health Insurance Exchange composed of private insurance companies would offer coverage for individuals and small companies without access to insurance. Refundable tax-credits would assist small businesses in providing health insurance. A new public plan, designed along the lines of the Federal Employee Health Benefit Plan, would also offer coverage to small companies and individuals.
Poor and unemployed persons would receive subsidies to obtain care from the public plan. Uniform standards for coverage would apply to both programs. No insurer in either plan could exclude anyone on the basis of pre-existing health conditions.
Individual states could continue to develop health reform plans so long as these meet national standards. The government would invest in electronic medical records as a means to improve efficiency and safety. The plan would establish a research institute to evaluate cost-effectiveness of new therapies.
The Obama proposal would abolish higher payments that are currently allocated to Medicare managed care plans. Savings would be realized from improvements in preventive care and management of chronic illness.
Critiques of both plans. The McCain plan effectively dismantles employment-based health insurance by removing its tax advantages. It leaves unclear what would happen to workers who no longer had work-based health insurance. Also worrisome is the reduction of regulation of health insurers. If patients are free to purchase insurance across state lines, governmental oversight of insurance practices will be weakened.
The Obama plan underestimates the cost of extending coverage to all children and to owners and workers at small companies. The plan does not provide cost estimates or a time-table for rolling out a national system for electronic medical records.
Runaway healthcare inflation is not addressed in a substantive fashion in either plan. Both plans offer choices in coverage; however, consumers lack access to reliable information for making informed choices regarding insurance.
Neither plan addresses work-force issues. Without prompt intervention, primary care providers — pediatricians, obstetricians, internists, and family physician — will soon disappear.
Controls of waste, fraud, and abuse are not detailed. Such practices drain billions of healthcare dollars from the economy each year. Enforceable, national standards for medical care should significantly limit this loss.
Except for references to electronic records, neither plan addresses the inefficiencies of a healthcare system that in most parts of the country exists as an uncoordinated, cottage industry. Patients waste time and money in making the rounds of multiple care-givers.
In my next column, I offer my thoughts about fixing a healthcare system that is becoming progressively inadequate and unaffordable.
Contact Clif Cleaveland at firstname.lastname@example.org.